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Yen-Bin Hsu, MD; Pen-Yuan Chu, MD; Juhn-Cherng Liu, MD; Ming-Chin Lan, MD; Shyue-Yih Chang, MD; Tung-Lung Tsai, MD; Jui-Lin Huang, MD; Yi-Feng Wang, MD; Shyh-Kuan Tai, MD

Arch Otolaryngol Head Neck Surg. 2008;134(10):1050-1054.

Objectives  To evaluate the role of chest computed tomography (CT) in patients with head and neck squamous cell carcinoma (HNSCC) and to determine the optimal timing and predictive factors for positive findings.

Design  Retrospective analysis.

Setting  Tertiary referral center.

Patients  Two hundred seventy screening chest CT scans performed in 192 patients with HNSCC during a 42-month period were reviewed.

Main Outcome Measures  The scans were categorized as new cases, follow-up cases, or recurrent cases. The results were classified as abnormal or normal. Scans of patients having a radiologic diagnosis of a malignant neoplasm of the lung or an indeterminate lesion were considered abnormal. Factors correlating with an abnormal chest CT scan or development of malignant neoplasm of the lung were analyzed, including the timing of imaging and the patients' clinicopathologic data.

Results  Seventy-nine scans (29.3%) were considered abnormal. The rate of an abnormal scan was significantly higher in the follow-up case group (44.2%) than in the new case group (14.2%) (P < .001). Ten of 15 indeterminate scans (66.7%) with small (<1 cm) solitary pulmonary nodules showed disease progression on subsequent follow-up scans, changing the patients' diagnoses to a malignant neoplasm of the lung. The predictive factors for development of a malignant neoplasm of the lung were initial N2 or N3 disease, stage IV disease, recurrent disease, and distant metastasis to another site.

Conclusions  Chest CT is recommended for high-risk patients, especially during the follow-up period. Intensified evaluation and management are mandatory for indeterminate small solitary pulmonary nodules because of the high rate of malignant neoplasms.

Author Affiliations: Department of Otolaryngology, Taipei Veterans General Hospital (Drs Hsu, Chu, Lan, Chang, Tsai, Huang, Wang, and Tai), and Department of Otolaryngology (Drs Hsu, Chu, Lan, Chang, Tsai, and Tai) and Institute of Clinical Medicine National Yang-Ming University, (Drs Hsu, Lan, Tsai, Wang, and Tai), Department of Otolaryngology, Taipei Medical University Wan Fang Hospital (Dr Hsu), and Department of Radiology, China Medical University Hospital, Taichung (Dr Liu), Taiwan.

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