The Utility of Gastrointestinal Endoscopic Examination Versus Positron Emission Tomography–Computed Tomography in the Detection of Second Primary Lesions in Korean Patients With Head and Neck Cancer

Objective: Head and neck cancer often accompany a synchronous secondary primary lesion in the digestive tract. The aim of this study was to compare detection rates between positron emission tomography–computed tomography (PET-CT) and esophagogastroduodenoscopy (G-fiber) or colonoscopy (C-fiber) in the initial staging and to analyze risk factors for premalignant, malignant, and total synchronous secondary primary lesions. Methods: A total of 739 patients with head and neck cancer who underwent PET-CT, G-fiber, or C-fiber were analyzed retrospectively. Results: Positron emission tomography–CT did not definitely detect any premalignant synchronous secondary primary lesions (0 [0%] of 739) but definitely detected 10 malignant synchronous secondary primary lesions (10 [1.35%] of 739). Esophagogastroduodenoscopy or C-fiber detected all 20 premalignant synchronous secondary primary lesions (20 [2.71%] of 739) and all 37 malignant synchronous secondary primary lesions (37 [5.00%] of 739). The patients with nasopharynx cancer tended to have premalignant synchronous secondary primary lesions (odds ratio [OR]: 3.793; 95% CI: 1.414-10.171; P =.008). Those with distant metastasis tended to have premalignant (OR: 4.743; 95% CI: 1.508-14.916; P =.009), malignant (OR: 3.803; 95% CI: 1.486-9.731; P =.005), and total synchronous secondary primary lesions (OR: 2.753; 95% CI: 1.159-6.538; P =.022). Conclusions: Premalignant or malignant synchronous secondary primary lesions that were not definitely detected by PET-CT could be found in the endoscopic examination.