Table 4.I.

National Comprehensive Cancer Network (NCCN) guidelines on staging of head and neck tumours, compared with AIOCC (Italian Association of Head and Neck Oncology) and AIOM (Italian Association of Medical Oncology).

Staging by imaging	NCCN guidelines version 1.2019	AIOCC guidelines 2012	AIOM guidelines 2018
SCC oral cavity	As clinically indicated: Chest CT (with or without contrast) 1 CT with contrast and/or MRI with contrast of primary and neck Panorex or dental CT without contrast	MRI of head and neck without and with contrast (first choice) CT without and with contrast of head and neck US of neck PET/CT in locally advanced stages Chest CT without and with contrast (if not done PET/CT) Dental CT If clinically indicated: Liver US Bone scintigraphy	Local staging with: MRI of primary and neck with contrast (first choice) or CT of primary and neck with contrast US of neck Panorex (or dental CT) Distant staging with: PET/CT in selected cases (III-IV stages) or chest CT (in T1 and T2 it can be sufficient chest X-ray, except in strong smoker)
SCC oropharynx	CT with contrast and/or MRI with contrast of primary and neck As clinically indicated: FDG-PET/CT Chest CT (with or without contrast) 1 Panorex	MRI (first choice) or CT (if MRI not feasible) of primary and neck Chest CT PET/CT for III-IV stages	Local staging with: MRI (firs choice) or CT (if MRI not feasible) Distant staging with: Chest CT (III-IV stages; T1-2 at high risk) PET/CT for stages III-IV
SCC hypopharynx	CT with contrast and/or MRI with contrast of primary and neck As clinically indicated: Chest CT (with or without contrast) 1 Consider FDG-PET-CT	CT or MRI + contrast of primary and neck PET/CT for III-IV stages Chest CT	Local staging with: CT or MRI with contrast of facial massif and neck Distant staging with: Chest CT with contrast (PET/CT in III-IV stages)
Cancer of nasopharynx	MRI with contrast of skull base to clavicle +/- CT of skull base/neck with contrast to evaluate skull base erosion Imaging for distant metastasis with FDG-PET/CT and/or chest CT with contrast	MRI (first choice) +/- CT of primary and neck US of neck Dental CT CT total body + bone scintigraphy or PET/CT	Local staging with: MRI (firs choice) +/- CT for skull base study US of neck Distant staging with: PET/CT (in alternative CT total body + bone scindigraphy)
SCC glottic larynx	CT with contrast and thin angled cuts through larynx and/or MRI with contrast of primary and neck As clinically indicated: Chest CT (with or without contrast) 1 Consider FDG-PET/CT	CT/MRI of primary and neck US of neck Chest CT PET/CT for III-IV stages	Local staging with: CT with contrast (first choice) MRI with dedicated superficial coils and sequences US of neck Distant staging with: Chest CT with contrast or PET/CT in III-IV stages
SCC supraglottic larynx	Chest CT (with or without contrast) as clinically indicated 1 CT with contrast and thin angled cuts through larynx and/or MRI with contrast of primary and neck Consider FDG-PET/CT
Ethmoid sinus tumors	CT with contrast or MRI with contrast of skull base As clinically indicated: Chest CT (with or without contrast) 1 Consider FDG-PET/CT	MRI and/or CT (skull base to clavicle) with contrast (axial, sagittal and coronal projections) Chest and abdomen CT + bone scintigraphy or PET/CT for more aggressive tumors (Same guidelines for all sinonasal tumors)	MRI and/or CT (skull base to clavicle) with contrast (particular attention on parapharyngeal chain) Chest X-ray (in less aggressive histotypes) Chest and abdomen CT + bone scintigraphy or whole body PET/CT for more aggressive tumors (Same guidelines for all sinonasal tumors)
Maxillary sinus tumors	Complete head and neck CT with contrast and/or MRI with contrast As clinically indicated: Chest CT (with or without contrast) 1 Consider FDG-PET/CT
Salivary gland tumors	FNA biopsy As clinically indicated: CT/MRI with contrast of skull base to clavicle Chest CT (with or without contrast) 1	Chest X-ray Neck US + FNA CT/MRI with contrast for the study of deep parotid lobe or in III-IV stages	US of neck + FNAB CT/MRI with contrast of primary and neck
Mucosal melanoma	CT with contrast and/or MRI with contrast to determine anatomic extent of disease, particularly for sinus disease As clinically indicated: Chest CT (with or without contrast) 1 Consider FDG-PET/CT or chest/abdominal/pelvic CT with contrast, and brain MRI (with and without contrast) to rule out metastatic disease

¹: Chest CT is recommended for advanced nodal disease to screen for distant metastasis and for selecting patients who smoke, to screen for lung cancer.