Post-therapeutic detection of local tumor persistence of head and neck cancer: the value of routine control endoscopy with biopsy and medical imaging

Tobias Engert; Leyla Acu; Johann Schoenhofer; Nikki Rommers; Nader Ahmad

doi:10.18203/issn.2454-5929.ijohns20240951

Authors

Tobias Engert Department of Otorhinolaryngology, Head and Neck Surgery, Kantonsspital Aarau, Aarau, Switzerland
Leyla Acu Department of Neuroradiology, Kantonsspital Aarau, Aarau, Switzerland
Johann Schoenhofer Department of Neuroradiology, Kantonsspital Aarau, Aarau, Switzerland
Nikki Rommers Department of Clinical Research, University Hospital Basel, Basel, Switzerland
Nader Ahmad Department of Otorhinolaryngology, Head and Neck Surgery, Kantonsspital Aarau, Aarau, Switzerland

DOI:

https://doi.org/10.18203/issn.2454-5929.ijohns20240951

Keywords:

Follow-up, HNC, Imaging, Re-staging

Abstract

Background: Insufficient local tumor control is the main cause of treatment failure in head and neck cancer (HNC). Re-staging HNC is challenging because of post-therapeutic tissue distortion. We investigate whether medical imaging and biopsy is more sensitive in identifying tumor persistence.

Methods: In our clinic a re-staging with a control endoscopy and medical imaging is performed 3 months after therapy for some HNC patients. In this retrospective study, we compare the accuracy of imaging to the histology (gold standard). Imaging reports were classified according to 3 scales and re-assessed by 2 neuroradiologists. Furthermore, we evaluate recurrence rates and disease-free survival.

Results: 100 cases were evaluated. 14 patients presented with positive histology at the re-staging. Biopsy detected malignancy in 7 patients with inconspicuous imaging. Disease-free survival during the first 2 years was generally low (n=55). The accuracy of the RECIST scale was 0.74 with a sensitivity of 0.50 and a specificity of 0.78. Imaging reports reviewed according to the Lee-scale and a self-developed scale presented an accuracy of 0.47 and 0.51. Re-assessment of imaging by 2 neuroradiologists showed an accuracy of 0.87.

Conclusions: Medical imaging alone serves as a moderate diagnostic tool to diagnose local persistence of HNC 3 months after therapy. Radiologic misdiagnosing can be addressed by control endoscopy. Our results indicate a benefit of routine biopsies since reliance on imaging may fail to notice tumor persistence. A binary classification of imaging showed a higher accuracy than conventional imaging scales and may help to predict tumor recurrence within 24 months after re-staging.

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