Die Wertigkeit der Computertomographie des Thorax im Rahmen des Stagings von fortgeschrittenen Kopf-Hals-Malignomen

Aim: At time of diagnosis, up to 17% of HNSCC present with distant metastasis or a second primary tumour. Distant metastases of these tumours most commonly occur in the lung, requiring a particularly precise evaluation of this organ within the staging process. It was the aim of this study to compare the radiological findings of plain chest X-rays with the results of CT-scans of the chest in regard to their sensitivity for metastasis detection. Patients and Methods: The staging examinations of 47 patients (f: 13, m: 34, mean age: 61.6 y) with progressed J3, T4, N+) or recurrent HNSCC were prospectively analysed and results of chest X-rays as well as CT-scans of the chest compared. Results: Only one plain chest X-ray showed a possible metastasis, which was excluded by the following CT-scan. In none of the other 46 patients did X-ray reveal findings of metastatic disease or second primary tumours. CT-scans of the chest showed tumorous lesions in 8/47 (17%) patients. Three of these tumours were confirmed as neoplastic by biopsy, in another case radiological signs and clinical symptoms permitted definite assumption of malignancy (4/47: 8.5 %). Histologically, only one of the latter four tumours could be identified as metastatic. In the remaining three cases we found second primary tumours. A follow up CT-scan of one of the remaining four cases showed normal results. In 3 cases the aetiology of the CT-findings remained unclear. Conclusion: Cervical lymph node metastases, tumour-size and recurrence of HNSCC are known risk factors for metastatic disease in HNSCC. Chest X-ray as staging procedure in patients with progressed or recurrent HNSCC may not be able to identify metastases or a second primary tumour of the lung. We therefore recommend a CT-scan of the chest as a routine procedure in such patients to optimise the pre-operative staging.