1. McGraw, Mark

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A new study finds that doing surveillance imaging with PET/CT and CT and/or MRI was linked to lower mortality of patients with head and neck cancer (HNC) with regionalized or distant disease. In Radiology, researchers from the University of Utah Health noted that "no strong evidence" has existed to support surveillance imaging in patients with head and neck cancer (2023; As such, the authors sought to investigate the association between surveillance imaging and mortality using a population-based study design with statewide cancer registry data, all-payer claims data, and health care facility data.

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"As diagnostic neuro/head and neck radiologists, we discovered a suspicious recurrent lesion on imaging that is not detected on physical examination," lead study author Yoshimi Anzai, MD, MPH, FACR, Professor of Radiology and Imaging Sciences at the University of Utah Health, told Oncology Times. "Therefore, we believe that medical imaging contributes to detecting early recurrence so that salvage therapy can be offered to those patients."


What was unknown, however, was "who benefits from surveillance imaging," said Anzai, who is also Director of Value and Safety of Enterprise Imaging at University of Utah Health. "Just like anything in medicine, one size does not fit all. I wanted to find a targeted population where we should do surveillance imaging."


Before conducting the study, Anzai and his colleagues hypothesized that surveillance imaging would benefit patients with head and neck cancer in an advanced stage, as the chance of recurrence is higher among those patients with advanced stage than in an early stage, he noted. "Another thought was that surveillance imaging benefits patients with head and neck cancer that is difficult to examine, such as nasopharynx, hypopharynx, or sinonasal cancer, but less so for patients with cancer that is easy to see and exam, such as lip cancer or oral tongue cancer."


Study Details

In this retrospective, population-based study, Anzai and his co-authors identified patients with HNC diagnosed between January 2012 and December 2017. The study identified 1,004 patients, including 902 patients with squamous cell carcinoma (SCC) HNC and 102 patients with non-SCC.


When the entire sample was analyzed, the effect of imaging on mortality among patients with SCC was not statistically significant. However, stratified analyses by cancer stage revealed that surveillance imaging was associated with lower mortality versus no surveillance imaging. PET/CT was associated with lower mortality for patients with SCC, and CT and/or MRI was associated with lower mortality for patients with non-SCC. The surveillance imaging protective association was observed up to 2 years after treatment completion, according to the authors.


"We wanted to believe that getting surveillance imaging allows the detection of early recurrent cancer as compared to those who did not get surveillance imaging," stated Anzai, noting that this study includes observational data from the Utah Population Database linked with the Cancer Registry.


"We were not able to prove that the stage of recurrent cancer was different among those who had surveillance imaging versus those who did not get surveillance imaging," he added. "That would be the next step of the research study.


"Some people may think that people with a higher risk of a recurrence tend to get surveillance imaging than those with a lower risk," Anzai continued. "If the risk of recurrence is associated with surveillance imaging use, then patients with surveillance imaging should have had higher mortality."


This study, however, revealed the opposite result, he said, noting the possibility that patients who receive surveillance imaging may also have more access to health care in general. This analysis incorporates the insurance status, he explained, but it still saw a significant difference in mortality rate.


Looking ahead, Anzai is hopeful that the study informs head and neck cancer care teams that surveillance imaging benefits patients with advanced HNC, such as those with regional lymph node metastases and distant metastases. He noted that the current recommendation is to have an imaging test done for up to 6 months, although most HNC recurrence occurs in the first 2 years.


"Therefore, we should use imaging studies to detect recurrent cancer before recurrent cancer is palpable or causes clinical symptoms up to 2 years after treatment," Anzai stated. "I would also like to inform payers that surveillance imaging helps patients with advanced HNC, so that HNC care teams do not spend much time getting pre-authorization for imaging tests."


Mark McGraw is a contributing writer.