Abstract：
OBJECTIVE: Blood-based multi-cancer early detection (MCED) tests are now commercially available. However, there are currently no consensus guidelines available for head and neck cancer (HNC) providers to direct work up or surveillance for patients with a positive MCED test. We seek to describe cases of patients with positive MCED tests suggesting HNC and provide insights for their evaluation.
METHODS: Retrospective chart review of patients referred to Otolaryngology with an MCED result suggesting HNC. Patients enrolled in prospective MCED clinical trials were excluded. Cancer diagnoses were confirmed via frozen-section pathology.
RESULTS: Five patients were included (mean age: 69.2 years, range 50-87; 4 male) with MCED-identified-high-risk for HNC or lymphoma. Only patient was symptomatic. After physical exam and follow-up head and neck imaging, circulating tumor HPV DNA testing, two patients were diagnosed with p16 + oropharyngeal squamous cell carcinomas and underwent appropriate therapy. A third patient had no evidence of head and neck cancer but was diagnosed with sarcoma of the thigh. The remaining two patients had no evidence of malignancy after in-depth workup.
CONCLUSIONS: In this retrospective study, 2 of 5 patients referred to Otolaryngology with a positive MCED result were diagnosed with HPV + oropharyngeal squamous cell carcinoma. We recommend that positive HNC MCED work up include thorough head and neck examination with flexible laryngoscopy and focused CT or MRI imaging. Given the potential for inaccurate MCED tissue of origin classification, PET/CT may be useful in specific situations. For a patient with no cancer identified, development of clear guidelines is warranted.
METHODS: Retrospective chart review of patients referred to Otolaryngology with an MCED result suggesting HNC. Patients enrolled in prospective MCED clinical trials were excluded. Cancer diagnoses were confirmed via frozen-section pathology.
RESULTS: Five patients were included (mean age: 69.2 years, range 50-87; 4 male) with MCED-identified-high-risk for HNC or lymphoma. Only patient was symptomatic. After physical exam and follow-up head and neck imaging, circulating tumor HPV DNA testing, two patients were diagnosed with p16 + oropharyngeal squamous cell carcinomas and underwent appropriate therapy. A third patient had no evidence of head and neck cancer but was diagnosed with sarcoma of the thigh. The remaining two patients had no evidence of malignancy after in-depth workup.
CONCLUSIONS: In this retrospective study, 2 of 5 patients referred to Otolaryngology with a positive MCED result were diagnosed with HPV + oropharyngeal squamous cell carcinoma. We recommend that positive HNC MCED work up include thorough head and neck examination with flexible laryngoscopy and focused CT or MRI imaging. Given the potential for inaccurate MCED tissue of origin classification, PET/CT may be useful in specific situations. For a patient with no cancer identified, development of clear guidelines is warranted.
摘要：
目的：基于血液的多癌早期检测（MCED）测试现已商业化。然而,目前没有针对头颈部癌(HNC)提供者的共识指南来指导MCED检测阳性患者的检查或监测.我们试图描述MCED测试阳性提示HNC的患者病例，并为他们的评估提供见解。
方法：回顾性图表回顾转诊至耳鼻喉科的患者，MCED结果提示HNC。纳入前瞻性MCED临床试验的患者被排除在外。癌症诊断通过冰冻切片病理证实。
结果：纳入5例患者（平均年龄：69.2岁，范围50-87；4名男性）患有MCED鉴定的HNC或淋巴瘤高风险。只有患者有症状。体格检查和随访头颈部成像后，循环肿瘤HPVDNA检测，两名患者被诊断为p16+口咽鳞癌，并接受了适当的治疗。第三名患者没有头颈癌的证据，但被诊断为大腿肉瘤。经过深入检查，其余两名患者没有恶性肿瘤的迹象。
结论：在这项回顾性研究中，5例MCED阳性的耳鼻喉科患者中有2例被诊断为HPV+口咽鳞状细胞癌。我们建议HNCMCED阳性检查包括使用柔性喉镜检查和聚焦CT或MRI成像进行彻底的头颈部检查。考虑到MCED组织起源分类不准确的可能性，PET/CT在特定情况下可能有用。对于一个没有癌症的病人，有必要制定明确的指导方针。
方法：回顾性图表回顾转诊至耳鼻喉科的患者，MCED结果提示HNC。纳入前瞻性MCED临床试验的患者被排除在外。癌症诊断通过冰冻切片病理证实。
结果：纳入5例患者（平均年龄：69.2岁，范围50-87；4名男性）患有MCED鉴定的HNC或淋巴瘤高风险。只有患者有症状。体格检查和随访头颈部成像后，循环肿瘤HPVDNA检测，两名患者被诊断为p16+口咽鳞癌，并接受了适当的治疗。第三名患者没有头颈癌的证据，但被诊断为大腿肉瘤。经过深入检查，其余两名患者没有恶性肿瘤的迹象。
结论：在这项回顾性研究中，5例MCED阳性的耳鼻喉科患者中有2例被诊断为HPV+口咽鳞状细胞癌。我们建议HNCMCED阳性检查包括使用柔性喉镜检查和聚焦CT或MRI成像进行彻底的头颈部检查。考虑到MCED组织起源分类不准确的可能性，PET/CT在特定情况下可能有用。对于一个没有癌症的病人，有必要制定明确的指导方针。
