Head and neck cancer surveillance: The value of computed tomography and clinical exam

Purpose: The recurrence of head and neck cancer (HNC) is most prevalent during the initial two years following curative treatment, underscoring the criticality of regular surveillance for HNC survivors. This study aims to evaluate the effectiveness of computed tomography (CT) imaging and clinical physical examination (CE) in HNC surveillance, assessing whether these imaging protocols meet the current treatment limitations confronting HNC specialists. Methods: Retrospective chart review of a 9-year experience with head and neck cancer patients at a single, academic tertiary care center. Demographic data was collected along with data regarding whether the recurrences were detected primarily through CE, flexible endoscopic exam (scope exam), or CT or CT/PET scan. Subsets of the data were analyzed and compared by sensitivity, specificity, and negative predictive values. Results: 264 HNC patients were identified. 72 total recurrences (27 %) were noted. The method of initial detection spurring further investigation was imaging in 42 (58.3 %) patients, CE (33.3 %) in 24 patients, scope exam in 6 (8.4 %) patients. Overall, 65 (90.3 %) patients had imaging that showed recurrence regardless of method of initial detection. Sensitivity, (87.1 % vs 70.5 %), and specificity (93.95 % vs 96.9 %) were noted for CT and CE respectively. Combined sensitivity and specificity for CT and CE was 96.2 % and 91.05 % respectively. Conclusion: The data suggests that imaging could provide sufficient methods of HNC surveillance despite limitations the COVID-19 pandemic presents.