Surveillance Imaging Following Head and Neck Cancer Treatment and Microvascular Reconstruction. (22nd June 2021)

• Record Type: Journal Article
• Authors: House, Adrian E.; Zebolsky, Aaron L.; Jacobs, Joanna; Likhterov, Ilya; Behr, Spencer; Glastonbury, Christine; Seth, Rahul; Heaton, Chase; Knott, Philip Daniel
• Is Part Of: Laryngoscope. Volume 131:Number 12(2021)
• Page Start: 2713
• Page End: 2718
• Publication Date: 2021-06-22
• Subjects: MRI -- PET/CT -- head and neck cancer -- surveillance -- free flap -- free tissue transfer; Otolaryngology -- Periodicals; 617.51005
• DOI: 10.1002/lary.29700
• Languages: English
• ISSNs: 0023-852X

Abstract

Abstract : Objectives/Hypothesis: To assess the accuracy and utility of positron emission tomography/computed tomography (PET/CT) compared with magnetic resonance imaging (MRI) for detecting head and neck cancer (HNC) recurrence after microvascular reconstructive surgery. Study Design: Retrospective cohort study. Methods: Analysis of HNC patients who underwent microvascular reconstruction at a single, tertiary academic center following ablative surgery from 1998 to 2015. Forty‐six patients aged 61.4 ± 15.8 years with both PET/CT and MRI examinations were identified. Two radiologists were blinded and interpreted each imaging study. Recurrence certainty scores were determined via continuous (0–100) and Likert ("Likely" to "Unlikely") scales, with larger values indicating a higher likelihood of recurrence. Pathologic confirmation of recurrence was confirmed in 23 patients (50%). Results: Among those with primary site recurrences, mean recurrence certainty was significantly higher with PET/CT versus MRI on the continuous scale (63.9 vs. 44.4, P = .006). A receiver operating characteristic analysis for predicting primary site recurrence demonstrated a significantly larger area under the curve of 0.79 for PET/CT compared to 0.64 for MRI ( P = .044). Categorization of "Likely" primary site recurrence on PET/CT, versus MRI, had higher sensitivity (0.63 vs. 0.40), but lower specificity (0.90 vs. 1.0). MRI demonstrated higher sensitivity (1.0 vs. 0.78) at detecting regional site recurrences. Conclusion: PET/CT demonstrates greater sensitivity than MRI as a surveillance tool for primary site recurrence following microvascular reconstruction where clinical evaluation is hindered by anatomical distortion. Therefore, PET/CT should be pursued as first‐line imaging, with MRI utilized for confirmation of positive imaging findings at the primary site. Level of Evidence: 2 Laryngoscope, 131:2713–2718, 2021