Chest CT gets a boost from Chinese study. Image Source: Brigham and Women’s Hospital

Among high-risk patients with head and neck cancer, chest CT may help detect disease progression involving the lungs, according to a report in the October issue of Archives of Otolaryngology–Head & Neck Surgery.

Developing a second, distant cancer is an important factor affecting survival for patients with head and neck squamous cell carcinoma, according to background information in the article. The most common site at which such patients develop new metastases is the lungs, with an incidence of 8 percent to 15 percent.

Yen-Bin Hsu, MD, of Taipei Veterans General Hospital in Taiwan, China, and colleagues evaluated 270 screening chest CT scans performed over 42 months in 192 patients with head and neck squamous cell carcinoma. The researchers categorized the scans as new cases, follow-up cases or recurrent cases and results classified as normal or abnormal.

Of the 270 scans, the investigators found that 29.3 percent were considered abnormal, including 20 percent that identified a malignant neoplasm of the lung and 9.3 percent showing indeterminate abnormalities.

“The rate of an abnormal scan was significantly higher in the follow-up case group (44.2 percent) than in the new case group (14.2 percent),” the authors wrote. Patients whose cancer was classified as stage N2 or N3, who had stage IV disease, who had recurrent disease or who had a distant metastasis in another site were more likely to have a malignant neoplasm of the lung and considered high risk.

“Indeterminate lesions were common on chest CT in our study, and special attention should be paid to them,” according to the authors. “Based on the progressive changes in follow-up scans, 44 percent of indeterminate lesions were eventually considered a malignant neoplasm of the lung. We also found that small (less than 1 centimeter) solitary nodules, which were usually resectable, carried significantly higher chances (66.7 percent) of being a malignant neoplasm.”

“For patients with head and neck squamous cell carcinoma, chest diagnosis is crucial and may influence their treatment plan," they said.

Hsu and colleagues concluded that “chest CT is recommended for high-risk patients, especially every six months for the first two years during the follow-up period, although its role is controversial for patients newly diagnosed as having head and neck squamous cell carcinoma. For patients with indeterminate small (less than 1 centimeter) solitary pulmonary nodules, aggressive evaluation and management are imperative because of the high rate of a malignant neoplasm of the lung.”