Fukuhara Takahiro, Fujiwara Kazunori, Fujii Taihei, Takeda Kenichi, Matsuda Eriko, Hasegawa Kensaku, Nomura Kenichi, Kitano Hiroya
Department of Otolaryngology-Head and Neck Surgery, Tottori University Faculty of Medicine, 36-1 Nishicho, Yonago 683-8504, Japan.
Department of Otolaryngology-Head and Neck Surgery, Tottori University Faculty of Medicine, 36-1 Nishicho, Yonago 683-8504, Japan.
Auris Nasus Larynx. 2015 Feb;42(1):49-52. doi: 10.1016/j.anl.2014.08.013. Epub 2014 Sep 16.
Chest computed tomography (CT) is not performed routinely or worldwide as the initial diagnostic procedure for patients with head and neck cancer (HNC). The significance of the chest CT scan for HNC diagnosis has not been thoroughly defined. The present study reports findings in an effort to broaden the acceptance and application of CT for HNC.
Using medical records, we assessed initial chest CT scans of the patients with new-onset HNC between April 2004 and March 2010. The results were classified into three groups: nodules ≥ 1 cm, small nodules (< 1 cm) that were indeterminate and normal lungs without nodules. Lung nodules that increased in size and/or number at follow-up were regarded as malignant. First, the sensitivity of X-ray and CT for detection of lung nodules in patients with HNC was compared. Second, the nodules were estimated to be malignant or not malignant by follow-up chest CT. Third, statistical analyses were performed to determine the association between variables and distant lung metastases in patients with head and neck squamous cell carcinoma.
In total, 332 patients underwent a chest CT scan as part of the initial examination. Lung nodules were detected on the initial chest CT in 77 patients: in contrast, lung nodules were detected on the initial chest X-ray in only five patients. On initial chest CT scans, lung nodules ≥ 1 cm were observed in 10 patients, small solitary lung nodules were observed in 67 patients, and lungs without nodules were observed in 255 patients. Lung nodules were detected in 77 (23.2%) patients, 25 (32.5%) of whom had malignant lung nodules. Moreover, in 18/67 patients (26.9%), small lung nodules initially classified as indeterminate were determined as malignant at follow-up. However, 30/255 patients (11.8%) without nodules at initial diagnosis developed lung nodules at follow-up. T3 or T4 disease (P = 0.006), N2 or N3 disease (P < 0.001) and stage 3 or 4 disease (P = 0.001) individually and significantly correlated with the development of lung metastases. In addition, lung nodules in initial CT scans (P = 0.004) and other distant metastases (P < 0.001) were significant predictors for the development of lung metastases at follow-up.
Initial chest CT scan is recommended for patients with advanced HNC. Further, patients with advanced HNC with or without lung nodules, as detected on initial chest CT scans, should be followed up with additional scanning.
胸部计算机断层扫描（CT）并非作为头颈部癌（HNC）患者的初始诊断程序在全球范围内常规进行。胸部CT扫描对HNC诊断的意义尚未得到充分明确。本研究报告相关发现，以努力扩大CT在HNC中的接受度和应用。
利用病历，我们评估了2004年4月至2010年3月期间新发HNC患者的初始胸部CT扫描。结果分为三组：结节≥1厘米、性质不确定的小结节（<1厘米）和无结节的正常肺。随访中大小和/或数量增加的肺结节被视为恶性。首先，比较X线和CT对HNC患者肺结节的检测敏感性。其次，通过随访胸部CT评估结节是恶性还是非恶性。第三，进行统计分析以确定头颈部鳞状细胞癌患者变量与远处肺转移之间的关联。
共有332例患者在初始检查时接受了胸部CT扫描。77例患者在初始胸部CT上检测到肺结节；相比之下，仅5例患者在初始胸部X线上检测到肺结节。在初始胸部CT扫描中，10例患者观察到≥1厘米的肺结节，67例患者观察到小的孤立性肺结节，255例患者观察到无结节的肺。77例（23.2%）患者检测到肺结节，其中25例（32.5%）有恶性肺结节。此外，在67例患者中的18例（26.9%）中，最初分类为性质不确定的小结节在随访中被确定为恶性。然而，30例（11.8%）初始诊断无结节的患者在随访中出现了肺结节。T3或T4期疾病（P = 0.006）、N2或N3期疾病（P < 0.001）以及3期或4期疾病（P = 0.001）分别与肺转移的发生显著相关。此外，初始CT扫描中的肺结节（P = 0.004）和其他远处转移（P < 0.001）是随访中肺转移发生的重要预测因素。
建议对晚期HNC患者进行初始胸部CT扫描。此外，初始胸部CT扫描检测到有或无肺结节的晚期HNC患者应进行额外扫描随访。
