Is routine triple endoscopy for head and neck carcinoma patients necessary in light of a negative chest computed tomography scan?

• Published in: Cancer 2004-11, Vol.101 (9), p.2028-2033
• Main Authors: Guardiola, Emmanuel, Pivot, Xavier, Dassonville, Olivier, Poissonnet, Gilles, Marcy, Pierre‐Yves, Otto, Josiane, Poudenx, Michel, Francois, Eric, Bensadoun, René‐Jean, Thyss, Antoine, Demard, François, Schneider, Maurice
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Bronchoscopy; carcinoma; Carcinoma, Squamous Cell - diagnosis; Carcinoma, Squamous Cell - diagnostic imaging; Carcinoma, Squamous Cell - pathology; endoscopy; Esophagoscopy; Female; head and neck; Head and Neck Neoplasms - diagnosis; Head and Neck Neoplasms - diagnostic imaging; Head and Neck Neoplasms - pathology; Humans; hypopharynx; Male; Medical sciences; Middle Aged; Neoplasms, Second Primary - diagnosis; Neoplasms, Second Primary - diagnostic imaging; Neoplasms, Second Primary - pathology; Radiography, Thoracic; Tomography, X-Ray Computed; Tumors
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.20623

BACKGROUND The objective of the current study was to analyze the results obtained by triple endoscopy during the initial evaluation of a primary carcinoma of the head and neck. METHODS A total of 487 patients with a squamous cell carcinoma of the head and neck was studied. None of the patients had evidence of metastasis or a second primary tumor on the thoracic computed tomography (CT) scan or chest X‐ray. All patients underwent a triple endoscopy including nasopharyngoscopy, laryngoscopy, pharyngoscopy, bronchoscopy, and esophagoscopy. RESULTS A synchronous primary invasive carcinoma of the lung and esophagus was diagnosed in 5 patients (1%) and 10 patients (2%), respectively. In addition, nine lesions were considered to be a regional extension of the primary tumor to the esophagus, and nine in situ carcinomas were observed. It is interesting to note that a significant correlation was found between the risk of a second synchronous esophageal carcinoma and the initial location of the primary head and neck carcinoma (P = 0.002, chi‐square test). Esophageal carcinoma was observed in 1.3% of the patients with an oropharyngeal tumor, 2% of the patients with a laryngeal tumor, none of the patients with a tumor of the oral cavity, and 9.2% of the patients with a hypopharyngeal tumor. CONCLUSIONS The role of bronchoscopy and esophagoscopy in the presence of a normal thoracic CT scan has been questioned because of the relatively low incidence of a second esophageal and/or lung primary tumor. Nonetheless, based on the same incidence criterion, it appears reasonable to schedule a routine esophagoscopy for those patients with a squamous cell carcinoma of the hypopharynx. Cancer 2004. © 2004 American Cancer Society. The role of bronchoscopy and esophagoscopy in the presence of a normal thoracic computed tomography scan has been questioned because of the relatively low incidence of a second esophageal and/or lung primary tumor. The objective of the current study was to analyze the results obtained by triple endoscopy during the initial evaluation of patients with a primary carcinoma of the head and neck.