Posttreatment Imaging in Patients with Head and Neck Cancer without Clinical Evidence of Recurrence: Should Surveillance Imaging Extend Beyond 6 Months?

The median time to recurrence was 16.5 ± 5.9 months for NI-RADS 2 (range, 6.3–58.2 months, with outliers excluded) and 9.7 ± 10.9 months for NI-RADS 3 (range, 3–107.9 months, with outliers excluded). There are 2 outliers (not shown in figure) with values of 58.2 months for NI-RADS-2 and 107.9 months for NI-RADS 3.

A, A 53-year-old man with a history of T2N0M0 left-tongue squamous cell carcinoma status post left hemiglossectomy and flap reconstruction. Surveillance imaging demonstrates a new hypoattenuating mass within the left floor of the mouth along the flap margin (B), with corresponding hypermetabolism on PET/CT (C). On clinical examination, no oropharyngeal narrowing, bulge, or ulcerations were detected. The patient did not have worrisome clinical symptoms suspicious for clinical recurrence. This new mass was clinically occult and biopsy-proved recurrent disease. Recurrence was detected 15 months posttreatment.