Is panendoscopy a necessary staging procedure in patients with lacking risk factors and oral squamous cell carcinoma?

J Craniomaxillofac Surg. 2019 Dec;47(12):1968-1972. doi: 10.1016/j.jcms.2019.11.009. Epub 2019 Nov 27.

Abstract

Objectives: Routine panendoscopy is used to detect synchronous malignancies of the upper aerodigestive tract in staging of oral squamous cell carcinoma. The goal of this study was to investigate the occurrence of synchronous malignancies at time of diagnosis using panendoscopy. To challenge the role of panendoscopy as inherent part of routine staging procedures, we were especially interested in low risk patients.

Materials and methods: Retrospectively, a cohort of 484 patients with pathologically confirmed diagnosis of primary oral and oropharyngeal squamous cell carcinoma was investigated. Electronically recorded findings of in-house conducted panendoscopy were retrieved and evaluated for the occurrence of pathological changes of the mucosa. In case of synchronous malignancies, findings were correlated to preoperative radiographic imaging. Patients were classified as high or low risk. Patients with lacking risk factors (no smoking, no drinking in history) were defined as low risk patients.

Results: Overall, we detected three synchronous malignancies of the upper aerodigestive tract (3/484; 0.6%). Two non-small cell lung cancers were detected in patients with a smoking history of 60 pack years. One esophageal carcinoma in situ was detected in a patient with reported alcohol consumption. No synchronous malignancy was detected in patients without risk factors and no malignancy was previously detected by diagnostic imaging.

Conclusion: Pre-treatment panendoscopy can reveal synchronous malignancies of the upper aerodigestive tract in patients with primary oral squamous cell carcinoma. Risk stratification of patients can avoid unnecessarily conducted panendoscopy in patients without risk factors. This may lead to a higher cost-efficacy in public health system, less treatment-related complications and earlier treatment initiation.

Keywords: Bronchoscopy; Esophagogastroduodenoscopy; OSCC; Oral squamous cell carcinoma; Panendoscopy; Staging.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Carcinoma, Squamous Cell / diagnostic imaging
  • Carcinoma, Squamous Cell / surgery*
  • Endoscopy / methods*
  • Endoscopy, Digestive System
  • Female
  • Head and Neck Neoplasms / diagnostic imaging
  • Head and Neck Neoplasms / surgery*
  • Humans
  • Male
  • Middle Aged
  • Mouth Neoplasms / diagnostic imaging
  • Mouth Neoplasms / surgery*
  • Neoplasm Staging
  • Neoplasms, Multiple Primary*
  • Retrospective Studies
  • Risk Factors
  • Young Adult