Initial staging of head and neck squamous cell carcinoma. What is the place of bronchoscopy and upper GI endoscopy?

Abstract

To determine the place of bronchoscopy and upper GI endoscopy in the initial staging of head and neck squamous cell carcinoma (HNSCC). A 10-year retrospective study was conducted on a series of 838 patients. As part of initial staging of the tumor, all patients were examined by neck and chest CT scan, 487 patients were examined by bronchoscopy and 588 patients were examined by upper GI endoscopy. Esophageal cancer was detected in 4.25 % of cases and lung cancer in 6.35 % of cases. Chest CT scan was statistically superior to bronchoscopy to detect second lung cancers (p < 0.05). On multivariate analysis, oral cancers (p = 0.009) and multiple (synchronous) HNSCC (p = 0.009) were associated with the presence of a second lung cancer. Systematic bronchoscopy (performed by a pulmonologist) might not to be indicated for initial staging of HNSCC, particularly in the presence of normal chest CT scan. In case of abnormal Chest CT scan, patients should be referred to a pulmonologist. However, as oral cancers and multiple (synchronous) HNSCCs were statistically associated with the presence of a second lung cancer in this study, bronchoscopy might be indicated in these cases in order to detect rare small proximal bronchic lesions which might be invisible on chest CT scan in these patients at risk. More, systematic upper GI endoscopy (performed by a gastroenterologist) for initial staging of HNSCC might also not to be indicated in a majority of cases.