Outcomes of Incidental Pulmonary Nodules Detected in Oral and Oropharyngeal Cancer Patients

Abstract

BackgroundComputed tomography (CT) of the chest is routinely performed as part of head and neck cancer (HNC) staging. Pulmonary nodules incidentally encountered present a clinical dilemma as they may represent early malignancy. Clinically indeterminate nodules are those that cannot be classed as definitively malignant or benign. This study aims to assess the outcomes of pulmonary nodules detected on initial staging CT chest in a consecutive cohort of patients with oral and oropharyngeal squamous cell carcinoma (SCC). MethodsRetrospective cohort study of newly diagnosed oral or oropharyngeal SCC patients with pulmonary nodules identified on staging CT chest patients at a single institution was conducted. Pulmonary nodules were categorised as benign, indeterminant or malignant. Indeterminant nodules underwent further investigations with either repeat imaging or needle biopsy to exclude malignancy where indicated. Descriptive and bivariate statistics were used to evaluate the association between pulmonary metastasis and patient demographics, disease characteristics and nodule features. P-value ≤ 0.05 was considered statistically significant. Results579 patients were diagnosed with HNC and had undergone staging CT chest between 2010 to 2015. 154 of 579 HNC patients had pulmonary nodules on staging CT chest. 26 (16.9%) of patients with indeterminate pulmonary nodules at staging were later confirmed to be lung metastases. Pulmonary nodules found in patients with N2/N3 disease and of subsolid type were significantly more likely to be metastatic disease. Isolated pulmonary nodules in the right lung were more likely to be benign. ConclusionsHNC specific protocol for the management of incidental pulmonary nodules should be developed to guide interval and duration for clinical and radiological surveillance required taking into account the disease characteristics as well as nodule features.