However, noncontrast MR sequences are routinely used to identify tumor recurrence and can define tumor extent, in particular marrow involvement, and are used in nodal assessment. Radiography Paranasal Sinuses There is no relevant literature to support the use of radiography of the paranasal sinuses in the follow-up imaging or evaluation of suspected or known recurrence of treated cancer of the oral cavity, oropharynx, hypopharynx, larynx, or cancer of unknown primary of the head and neck. US Neck US coupled with fine-needle aspiration and/or core-needle biopsy can be a useful tool in regional nodal evaluation following treatment of cancer of the oral cavity, oropharynx, hypopharynx, larynx, or cancer of unknown primary of the head and neck [140]. A range of sensitivities and specificities for detection of nodal disease are found in the literature, likely reflecting the highly operator dependent nature of this technique. US alone has been shown to very sensitive (77.8%-96.8%) and specific (68.75%-97%) in detecting cervical nodal metastases [47,63-65]. In the presence of bulky nodal disease, US combined with FDG-PET/CT was found to be a reliable strategy to identify patients with complete nodal response to therapy with a higher combined NPV [65]. US has been shown to perform similar to CT in detection of recurrence of head and neck squamous cell carcinomas [141] but is inherently limited by operator skill and its inability to evaluate deep neck structures. Variant 6: Treated nasopharynx cancer or EBV-associated unknown primary of the head and neck. Surveillance imaging or follow-up imaging for suspected or known recurrence. Nasopharynx cancer and EBV-associated unknown primary of the head and neck is known to be responsive to radiotherapy and, in advanced disease, the combination of radiation and chemotherapy.
Staging and Post Therapy Assessment of Head and Neck Cancer. However, noncontrast MR sequences are routinely used to identify tumor recurrence and can define tumor extent, in particular marrow involvement, and are used in nodal assessment. Radiography Paranasal Sinuses There is no relevant literature to support the use of radiography of the paranasal sinuses in the follow-up imaging or evaluation of suspected or known recurrence of treated cancer of the oral cavity, oropharynx, hypopharynx, larynx, or cancer of unknown primary of the head and neck. US Neck US coupled with fine-needle aspiration and/or core-needle biopsy can be a useful tool in regional nodal evaluation following treatment of cancer of the oral cavity, oropharynx, hypopharynx, larynx, or cancer of unknown primary of the head and neck [140]. A range of sensitivities and specificities for detection of nodal disease are found in the literature, likely reflecting the highly operator dependent nature of this technique. US alone has been shown to very sensitive (77.8%-96.8%) and specific (68.75%-97%) in detecting cervical nodal metastases [47,63-65]. In the presence of bulky nodal disease, US combined with FDG-PET/CT was found to be a reliable strategy to identify patients with complete nodal response to therapy with a higher combined NPV [65]. US has been shown to perform similar to CT in detection of recurrence of head and neck squamous cell carcinomas [141] but is inherently limited by operator skill and its inability to evaluate deep neck structures. Variant 6: Treated nasopharynx cancer or EBV-associated unknown primary of the head and neck. Surveillance imaging or follow-up imaging for suspected or known recurrence. Nasopharynx cancer and EBV-associated unknown primary of the head and neck is known to be responsive to radiotherapy and, in advanced disease, the combination of radiation and chemotherapy.