Screening for Distant Metastases in Patients With Head and Neck Cancer: Is Chest Computed Tomography Sufficient?

Authors

  • Jolijn Brouwer,

    1. Department of Otolaryngology—Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands.
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  • Remco de Bree,

    Corresponding author
    1. Department of Otolaryngology—Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands.
    • Remco de Bree, MD, PhD, Department of Otolaryngology—Head and Neck Surgery, VU University Medical Center De Boelelaan 1117, 1081 HV Amsterdam P. O. Box 7057, 1007 MB Amsterdam, The Netherlands.
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  • Otto S. Hoekstra,

    1. Department of Clinical Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands.
    2. Department of Nuclear Medicine and Positron Emission Tomography Research, VU University Medical Center, Amsterdam, The Netherlands.
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  • Richard P. Golding,

    1. Department of Radiology, VU University Medical Center, Amsterdam, The Netherlands.
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  • Johannes A. Langendijk,

    1. Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands.
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  • Jonas A. Castelijns,

    1. Department of Radiology, VU University Medical Center, Amsterdam, The Netherlands.
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  • C René Leemans

    1. Department of Otolaryngology—Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands.
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Abstract

Objectives/Hypothesis: The detection of distant metastases during screening influences the choice of treatment in patients with head and neck squamous cell carcinoma. A previous study in the authors' institution showed that chest computed tomography (CT) scan was the most important screening technique. Different clinical risk factors in patients with head and neck squamous cell carcinoma for the development of distant metastases were identified.

Study Design: Retrospective cohort study.

Methods: To evaluate the authors' diagnostic strategy, the accuracy of screening for distant metastases with chest CT in 109 consecutive patients with head and neck squamous cell carcinoma with risk factors between 1997 and 2000 was retrospectively analyzed.

Results: Preoperative screening with CT revealed 20 patients (18%) with lung metastases and 1 liver metastasis. Despite negative screening with chest CT, 9 (11%) patients developed distant metastases within 12 months during follow-up. Sensitivity of the chest CT was 73%; the specificity was 80%.

Conclusion: Although chest CT frequently detects distant metastases, there seems to be a need for a more sensitive and whole-body screening technique.

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