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38% (CT)

85% (CT)

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FIGURE 3.5 PET image of a patient with a history of treated larynx cancer who returned with local recurrence. PET showed metastatic disease in the right lung apex.

FIGURE 3.5 PET image of a patient with a history of treated larynx cancer who returned with local recurrence. PET showed metastatic disease in the right lung apex.

FIGURE 3.6 PET image of a patient who had previous larynx cancer treated by radiation who returns with what is thought to be edema that shows local recurrence (arrow). Biopsies were initially negative, and PET findings could not be confirmed for 4 months.

recurrence by PET with the exception of Lapela and colleagues [33], who showed a slightly higher sensitivity of CT (difference of 4%) for recurrence in their series (PET had a 36% higher specificity in this group). One paper that did a statistical analysis of their results showed a statistically significant advantage for PET over CT/MRI in detecting recurrent disease. When PET is used in the surveillance of patients who have completed treatment for head and neck cancer, PET can identify nearly twice as many cases of recurrent tumor as a regular physical examination or routine CT imaging [35]. Most of these early recurrences are understandably small and require biopsies for confirmation. If an initial biopsy is not positive where PET shows an abnormality, a repeat biopsy or close follow-up should be undertaken. Surgical exploration should also be considered if the PET results are impressive, as they are rarely incorrect (Figs. 3.5 and 3.6).

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