The Role of Panendoscopy in Primary Diagnostics of Patients with Oral Cavity Cancer

Panendoscopy is known as a standard procedure in the staging of oral cavity cancer (OCC), which is intended to rule out synchronous second carcinomas (SSC) (Metzger K et al in J Craniomaxillofac Surg 47(12):1968-1972, 2019; Priante et al. in Curr Oncol Rep 13(2):132-137, 2011; Stoeckli et al. in Otolaryngol Head Neck Surg 124(2):208-212, 2001; Sharma et al in Laryngorhinootologie 92(3):166-169, 2013). However, the value in relation to the detection of SSC in the upper aerodigestive tract is questionable (Deutsche Gesellschaft für Mund- Kiefer- und Gesichtschirurgie (DGMKG), S3-Leitlinie Diagnostik und Therapie des Mundhöhlenkarzinoms. https://www.leitlinienprogramm-onkologie.de/leitlinien/mundhoehlenkarzinom/, 2021). The aim of the study was to redefine the role of panendoscopy in the staging of OCC-not only with regard to the detection of SSC-as the arrangement of panendoscopy is subject to further influencing factors. In addition, the diagnostic added value and effects on the therapy of the index tumor were elicited.

A retrospective review of 191 patients with a confirmed diagnosis of OCC was conducted, between January 2018 and December 2019, at the Department of Oral and Maxillofacial Surgery of the clinic of the Technical University of Munich, Germany. Panendoscopy included inspection and palpation of the oral cavity and oropharynx, epipharyngoscopy, microlaryngoscopy, and rigid esophagoscopy.

The following parameters had a statistically significant influence on the decision to perform panendoscopy in primary diagnostics: risk factors, ENT status, and imaging. Panendoscopy was indicated in the primary diagnostics due to a suspicion of an SSC in 22.5% of patients and due to recurrence in 29%. The exact determination of localization and assessment of tumor extent was the decisive indicator for panendoscopy in 25.8% of patients. Of the 31 panendoscopies performed, a tissue sample was obtained in 67.7% (n = 21); none of the suspected cases proved to be an SSC.

Panendoscopy in the primary diagnostics of OCC should not be routinely indicated (Koerdt et al in Anticancer Res 41(4):2039-2044, 2021), but should be indicated on an as-needed basis, taking patient-specific criteria into account. In addition to ENT status and imaging, the risk factors of smoking and alcohol should be considered. In patients with unremarkable mirror and radiological findings and no risk factors, panendoscopy can be omitted without further risk (Metzger K et al in J Craniomaxillofac Surg 47(12):1968-1972, 2019; Koerdt et al in Anticancer Res 41(4):2039-2044, 2021).