Is pan-endoscopy necessary to detect synchronous primary in upper aerodigestive tract cancer?
Reviewed by Madhup K Chaurasia

Diagnosis of head and neck cancer requires speed. It has also to be comprehensive in view of the possibility of synchronous primary cancer (SPC) associated with upper aerodigestive tract cancer (UADTC). Some centres still consider pan-endoscopy essential in the diagnostic pathway. In this retrospective study of 2325 new patients presenting in just over two years, 54 patients (2.3%) had SPC. However, this is down from the incidence of 5.3% reported in an earlier study which was considered to be due to a rise in HPV-related cancer. The diagnosis of SPC was made in all but one patient who did not have flexible nasendoscopy (FNE). The additional cancer was picked up on examination under general anaesthesia. The authors have therefore defined a ‘comprehensive’ outpatient head and neck cancer assessment which includes clinical examination, FNE, imaging with CT or MRI and CT of thorax to pick up cancer in the lungs. Mention is also made of narrow band imaging (NBI) which picks up neo-vascularisation as a suspicious index of cancer. In this cohort, 63.8% of patients had pan-endoscopy. The authors feel, with comprehensive outpatients assessment, this was oversubscribed. A clinic-based LA biopsy is recommended, unless sites are difficult to access. LA biopsy will reduce delays in treatment. With these observations, the authors conclude that pan-endoscopy does not have a role in the diagnosis of head and neck cancer.

Changing rates of synchronous upper aerodigestive tract malignancy in head and neck cancer: why are we still using panendoscopy?
Lim Ae, McKeegan E, Townsley RB, Montogomery J.
J LARYNGOL OTOL
2025;139:373–6.