Current value of double-contrast pharyngography and of computed tomography for the detection and for staging of hypopharyngeal, oropharyngeal and supraglottic tumors

Abstract

In light of recent endoscopic techniques the current value of double-contrast pharyngography (DCP) and of CT for detection and staging of hypo-, oropharyngeal, and supraglottic tumors is evaluated. The DCP of 151 patients and CT obtained from 99 of these patients were retrospectively analyzed in a double-blinded manner. We used a standard protocol which comprised all relevant anatomical subregions. Results were compared with direct microlaryngoscopy (DL), indirect laryngoscopy (IL), and post-operative histopathological findings. Sensitivity and specificity of DCP was 75.0 % and 86.7 %, respectively. The DCP and IL techniques together yielded a higher sensitivity (96.7 %) than each method separately. Sensitivity and specificity of CT was 87.5 and 100 %, respectively. In 74.7 % CT provided correct staging. Subregional analysis revealed that the results of DCP and CT depend highly on the localization of the tumor. Our results indicate that DCP represents an important screening method for diagnosing hypo-, oropharyngeal, and supraglottic tumors to complete IL and DL. We show that CT is a reliable method for preoperative staging, although small superficial tumors may occasionally be missed by this method.

Tumor volume as determined by computed tomography predicts local control in hypopharyngeal squamous cell carcinoma treated with primary surgery

“…In contrast to clinical examinations, the exact determination of deep infiltration of laryngopharyngeal SCC, i.e., involvement of laryngeal cartilage, the prevertebral fascia, the paraglottic space, or submucosal infiltration of the apex of the piriform sinus or the esophageal inlet, is best achieved with CT (or MRI) [9,10,11,12,13,14], also resulting in the correct T classification. Moreover, pretreatment CT allows for an accurate and reproducible measurement of tumor volumes [15,16].…”

Current concepts in imaging of laryngeal and hypopharyngeal cancer

“…Staging accuracy of a combined evaluation by CT and clinical examination as determined for tumors of the larynx and the hypopharynx range between 73 and 88% compared with 55-64% by clinical examination alone [3,4,5,6,23]. Regional staging accuracies are 86.4 for hypopharyngeal and 80.0% for laryngeal carcinomas; not including small superficially growing T1 tumors out of a series of 88 squamous cell carcinomas, the staging accuracy by CT could be improved to 94.3% [6].…”

“…Especially, T1-tumors of the glottis, the deep hypopharyngeal recessus, and the postcricoid region are difficult to detect; however, most tumors can be easily localized both, transversally as well as in their craniocaudal extension. Especially, deep tumor infiltration is a domain of CT, in contrast to endoscopic methods, so that CT provides additional information in the majority of the patients [1,5,6]. In more than 90% of patients, laryngopharyngeal squamous cell carcinomas enhance sufficiently after IV contrast administration (96±16 HU) and, therefore, can be readily delineated from muscle (70±6 HU) [17] and fatty tissue (<0 HU).…”

“…In contrast to the first procedure, the latter procedure spares the suprahyoid portions of the epiglottis and is contraindicated in case of an infiltration of the preepiglottic space. If all the above-mentioned surgical procedures are contraindicated, total laryngectomy (with partial pharyngectomy) 1673 and parapharyngeal fat spaces, as well as tumor spread beneath an intact mucosa, i.e., into the apex of the pyriform sinus or across the midline, are important pretherapeutic criteria which often remain unanswered by clinical examination [3,4,5,6]. Presently, therapy of laryngopharyngeal squamous cell carcinomas aims to retain laryngeal function instead of instantly removing the entire larynx.…”

Multiplanar functional imaging of the larynx and hypopharynx with multislice spiral CT

“…While inspiration, phonation and the Valsalva maneuvers are well established in barium swallow studies [6][7][8], there are few reports on the value of these functional studies performed with CT [9][10][11][12]. Clinical and radiological examination is more difficult following therapy because of edema, fibrosis and inflammation [13][14][15][16][17][18].…”