Routine panendoscopy in oral squamous cell cancer patients: mandatory or facultative?

Abstract

Objectives This study investigated benefits of routine panendoscopy in staging of oral squamous cell cancer patients. Materials and methods From 2013 to 2017, 194 oral squamous cell cancer patients were staged. Reports of routine flexible panendoscopy including oropharyngolaryngoscopy, bronchoscopy, and esophagogastroduodenoscopy were retrospectively analyzed for diagnoses of inflammation and second primary malignancies (carcinoma in situ or cancer) and compared to results of computed tomography. The effects of alcohol and tobacco history of 142 patients were assessed. Results Overall, a second primary malignancy was detected in seven patients. In four patients this discovery was only found by panendoscopy. One invasive carcinoma (esophagus) was detected as well as three carcinoma in situ. The second primary malignancies were located in the lung (3), esophagus (3), and stomach (1). In one patient index tumor therapy was modified after panendoscopy. Upper gastrointestinal inflammation was present in 73.2% of patients and 61.9% required treatment. About 91.8% of bronchoscopies and 34.5% of panendoscopies were without therapeutic consequences. Patients with higher risk from smoking were more likely to benefit from panendoscopy and to have a Helicobacter pylori infection. Conclusion We do not recommend routine panendoscopy for all oral squamous cell cancer patients. Esophagogastroduodenoscopy benefitted smoking patients primarily concerning the secondary diagnosis of inflammation of the upper digestive tract. Selective bronchoscopy, esophagogastroduodenoscopy, and oropharyngolaryngoscopy should be performed if clinical examination or medical history indicates risks for additional malignancies of the upper aerodigestive tract. Clinical relevance Routine panendoscopy is not recommended in all, especially not in low-risk oral cancer patients like non-smokers and non-drinkers.

Clinical Value of Endoscopic Esophageal Screening in Head and Neck Squamous Cell Carcinoma Patients

“…Although results regarding the value of routine endoscopic esophageal screening vary, most studies have reported benefits for patients with lifestyle risk factors. 20,35,37,38 Endoscopic esophageal screening could also be considered in areas with high EC prevalence rates, including East Asia and southern sub-Saharan Africa. 23 As well as EC, it is not uncommon to find epithelium dysplastic lesions when performing endoscopic screening.…”

The Clinical Utility and Cost of Routine Staging Exam under Anesthesia for Oral Cavity Squamous Cell Carcinoma

“…Similarly, in their cohort of 484 patients with primary oral and oropharyngeal squamous cell carcinoma, Metzger et al [22] found no synchronous malignancies in patients without risk factors such as smoking and drinking, highlighting that risk stratification of patients can avoid unnecessarily conducting panendoscopy in patients without risk factors [21]. Findings by Valentin et al [23] further reinforced that panendoscopy is not recommended in all patients, particularly in low-risk oral cancer patients like nonsmokers and nondrinkers, as they demonstrated that from a patient cohort of 194 oral squamous cell cancer patients, an SPM was found in 7 patients (3.6%), four (2.1%) of which were only found on panendoscopy. Similarly, in their 265 OSCC patient cohort, Koerdt et al [24] only found five SPM (1.9%), of these only two (0.8%) were located within the area of panendoscopy and were diagnosed in patients with regular alcohol and/or tobacco abuse.…”

“…While a staging EUA has represented the gold standard for assessment of HNSCC for decades, several studies have called into question the need for its near universal application [3-6, 10, 15, 17-23]. The typical goals of a staging EUA include diagnostic purposes, assessing the extent of the primary for accurate staging and devising an appropriate treatment plan, and discovering second primary tumors.…”

Endoscopic Screening for Second Primary Tumors of the Esophagus Among Head and Neck Cancer Patients

“…Of note, a significantly lower risk of SPTs has been demonstrated among patients with oropharyngeal SCC in the HPV infection era (annual percentage change in EAR, -4.6%; p = 0.03), and that routine panendoscopy examinations are not even recommended in some studies ( 56 , 61 ). A Canadian retrospective study of 406 oropharyngeal cancer patients reported a significantly lower incidence rate of SPTs in those who were p16-positive, which is indicative of HPV -related oropharyngeal cancer patients (0.7 per 100 patient-years vs. 8.5 in p16-negative patients, p < 0.0001) ( 40 ).…”