How good is a chest CT scan at predicting the risk of pulmonary metastatic disease in patients with head and neck cancer? A retrospective observational study

Abstract

The CT chest is a useful screening tool but is not infallible. Small nodules should be taken seriously and monitored, but should not alter the initial decision as to the management of the patient.

Prevalence of alterations in chest computerized tomography in patients with head and neck cancer

“…This prevalence is in line with other published data, which found the presence of metastases in 10.8% and 19% 7 . Also in relation to thoracic metastases, the majority affected the lung, but they also occurred in the mediastinum and spinal cord, all with good accuracy detection by CT.…”

“…Such second primaries are often located in the chest, showing the importance of screening in this region and the use of CT for this purpose. The most common site of distant metastasis are the lungs and various centers around the world consider screening for lung metastasis important in these patients 7 . However, the widespread use of CT is still controversial, since, theoretically, it would have a greater impact on therapy by detecting alterations in initial cases, although some authors demonstrate limitations of its routine use in all cases, especially in the newly diagnosed 10 .…”

“…The dramatic change in technology in recent years also enhances the use of CT, the advent of multi-slice CT in the 1990s enabling shorter examination time, closer proximity in cuts and higher detailing of dimensions and objects' characteristics 7 . Surgical treatment or rescue radiation therapy are the leading solution in managing patients with recurrent head and neck tumors.…”

“…It is noteworthy that computed tomography (CT) has a good accuracy in differentiating lesions with metastatic pattern from the ones without oncologic meaning, causing head and neck surgeons to resort to radiologists for the aid in planning the best treatment 7 . Even in non-neoplastic findings, alterations can be found which, although not increasing mortality, increase morbidity, such as emphysema.…”

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

“…Beech et al analyzed 239 patients from the United Kingdom. They identified lung nodules in only 13% of their study group, of which none proved to be malignant on follow‐up.…”