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

2004; Wiley; Volume: 101; Issue: 9 Linguagem: Inglês

10.1002/cncr.20623

1097-0142

Emmanuel Guardiola, X. Pivot, O. Dassonville, G. Poissonnet, Pierre Yves Marcy, Josiane Otto, M. Poudenx, Éric François, René‐Jean Bensadoun, Antoine Thyss, F Démard, M. Schneider,

Head and Neck Cancer Studies

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.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.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.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.