A rational approach to pulmonary screening in newly diagnosed head and neck cancer
Bibliographic record
Abstract
BACKGROUND: The purpose of this study was to determine the detection rate of lung metastasis or a synchronous lung primary tumor in patients with newly diagnosed head and neck mucosal squamous cell carcinoma (SCC) and to determine factors that are associated with positive findings. METHODS: This was a prospective cohort study of 102 patients with head and neck mucosal SCC diagnosed in a tertiary cancer center. Chest x-rays and a CT scan of the thorax were performed. An indeterminate nodule on CT scan was followed with either a repeat scan to assess progression or a CT-guided needle biopsy. Metastasis or synchronous lung primary tumor were determined by CT scan. The findings were correlated with age, sex, duration of symptoms, site of primary tumor, grade of tumor, T classification, and N classification. RESULTS: A CT scan of the thorax showed abnormalities or suspicious nodules in 20 patients (19.6%). With either follow-up scans or CT-guided biopsy, 10 patients were eventually proven to have pulmonary metastasis and one a synchronous lung primary tumor. Of those eleven patients (10.8%), seven had normal chest x-ray. Eight (72.7%) of 11 patients with a positive CT scan had N2 or N3 disease in contrast to 32 (35.2%) of 91 patients with a normal CT scan (p = .02). Seven patients (63.6%) with a positive CT scan had T4 disease, whereas 34 (37.4%) with a normal CT scan had T4 disease (p = .08). Primary tumors arising in the oropharynx, hypopharynx, and supraglottis had a greater risk of a positive CT scan than tumors arising in the oral cavity, glottis, or unknown sites (OR = 5.4; 95% CI, 1.3-21.9). Age, sex, duration of symptoms, and grade of disease did not predict a positive CT scan. CONCLUSIONS: The detection rate of lung metastasis or a synchronous lung primary tumor by CT scan is 10.8%. We recommend the use of CT scans of the thorax in screening the lungs of newly diagnosed patients with T4 and/or N2 or N3 oropharyngeal, hypopharyngeal, and supraglottic SCC.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".