Among high-risk patients with head and neck cancer, chest computed tomography (CT) may help detect disease progression involving the lungs, according to study published in the October issue of Archives of Otolaryngology-Head & Neck Surgery.

Yen-Bin Hsu, MD, Taipei Veterans General Hospital, Taipei, Taiwan, and colleagues evaluated 270 screening chest CT scans performed over 42 months in 192 patients with head and neck squamous cell carcinoma. The scans were categorized as new cases, follow-up cases, or recurrent cases, and results were classified as normal or abnormal.

Of the 270 scans, 79 (29.3%) were considered abnormal, including 54 (20%) that identified a malignant neoplasm of the lung and 25 (9.3%) showing indeterminate abnormalities.

"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%]," the authors wrote.

Patients whose cancer was classified as stage N2 or N3, who had stage IV disease, who had recurrent disease, or who had a distant metastasis in another site were more likely to have a malignant neoplasm of the lung.

"Indeterminate lesions were common on chest CT in our study, and special attention should be paid to them," the authors wrote. "Based on the progressive changes in follow-up scans, 44% of indeterminate lesions were eventually considered a malignant neoplasm of the lung. We also found that small solitary nodules, which were usually respectable, carried significantly higher chances (66.7%) of being a malignant neoplasm."

"For patients with head and neck squamous cell carcinoma, chest diagnosis is crucial and may influence their treatment plan," they continued.

"In conclusion, chest CT is recommended for high-risk patients, especially every 6 months for the first 2 years during the follow-up period, although its role is controversial for patients newly diagnosed as having head and neck squamous cell carcinoma."