Bronchoscopy in the staging and evaluation of head and neck carcinoma

There is no consensus of opinion regarding the use of routine bronchoscopy, either rigid or flexible, to evaluate patients with primary squamous cell carcinomas of the upper aerodigestive tract for the possibility of second synchronous primary cancers. Whereas there is certainty of the effectiveness of this endoscopy in patients with questionable lesions or masses on chest radiographs, the value of this procedure in the face of a normal, unequivocal chest radiograph remains questionable. Six patients with primary carcinomas in the upper head and neck region and normal chest radiographs were among 98 patients evaluated within the past 6 months by triple endoscopy. In three instances, a small (less than 2 cm) lesion was discovered in the tracheobronchial tree, utilizing rigid diagnostic bronchoscopy. In three other patients with positive cytology from bronchial washings, a lung primary carcinoma has not been discovered. These presumed false-positive findings add a watchword of warning. The observation of these patients provides evidence to support the routine panendoscopic evaluation of all patients with squamous cell carcinomas of the head and neck. A valid study to identify subgroups at risk to develop these cancers should be encouraged.