Strategies for Patients with newly Diagnosed Oral Squamous Cell Carcinoma and a Positive Chest CT

Abstract

Background: Head and neck squamous cell carcinoma (HNSCC) demands meticulous diagnostic strategies for precise staging, with the “Dutch Cooperative Head and Neck Oncology Group” guidelines guiding the selection of imaging modalities. Notably, patients with specific characteristics, such as three or more three, 'bilateral', 'low jugular', or 'N3-neck lymph node metastases, necessitate chest computed tomography (CT) for identifying those at the highest risk for distant metastasis. Objective: The primary objective is to assess the value of routine chest CT scans in oral cavity SCC that has recently been discovered, regardless of the stage of tumor. Specific goals include exploring the frequency of positive findings, understanding their impact on treatment plans, evaluating potential treatment delays, and conducting a cost-effectiveness analysis.Methodology: A retrospective study was conducted on a cohort of 115 patients at Khyber Teaching Hospital from time duration of January 2020 to January 2021. All diagnosed cases of Oral Squamous Cell Carcinoma (OSCC) were included. All patients underwent both head and neck CT scans and chest CT scans. The study aimed to identify abnormalities on chest CT, analyze their influence on treatment decisions, assess treatment delays, and calculate the cost-effectiveness of this diagnostic approach.Results: Among the 115 patients, chest abnormalities were observed in 30% of cases, with malignancy confirmed in 15%. The oral malignancy stage had no impact on metastases or primary tumors in the lungs. The amount of time that passed between the first consultation and the start of treatment did not considerably increase with additional diagnostic procedures. Each lung cancer that was discovered incurred a screening fee of 24,86 rupees.Conclusion: This study advocates for the routine use of chest CT in the diagnostic workup for all individuals with recently diagnosed SCC of the mouth, regardless of tumor stage. The findings underscore the clinical significance of chest imaging, offering insights into its frequency, impact on treatment planning, and cost-effectiveness. Integrating chest CT into standard protocols for this patient cohort is crucial for enhancing diagnostic precision and optimizing treatment strategies.