Abstract
One pathologic tumor type, squamous cell carcinoma (SCC), accounts for the majority of all head and neck (HN) cancers yet is a heterogeneous malignancy (Chegini et al., J Oral Pathol Med 00:1–5, 2019). SCC arises from the squamous lining of moist mucosal surfaces of the HN, the pharynx, larynx, and paranasal sinuses. It also arises from the skin surface, with the greatest proportion of cutaneous SCC arising in the sun-exposed head and neck (Gurudutt and Genden, J Skin Cancer 2011:502723, 2011; Ouyang, Semin Plast Surg 24:117–126, 2010). In most sites of the HN, tobacco is the most common causative agent in the development of mucosal dysplasia and neoplasia (Gandini et al., Int J Cancer 122:155–164, 2008). Alcohol is a synergistic cofactor while poor oral hygiene and genetics are also contributing risk factors to the development of SCC (Hashibe et al., Cancer Epidemiol Biomark Prev 15:696–703, 2006; Hashibe et al., J Natl Cancer Inst 99:777–789, 2007). Paralleling the declining trend of smoking over the last 30 years has been an overall decline in the incidence of HN SCC, particularly in the oral cavity, larynx, and hypopharynx. Conversely, in the oropharynx there has been a rise in lingual and palatine tonsillar SCC, particularly in patients under the age of 60 years, who may have no or a limited history of tobacco and alcohol use. This increasingly common group of SCC tumors has been shown to be positive for human papilloma virus (HPV) and most commonly the high-risk HPV 16 subtype, which is responsible for anogenital neoplasms. Currently in the USA about 70% of oropharyngeal tonsillar SCC are due to HPV (https://seer.cancer.gov/statfacts/html/oralcav.html). HPV-positive SCC is more responsive to chemoradiation than HPV-negative SCC, and patients have an overall better prognosis. Patients with HPV-positive tumors who are also smokers carry an intermediate prognosis.
Highlights
To recognize the important features of the AJCC/ UICC staging system and how radiologists can use this system to provide more detailed, valuable reports
MR is so affected by motion artifact that it is largely reserved for determination of cartilage penetration (T4a) when CT is equivocal
Biopsy of the primary site or lymph nodes is recommended if there is strong concern for residual/ recurrent disease [NI-RADS 3] such as a new or enlarging, discrete nodule with robust enhancement or intense focal FDG uptake on PET
Summary
Across the USA and across the world there are different thoughts and perspectives as to the best imaging modality to use for staging and surveillance, and as to the ideal timing for use of the modalities after treatment and for ongoing surveillance. Non-optimized MR sequences and lack of familiarity with basic neck anatomy or MR artifacts will make detection of key findings difficult for the less experienced radiologist With these caveats in mind, MR offers specific utility in certain areas. MR offers significantly better soft tissue contrast for detecting small primary tonsillar tumors and evaluating the deep extent of an infiltrative lesion when planning surgical resection or intensity modulated radiation therapy (IMRT) For this reason it is often used in the oral cavity and oropharynx. Glastonbury aware of the many tissues with variable degrees of normal FDG uptake, muscles, brown fat, salivary and lymphoid tissue, and recent biopsy sites These all serve as potential false-positive pitfalls in PET imaging. US can serve as imaging guidance for fine needle aspiration (FNA)
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