Letter from the Editors

Article Outline

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Head and neck cancer, including squamous cell carcinoma (HNSCC), is the sixth most frequent malignant neoplasm worldwide. In the United States, it accounts for 2% of all malignancies. Despite this relatively low incidence, it is an area of oncologic diagnosis that is of considerable importance to radiologists and nuclear medicine physicians because of the key role that imaging procedures play in its initial diagnosis and staging. Imaging also has an important role in restaging of recurrences and monitoring the effectiveness of chemotherapy and radiation. Computed tomography (CT) and magnetic resonance imaging (MRI) have played a very significant role in the diagnosis and staging of disease. Unfortunately, the majority of patients with HNSCC already have regional node (45%) or distant (10%) metastases at the time of their initial presentation. It is in these cases of spread beyond the primary that ¹⁸F-fluorodeoxyglucose/positron emission tomography (FDG-PET) has an important impact on management. In addition, a very significant number of patients initially present only with neck nodes and a search for the primary site is needed. FDG-PET and, in particular, PET/CT have proven significant additions to the purely anatomic CT or MRI.

An understanding of anatomy is essential to proper head and neck imaging with PET, perhaps more so than in any other part of the body. It is necessary for nuclear medicine physicians to gain expertise in the morphology of the region as depicted on CT images. We are very fortunate to have Drs. Michael Graham and Yusuf Menda provide an excellent teaching atlas of head and neck PET/CT. Their wonderful color images depict both the normal and abnormal functional and anatomic detail with PET, CT, and fusion methodology. This will serve as an excellent reference source for everyone involved in interpreting these studies. We are very indebted to Drs. Graham and Menda for their great effort in putting this together.

Sentinel node localization technology is well established in the areas of melanoma and breast cancer. It is being found useful in other diagnostic areas as well. This includes the genitourinary tract and, now, preoperative head and neck cancer evaluation. Dr. Karen Pitman, head and neck surgeon at the University of Mississippi, has considerable experience with this application and shares it with us in this issue as well.

Excellent articles reviewing thyroid cancer management by Dr. Charles Intenzo and colleaugues and parathyroid localization studies by Dr. Chris Palestro and colleagues complete this most informative head and neck issue. We look forward to continued development and the introduction of newer PET radiopharmaceuticals that should further enhance patient management in this challenging area of cancer management.