Analysis of the incidence and factors predictive of outcome in patients with head and neck cancer with pulmonary nodules

Abstract

Patients presenting with head and neck cancer have a higher incidence of pulmonary nodules and a higher risk of malignancy. In contrast to the British Thoracic Society (BTS) guidelines, which use size to guide the need for serial scans, we would recommend follow-up imaging in all patients with head and neck cancer with nodules, irrespective of size.

CT Lung Screening in Patients with Laryngeal Cancer

“…Our results are consistent with the previous report of Green et al 7 , who reported that in a cohort of 400 HNSCC patients pulmonary nodules were present in 58% of patients and the lung malignancy rate equalled 6%. However, the aforementioned study included patients regardless of their age or smoking history and a Supraglottic T1 N0 56 2010 2017 7 2 77 w M Supraglottic T2 N0 100 2008 2012 4 3 71 o M Glottic T2 N0 30 2003 2015 12 4 76 w M Glottic T2 N0 150 2007 2015 8 5 83 w M Supraglottic T3 N0 50 2012 2015 3 6 70 b F Supraglottic T4 N0 50 2012 2014 2 7 72 w F Supraglottic T2 N1 60 2005 2013 8 8 72 w M Supraglottic T3 N2 45 2013 2014 www.nature.com/scientificreports www.nature.com/scientificreports/ considerable percentage of included patients had oropharyngeal cancer, where smoking is not as pronounced a risk factor as in laryngeal cancer.…”

Analysis of the interactions between small pulmonary nodules, clinical factors and the risk of malignancy in the chest following diagnosis of head and neck cancer

“…In our cohort, we were unable to identify any patient factors associated with the presence of a pulmonary nodule, despite previous reports that older patients are more likely to have nodules 3 . Although not found to be statistically significant in our cohort, previous smoking did appear to be associated with the presence of pulmonary nodules with 67.1% of smokers having pulmonary nodules and only 58.6% of those who had never smoked.…”

“…The present study adds to the literature available on the significance of pulmonary nodules in patients with HNC. Previously, we have reported the prevalence of pulmonary nodules in patients with HNC to be as high as 58% 3 ; subsequently, similar results have been demonstrated in a group of patients with laryngeal cancer at 52%. The present study found that 61.8% of patients had at least one pulmonary nodule.…”

“…Importantly, no significant difference in the size of nodules which were subsequently demonstrated to represent metastatic disease compared to those that did not were identified, with a median greatest diameter of 4 mm in both cases and volume of 20 mm 3 and 25 mm 3 , respectively. Although there is a vast body of evidence that size is important when determining the risk of malignancy in pulmonary nodules, when considering small, indeterminate nodules in the context of HNC, our evidence challenges the dogma that pulmonary nodules under 80 mm 3 according to the Fleischner guidelines or 100 mm 3 according to BTS can be dismissed as benign and raises the question as to whether all pulmonary nodules should be followed up in cases of HNC.…”

“…1,2 Staging for HNC commonly involves cross-sectional imaging of the chest and pulmonary nodules can be identified in this context in more than 50% of cases. 3,4 The chest is one of the most common sites for metastatic disease in HNC. There is also an increased risk of synchronous primary malignancy in the chest in patients with HNC due to common risk factors such as smoking.…”