However, noncontrast MR sequences are routinely used to identify the primary tumor, define tumor extent, in particular marrow involvement, and are used in nodal staging. Radiography Paranasal Sinuses There is no relevant literature to support the use of radiography of the sinuses in the initial staging of suspected or diagnosed cancer the oral cavity or oropharynx or hypopharynx or larynx or cancer of unknown primary of the head and neck. US Neck Ultrasound (US) can be a useful adjunct to cross-sectional imaging, in particular for nodal staging of head and neck cancer. Coupled with fine-needle aspiration and/or core-needle biopsy, nodal evaluation with US is a reliable tool and correlates well with staging following neck dissection [62]. 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]. US is not typically used to stage the primary site, although there is a growing body of research demonstrating the utility of US in delineating primary tumors of the oral cavity, oropharynx, hypopharynx, and larynx. Recent studies comparing transcervical US to CT and FDG-PET/CT and US to CT and MRI demonstrated increased accuracy of US in detecting primary site in patients with HPV-related oropharyngeal carcinoma [51,66]. Intraoral US of the tongue has been proven to be accurate in the evaluation of depth of invasion, which is an important staging feature of oral cavity cancers that has prognostic and therapeutic implications [67,68]. A few studies demonstrated the utility of US in the delineation of oral cavity primary in patients in which the tumor was obscured by metal on cross- sectional imaging [25,69].
Staging and Post Therapy Assessment of Head and Neck Cancer. However, noncontrast MR sequences are routinely used to identify the primary tumor, define tumor extent, in particular marrow involvement, and are used in nodal staging. Radiography Paranasal Sinuses There is no relevant literature to support the use of radiography of the sinuses in the initial staging of suspected or diagnosed cancer the oral cavity or oropharynx or hypopharynx or larynx or cancer of unknown primary of the head and neck. US Neck Ultrasound (US) can be a useful adjunct to cross-sectional imaging, in particular for nodal staging of head and neck cancer. Coupled with fine-needle aspiration and/or core-needle biopsy, nodal evaluation with US is a reliable tool and correlates well with staging following neck dissection [62]. 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]. US is not typically used to stage the primary site, although there is a growing body of research demonstrating the utility of US in delineating primary tumors of the oral cavity, oropharynx, hypopharynx, and larynx. Recent studies comparing transcervical US to CT and FDG-PET/CT and US to CT and MRI demonstrated increased accuracy of US in detecting primary site in patients with HPV-related oropharyngeal carcinoma [51,66]. Intraoral US of the tongue has been proven to be accurate in the evaluation of depth of invasion, which is an important staging feature of oral cavity cancers that has prognostic and therapeutic implications [67,68]. A few studies demonstrated the utility of US in the delineation of oral cavity primary in patients in which the tumor was obscured by metal on cross- sectional imaging [25,69].