Symptom-directed selective endoscopy: long-term efficacy

Area of Science:

• Oncology
• Otolaryngology
• Diagnostic Imaging

Background:

• Synchronous primary neoplasms occur in patients with head and neck mucosal squamous cell carcinoma.
• Routine panendoscopy and radiological tests are traditionally used for detection.
• Symptom-directed, selective endoscopy was previously proposed as an efficient, cost-effective alternative.

Purpose of the Study:

• To evaluate the long-term success of symptom-directed, selective endoscopy in identifying synchronous primary neoplasms.
• To assess the program's longitudinal success in clinical practice over six years.

Main Methods:

• Review of 100 patients from the original selective endoscopy study cohort (minimum 6-month follow-up).
• Review of a random sample of 101 subsequent patients with at least 6-month follow-up or until death.
• Utilized symptom-directed evaluation, direct laryngopharyngoscopy, and chest X-rays for the new cohort.

Main Results:

• No additional synchronous primary cancers were found in the original cohort, indicating initial detection was comprehensive.
• Sixteen metachronous primary cancers were identified between 12 and 70 months post-initial evaluation.
• Eight synchronous primary cancers were detected in the new cohort; no additional tumors emerged within six months.

Conclusions:

• Symptom-directed, selective endoscopy is an effective strategy for detecting synchronous primary cancers.
• It serves as a viable alternative to routine panendoscopy in managing head and neck cancer patients.