The role of thoracic computed tomography in staging newly-diagnosed oral squamous cell carcinoma

Strategies for patients with newly diagnosed oral squamous cell carcinoma and a positive chest CT. A cohort study on the effects on treatment planning and incidence

The purpose of this study was to establish how often routine CT scan of the chest yields positive findings in patients suffering from oral SCC and how it influences the treatment in terms of extra diagnostic procedures, treatment planning and treatment delay. Costs of this additional diagnostic approach for pulmonary tumors in a selected group were also calculated. A retrospective study was conducted of a group of 196 patients who were newly diagnosed with a squamous cell carcinoma of the oral cavity between January 2004 and July 2006; 142 hospital files were eligible for reviewing. In 20 (13%) patients chest abnormalities were observed on CT scan of the chest and in 6 (4%) patients malignancy was pathologically confirmed. Both pulmonary second primary tumors and pulmonary metastases were independent of stage of oral malignancy. We found that additional diagnostic procedures did not significantly lengthen the time interval between first consult and start of treatment. The cost of the screening for pulmonary malignancies in the group was € 8.214 per observed pulmonary malignancy. We advocate that CT imaging of the chest should be routinely performed in the diagnostic work up of all patients with a newly discovered SCC of the oral cavity, irrespective of the tumor stage of the oral malignancy.

Bronchoscopy screening in primary oral squamous cell carcinoma: a 10-year experience

Squamous cell carcinoma (SCC) in the head and neck is associated with synchronous or metachronous carcinomas of the lung. Preoperative pulmonary screening is advocated and may be done by bronchoscopy, thoracic radiograph, computed tomography (CT), or positron emission tomography (PET) with CT (PET/CT fusion). We evaluated the role of bronchoscopy in patients with primary oral SCC to ascertain the incidence of synchronous malignancies of the lung. We retrospectively reviewed a decade's experience of screening by bronchoscopy in 570 pathologically confirmed and previously untreated patients with oral SCC (188 female, 382 male). Univariate and multivariate analyses were done after evaluating the incidence of synchronous lesions and the clinical and histological features of the index tumour. Investigation by bronchoscopy showed disease in 166 patients, and malignancy of the lung in 9 (2%). The Union International contre le Cancer (UICC) stages I and II oral SCC were significantly associated with a synchronous malignancy of the lung (p=0.038). We recommend the use of bronchoscopy even in early tumour stages. Some patients had their treatment altered because of its use, including upstaging, diagnosis of distant and unresectable disease, and investigation of second primary malignancies.