Mukherji SK, consulting ed. Hudgins P, Saindane A, guest eds. Head and Neck Cancer. Elsevier; February 2013. Neuroimaging Clinics of North America; vol. 23; no. 1; pgs. 1-182; $342.
As radiologists, the value we add with our interpretations lies not simply in our ability to see and report an abnormality: most any physician could correctly identify a large necrotic mass on a neck CT or a multilobe glioblastoma on a brain MRI. Rather, our value to clinicians derives from our ability to pick out those subtle but critical imaging findings which help to determine a patient’s diagnosis, prognosis, and, ultimately, optimal treatment. In perhaps no area of neuroradiology is this truer than in head and neck oncology. Cross sectional imaging is indispensible in the workup of head and neck cancers, and provides information which may not be evident from clinical assessment alone—such as deep tumor extension or contralateral nodal metastasis—but which is important for accurate staging.
For those who evaluate a large number of head and neck cancer patients in practice, the American Joint Committee on Cancer (AJCC) Cancer Staging Manual is the indispensible bible of cancer imaging, as it provides the basic framework and definitions upon which we base our interpretations of scans performed for known or suspected head and neck malignancies. Although the 7th edition of AJCC manual, released in 2010, introduced relatively few changes TNM staging system, some of these changes do occasionally alter how certain cancers are now staged and, in some cases, treated. It is therefore essential for anyone involved in head and neck imaging to be familiar with the current staging system. Unfortunately, as anyone who has had the pleasure of reading through it can attest, the AJCC manual is not a radiology text. Nowhere in the book can one find an image from a CT, an MRI, or a PET/CT, nor will one find in it much practical guidance on how to utilize imaging in patients head and neck cancer.
The most recent issue of Neuroimaging Clinics, devoted entirely to head and neck cancer, attempts to demystify cancer staging by emphasizing what radiologists are most likely to encounter in routine practice and, as such, serves as an excellent imaging complement to the AJCC manual. Edited by Patricia Hudgins and Amit Saindane from Emory University, this volume reviews the role of imaging plays in the staging and surveillance of carcinomas of the nasopharynx, oral cavity, oropharynx, hypopharynx, larynx, major salivary glands, and thyroid, and also covers imaging for nodal staging and image-guided tissue sampling. Skimming the titles in the table of contents makes abundantly clear the intent of the editors in putting together this issue. With the exception of the first chapter, entitled “Introduction to the Imaging and Staging of Cancer,” all of the subsequent chapters have titles beginning with “Pitfalls in…”, suggesting that these reviews are focused much more on the practical than on the esoteric.
The strong vision and guiding hand of the co-editors is clearly evident throughout the issue, with all of the chapters adhering fairly closely to a prescribed format, both in organization and content. Most of the reviews are, more or less, divided into sections covering relevant anatomy, epidemiology, TNM staging, patterns of tumor spread, current treatment trends, and posttreatment surveillance. Tables reprinting the updated TNM classifications from the 7th edition of the AJCC staging manual for each site are included in their respective chapters, and the authors each make it a point to highlight notable differences between the current and previous AJCC staging guidelines, with numerous excellent illustrative figures provided throughout.
The high level of editorial oversight is certainly welcome and makes the book feel more coherent as a whole than typical editions of the Clinics series have been in the past. One particularly nice feature of the collection is how each of the chapters, as suggested by their titles, focuses on common imaging “pitfalls” associated with each cancer type and includes a table listing the various pitfalls in addition to providing common sense advice as to how to avoid them. All of the reviews are extremely well researched and well written, with a particular standout chapter being the one on laryngeal squamous cell carcinoma, by Drs. Baugnon and Beitler.
The book is not entirely without faults, though these are relatively few and mostly inconsequential. For example, in the chapter on thyroid cancer, the caption for Figure 8 mislabels a thyroid cancer metastasis to a level IIb lymph node as N1a disease rather than N1b disease, most likely a typographical error, as the text and tables from the chapter clearly define the correct nodal staging for the reader. In addition, I would also have preferred a more detailed discussion of CT approaches for deep neck biopsies in the last chapter on image-guided tissue sampling, as the topic is for the most part glossed over in favor of ultrasound-guided procedures. These are minor complaints, however, and overall, any negatives are far outweighed by the many positives of the book.
All in all, this is an outstanding addition to the Clinics series of neuroradiology reviews and to existing head and neck imaging literature in general. The articles contained within the book are superbly researched and written, reader friendly, and, perhaps most importantly, clinically relevant. Dr. Hudgins, Dr. Saindane, and all of the contributing authors have accomplished the very impressive task of fitting a large amount of very practical information into a relatively compact and easily digestible package (weighing in at a lean 182 pages). A well seasoned head and neck radiologist should find a great deal within the issue to recommend it, but it’s likely that residents and fellows will find the articles quite accessible as well.
