Surveillance Imaging Following Head and Neck Cancer Treatment and Microvascular Reconstruction.
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.
['House|Adrian E|AE|', 'Zebolsky|Aaron L|AL|0000-0003-3632-0498', 'Jacobs|Joanna|J|', 'Likhterov|Ilya|I|', 'Behr|Spencer|S|', 'Glastonbury|Christine|C|', 'Seth|Rahul|R|', 'Heaton|Chase|C|', 'Knott|Philip Daniel|PD|0000-0002-8986-5961']
D000368:Aged D005260:Female D019788:Fluorodeoxyglucose F18 D006258:Head and Neck Neoplasms D006801:Humans D008279:Magnetic Resonance Imaging D008297:Male D008866:Microsurgery D008875:Middle Aged D009364:Neoplasm Recurrence, Local D000072078:Positron Emission Tomography Computed Tomography D019275:Radiopharmaceuticals D012189:Retrospective Studies
surveillance head and neck cancer PET/CT MRI free flap free tissue transfer