CT Vs X-Ray to Identify Lung Cancer in HNSCC: Is One Better?

TOPLINE:

In patients with head and neck squamous cell carcinoma (HNSCC), low-dose CT achieved higher sensitivity than chest x-ray for detecting lung metastases and second primary lung cancer, but patients demonstrated similar survival outcomes regardless of screening modality.

METHODOLOGY:

• Patients with HNSCC face an increased risk for pulmonary metastases and second primary lung cancer, necessitating effective surveillance strategies. Although low-dose CT and chest radiography are used for screening, their impact on survival outcomes remains uncertain.
• Researchers conducted a randomized parallel trial which involved 137 treatment-naive patients with de novo HNSCC (mean age, 65.1 years; 24.8% women) between September 2015 and December 2022.
• Participants were randomly assigned to either the chest radiography group (n = 68) or the low-dose CT group (n = 69). Initial lung screening was performed at the time of HNSCC diagnosis using the assigned modality, followed by surveillance every 6-12 months after treatment completion.
• The median follow-up was 52.8 months.

TAKEAWAY:

• Lung metastases or second primary lung cancer were identified in 7.4% of patients screened with chest x-ray and in 55.1% of those screened with low-dose CT.
• Chest x-ray demonstrated a sensitivity of 66.7% and a specificity of 100%, while low-dose CT demonstrated 100% sensitivity and 100% specificity for an overall accuracy of 100%.
• However, patients receiving chest x-ray vs low-dose CT did not demonstrate clinically meaningful differences in 5-year survival outcomes — 89.2% vs 92.3%, respectively, for overall survival and 97.2% vs 90.9%, respectively, for disease-free survival.

IN PRACTICE:

“In this randomized parallel trial, [low-dose CT] exhibited superior sensitivity compared to [chest x-ray] for diagnosing lung metastases or [second primary lung cancer]. However, there were no clinically meaningful differences in survival rates between the groups who received [low-dose CT] or [chest x-ray],” the authors wrote.

SOURCE:

This study was led by Naif Fnais, MBBS, MSc, Department of Otolaryngology-Head and Neck Surgery, King Saud University, Riyadh, Saudi Arabia, and was published online in JAMA Otolaryngology–Head & Neck Surgery.

LIMITATIONS:

The relatively small sample size and low incidence of positive imaging findings limited the ability to draw reliable conclusions. The evaluation of the efficacy of chest x-ray in monitoring lung metastases or primary cancer was hindered by the requirement for a CT scan upon detecting a positive nodule.

DISCLOSURES:

No funding information was provided for the study. One author reported receiving speaking and consulting fees and grants and having other ties with various sources.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.