A rational approach to pulmonary screening in newly diagnosed head and neck cancer
A rational approach to pulmonary screening in newly diagnosed head and neck cancer
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DOI：
10.1002/hed.20261
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发表时间：
2005-11-01
影响因子：
2.9
通讯作者：
Irish, JC
中科院分区：
文献类型：
--
作者：
Loh, KS;Brown, DH;Irish, JC
背景。本研究的目的是确定新诊断的头颈粘膜鳞状细胞癌（SCC）患者肺转移或同步肺原发肿瘤的检出率，并确定与阳性结果相关的因素。这是一项前瞻性队列研究，纳入了 102 名在三级癌症中心诊断出的头颈部粘膜鳞状细胞癌患者。进行了胸部 X 光检查和胸部 CT 扫描。 CT 扫描中不确定的结节随后进行重复扫描以评估进展或 CT 引导的针吸活检。通过CT扫描确定转移或同时肺部原发肿瘤。研究结果与年龄、性别、症状持续时间、原发肿瘤部位、肿瘤分级、T 分类和 N 分类相关。结果。胸部 CT 扫描显示 20 名患者 (19.6%) 存在异常或可疑结节。通过随访扫描或 CT 引导活检，最终证明 10 名患者患有肺转移，其中 1 名患者同时患有肺原发肿瘤。在这 11 名患者 (10.8%) 中，7 名胸部 X 光检查结果正常。 11 名 CT 扫描呈阳性的患者中，有 8 名 (72.7%) 患有 N2 或 N3 疾病，而 91 名 CT 扫描正常的患者中，有 32 名 (35.2%) 患有 N2 或 N3 疾病 (p = .02)。 CT 扫描呈阳性的 7 名患者 (63.6%) 患有 T4 疾病，而 CT 扫描正常的 34 名患者 (37.4%) 患有 T4 疾病 (p = .08)。发生在口咽、下咽和声门上的原发肿瘤比发生在口腔、声门或未知部位的肿瘤具有更大的 CT 扫描阳性风险（OR = 5.4；95% CI，1.3-21.9）。年龄、性别、症状持续时间和疾病分级不能预测 CT 扫描呈阳性。结论。 CT扫描肺转移或同时肺原发肿瘤的检出率为10.8%。我们建议使用胸部 CT 扫描来筛查新诊断的 T4 和/或 N2 或 N3 口咽、下咽和声门上 SCC 患者的肺部。 (c) 2005 年 Wiley 期刊公司。
Background. The purpose of this study was to determine the detection rate of lung metastasis or a synchronous lung primary tumor in patients with newly diagnosed head and neck mucosal squamous cell carcinoma (SCC) and to determine factors that are associated with positive findings,Methods. This was a prospective cohort study of 102 patients with head and neck mucosal SCC diagnosed in a tertiary cancer center. Chest x-rays and a CT scan of the thorax were performed. An indeterminate nodule on CT scan was followed with either a repeat scan to assess progression or a CT-guided needle biopsy. Metastasis or synchronous lung primary tumor were determined by CT scan. The findings were correlated with age, sex, duration of symptoms, site of primary tumor, grade of tumor, T classification, and N classification.Results. A CT scan of the thorax showed abnormalities or suspicious nodules in 20 patients (19.6%). With either follow-up scans or CT-guided biopsy, 10 patients were eventually proven to have pulmonary metastasis and one a synchronous lung primary tumor. Of those eleven patients (10.8%), seven had normal chest x-ray. Eight (72.7%) of 11 patients with a positive CT scan had N2 or N3 disease in contrast to 32 (35.2%) of 91 patients with a normal CT scan (p = .02). Seven patients (63.6%) with a positive CT scan had T4 disease, whereas 34 (37.4%) with a normal CT scan had T4 disease (p = .08). Primary tumors arising in the oropharynx, hypopharynx, and supraglottis had a greater risk of a positive CT scan than tumors arising in the oral cavity, glottis, or unknown sites (OR = 5.4; 95% CI, 1.3-21.9). Age, sex, duration of symptoms, and grade of disease did not predict a positive CT scan.Conclusions. The detection rate of lung metastasis or a synchronous lung primary tumor by CT scan is 10.8%. We recommend the use of CT scans of the thorax in screening the lungs of newly diagnosed patients with T4 and/or N2 or N3 oropharyngeal, hypopharyngeal, and supraglottic SCC. (c) 2005 Wiley Periodicals, Inc.