Chen Philip G, Schoeff Stephen S, Watts Cara A, Reibel James F, Levine Paul A, Shonka David C, Jameson Mark J
Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, VA.
Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, VA.
Am J Otolaryngol. 2014 Mar-Apr;35(2):137-40. doi: 10.1016/j.amjoto.2013.10.004. Epub 2013 Oct 29.
To determine the utility of abdominal imaging to further evaluate abnormal pre-operative liver function tests (LFTs) in patients with head and neck squamous cell carcinoma (HNSCC).
Records of patients evaluated by the head and neck surgery service from January 2004 through December 2009 were reviewed. For patients with abnormal alkaline phosphatase, alanine transaminase, or aspartate transaminase, subsequent abdominal imaging was assessed.
Of the 862 patients with HNSCC who had documented LFTs, 109 (12.6%) had one or more abnormal values. In the same time period, LFTs were also obtained on 361 patients with benign head and neck tumors; of these, 40 (11.1%) had abnormalities. Of the 109 patients with HNSCC and abnormal LFTs, 78 (71.6%) underwent abdominal imaging (ultrasound, CT, MRI, or PET/CT). Overall, liver metastasis was demonstrated in only 1 of 109 patients with abnormal LFTs (0.92%) and in only 1 of 862 patients with HNSCC (0.12%).
While HNSCC patients rarely present with liver metastasis, they often have abnormal LFTs. Although the presence of liver metastasis can dramatically change patient management, the yield of follow-up liver imaging for all patients with elevated LFTs is exceedingly low. Thus, the use of risk-stratified abdominal imaging may be prudent and cost effective in a select group of patients in whom distant metastasis is more likely. However, characteristics of this group are difficult to define given the rarity of liver metastasis in HNSCC.
确定腹部成像在进一步评估头颈部鳞状细胞癌（HNSCC）患者术前肝功能检查（LFTs）异常方面的作用。
回顾了2004年1月至2009年12月期间头颈外科服务评估的患者记录。对于碱性磷酸酶、丙氨酸转氨酶或天冬氨酸转氨酶异常的患者，评估其随后的腹部成像情况。
在862例记录了LFTs的HNSCC患者中，109例（12.6%）有一个或多个异常值。在同一时期，还对361例良性头颈肿瘤患者进行了LFTs检测；其中40例（11.1%）有异常。在109例LFTs异常的HNSCC患者中，78例（71.6%）接受了腹部成像（超声、CT、MRI或PET/CT）。总体而言，109例LFTs异常的患者中仅1例（0.92%）显示有肝转移，862例HNSCC患者中仅1例（0.12%）有肝转移。
虽然HNSCC患者很少出现肝转移，但他们的LFTs常常异常。尽管肝转移的存在可显著改变患者的治疗方案，但对所有LFTs升高的患者进行后续肝脏成像的检出率极低。因此，对于一组更可能发生远处转移的特定患者，采用风险分层的腹部成像可能是谨慎且具有成本效益的。然而，鉴于HNSCC中肝转移罕见，该组患者的特征难以界定。
