The Systematic Use of Tomography in the Diagnosis of Carcinoma of the Paranasal Sinuses

Abstract

Advocacy of the use of routine tomography in patients suspected of harboring malignant tumors of the paranasal sinuses is not new. In 1944 Holvey (4) recommended the method as a means of better delineating the extent of tumors of the maxillary antra, and subsequently Dargent and his associates (2) in 1948 and Leroux-Robert and Ennuyer (5) and Baclesse (1) in 1951 and 1952 cited it as an indispensable aid in the diagnosis and treatment planning of such tumors. The current work is an extension of studies begun in 1948 by Dr. Gilbert H. Fletcher, who employed the basic technic then in use at the Curie Foundation. To date, we have examined 123 patients with primary tumors of the ethmoid, maxillary, or sphenoid sinuses. No malignant frontal lesion has been encountered. In each instance conventional radiographic projections were supplemented by tomograms. It is the purpose of this paper to cite briefly the incidence, clinical findings, and natural history of these tumors as they relate to the roentgen examination, stressing the need for and advantages of tomographic studies. The differential diagnosis of secondary and primary neoplasms will also be considered. Incidence and Symptomatology At the M. D. Anderson Hospital and Tumor Institute the percentage distribution of cancer of the paranasal sinuses is 0.7 per cent, as contrasted with an average of eight sources quoted by Wille (8) which places the figure at 1.6 per cent of the general cancer population. Since all these estimates are largely based upon cancer center statistics, the community level incidence of 0.2 per cent of the general cancer population (6) is more pertinent to the present discussion. If this rate is applied to the current population of the United States, at least 800 to 1,000 new cases may be expected yearly. While comparatively low, this incidence is sufficient to warrant a renewed awareness of the disease on the part of all physicians. That such a need exists has been well documented by Wille's series of 220 patients, 131 of whom were treated symptomatically for two to six months and 47 for six to twenty-four months before proper definitive therapy was undertaken. The average age of our patients was 55.6 years, with the tumors occurring twice as frequently in males as in females (83 males, 40 females). There was no significant variation in the age of onset for squamous-cell carcinoma as opposed to adenocarcinoma. The average age for tumors of non-epithelial origin was 50 years. The youngest patient in the squamous-cell-adenocarcinoma group was 13 years of age, the oldest 86 years. Eight patients (7.5 per cent) were less than 40, and a like number were over 75. The clinical picture varied somewhat, depending upon the location and extent of the individual tumor, but many initial complaints were common to all varieties. The commonest presenting symptoms, in order of frequency, are as follows: