Importance of PET/CT in Initial Workup of Head and Neck Squamous Cell Carcinoma

OBJECTIVE: Assess the impact of positron emission tomography/computed tomography (PET/CT) on disease staging at presentation in patients with head and neck squamous cell carcinoma. STUDY DESIGN: Retrospective cross‐sectional review. SETTING: Academic multicenter single institution (Geisinger Health System). METHODS: All patients who had PET/CT imaging during workup for head and neck squamous cell carcinoma were included in the study. Pre‐ and post‐PET/CT clinical staging were recorded. Statistical analyses were performed for patients with a change in clinical staging or detection of second primary malignancies on PET/CT. RESULTS: A total of 292 patients were included in the study, 238 of whom underwent PET/CT imaging as part of their initial workup. Twenty‐eight (11.9%) patients were clinically upstaged on PET/CT with 7 patients having treatment alterations based on imaging. Eighteen (7.6%) patients were found to have second primary malignancies on PET/CT. CONCLUSION: The current study further illustrates the importance of PET/CT in the workup of head and neck squamous cell carcinoma. Without the inclusion of PET/CT imaging, 19.3% of patients would have either been staged inappropriately or had second primary malignancies missed, again confirming the necessity of comprehensive functional imaging during the initial pretreatment workup.