ACR Appropriateness Criteria® Staging and Post-Therapy Assessment of Head and Neck Cancer


Maria K. Gule-Monroe, The University of Texas MD Anderson Cancer Center, Houston, Texas. Electronic address:
Susana Calle, Research Author, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Bruno Policeni, Panel Chair, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
Amy F. Juliano, Panel Vice-Chair, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts.
Mohit Agarwal, Froedtert Memorial Lutheran Hospital Medical College of Wisconsin, Milwaukee, Wisconsin.
Laura Q. Chow, University of Texas at Austin, Dell Medical School, Austin, Texas; American Society of Clinical Oncology.
Prachi Dubey, Houston Methodist Hospital, Houston, Texas.
Elliott R. Friedman, Houston Methodist Hospital, Houston, Texas.
Mari Hagiwara, New York University Langone Health, New York, New York.
Kate DuChene Hanrahan, University of Iowa Hospital, Iowa City, Iowa, Primary care physician.
Vikas Jain, MetroHealth Medical Center, Cleveland, Ohio.
Tanya J. Rath, Mayo Clinic Arizona, Phoenix, Arizona.
Russell B. Smith, Baptist Medical Center, Jacksonville, Florida; American Academy of Otolaryngology-Head and Neck Surgery.
Rathan M. Subramaniam, University of Otago, Dunedin, Otepoti, New Zealand; Commission on Nuclear Medicine and Molecular Imaging.
M Reza Taheri, George Washington University Hospital, Washington, District of Columbia.
Sue S. Yom, University of California, San Francisco, San Francisco, California.
David Zander, University of Colorado Denver, Denver, Colorado.
Judah Burns, Specialty Chair, Montefiore Medical Center, Bronx, New York.

Document Type

Journal Article

Publication Date



Journal of the American College of Radiology : JACR








AUC; Appropriateness Criteria; appropriate use criteria; cancer; head and neck; imaging; squamous cell carcinoma; staging; surveillance


Imaging of head and neck cancer at initial staging and as part of post-treatment surveillance is a key component of patient care as it guides treatment strategy and aids determination of prognosis. Head and neck cancer includes a heterogenous group of malignancies encompassing several anatomic sites and histologies, with squamous cell carcinoma the most common. Together this comprises the seventh most common cancer worldwide. At initial staging comprehensive imaging delineating the anatomic extent of the primary site, while also assessing the nodal involvement of the neck is necessary. The treatment of head and neck cancer often includes a combination of surgery, radiation, and chemotherapy. Post-treatment imaging is tailored for the evaluation of treatment response and early detection of local, locoregional, and distant recurrent tumor. Cross-sectional imaging with CT or MRI is recommended for the detailed anatomic delineation of the primary site. PET/CT provides complementary metabolic information and can map systemic involvement. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.