Background: Head and neck cancers are the seventh most common cancer worldwide, with squamous cell carcinoma accounting for 90%.(1) Accurate workup and staging of disease are essential and involves radiological investigations. PET/CT is widely accepted as a primary investigation when managing patients with suspected unknown primary, recurrent/advanced disease, melanoma, nasopharyngeal cancer and human papilloma virus (HPV) positive oropharyngeal cancer.(2) The role of PET/CT in other head-neck mucosal malignancies is not clearly defined. The aim of this study is to evaluate the outcomes of PET/CT versus routine CT in this cohort.
Methods: A single centre retrospective cohort study, reviewing all patients discussed at our institutions Head and Neck Multidisciplinary Meeting (MDM) between January 2020 and December 2021. Including those who underwent a PET-CT scan. The primary outcome was measured as synchronous second primary tumours (SPT) detected or significant change to management.
Results: A total of 279 patients were identified, with 92 patients included in the final analysis. 62 were male (67.4%). Median age 72 (IQR 62.5-80). 68 were NZ European (73.9%) and 11 were Maori (11.9%). 17 patients (18.5%) had SPT picked up on PET-CT. 23 (25.0%) had significant changes to management. With 8 (34.8%) requiring further surgical treatment and 4 (17.4%) deferred for palliative intent. 23 (25.0%) had additional lymphadenopathy seen on PET/CT. Within this, 13 (56.5%) had changes to the TNM staging. 33 (35.9%) required further investigations.
Conclusion: These findings support an expanded role of PET-CT in head and neck cancer which may improve staging and overall patient management.