Imaging checklist for preoperative evaluation of laryngeal tumors to be treated by transoral microsurgery: guidelines from the European Laryngological Society

Chiesa‐Estomba, Carlos Miguel; Ravanelli, Marco; Farina, Davide; Remacle, Marc; Simó, Ricard; Peretti, Giorgio; Sjogren, Elizabeth; Sistiaga-Suárez, Jon Alexander; González-García, José Ángel; Larruscain, Ehkiñe; Piazza, Cesare

doi:10.1007/s00405-020-05869-0

Cited by 16 publications

(19 citation statements)

References 13 publications

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“…Although an MRI provides a better discrimination of submucosal tissue changes, it has some disadvantages in terms of availability, costs, acquisition time and patient tolerance. Moreover, it does not permit a dynamic evaluation of the larynx, and degradation of the image quality related to motion artifacts is a common pitfall [9,11,13].…”

Section: Discussionmentioning

confidence: 99%

“…The radiological evidence of pPGS involvement has been identified as the critical parameter in surgical decision algorithms in glottic T3 tumors [9]. Even if recent studies have shown the importance of magnetic resonance imaging (MRI) in glottic tumor preoperative staging and assessment [9,10], contrast-enhanced computed tomography (CT) remains the most commonly used imaging method in clinical settings [9,[11][12][13].…”

Section: Introductionmentioning

confidence: 99%

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Imaging Accuracy in Preoperative Staging of T3-T4 Laryngeal Cancers

Benazzo

Sovardi

Preda

et al. 2020

Cancers

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Background: Preoperative imaging impacts treatment planning and prognosis in laryngeal cancers. We investigated the accuracy of standard computed tomography (CT) in evaluating tumor invasions at critical glottic areas. Methods: CT scans of glottic cancers treated by partial or total laryngectomy between Jan 2015 and Aug 2019 were reviewed to assess levels of tumor invasion at critical glottic subsites. CT accuracy in the identification of tumor extensions was determined against the gold standard of histopathological analysis of surgical samples. Results: This study included 64 patients. In the anterior commissure, CT showed high rates of false positives at all levels (sensitivity 56.2–70%, specificity 87.8–92.3%); in the anterior vocal fold, it overestimated the deep invasion (19.5% specificity, 90.3% sensitivity), while it underestimated the extralaryngeal spread (63.6% sensitivity, 98.1% specificity). In the posterior paraglottic space (pPGS), false negative results were more frequent for superficial extensions (25% sensitivity, 95.8% specificity) and deep invasions (58.8% sensitivity, 82.3% specificity). Shorter disease-specific and disease-free survivals were associated with pStage IV (p: 0.045 and 0.008) and with the pathological involvement of pPGS (p: 0.045 and 0.015). Conclusions: Negative prognostic correlation of pPGS involvement was confirmed on histopathological data. CT staging did not provide a satisfactory prognostic stratification and should be complemented with magnetic resonance imaging.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Imaging Accuracy in Preoperative Staging of T3-T4 Laryngeal Cancers

Benazzo

Sovardi

Preda

et al. 2020

Cancers

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“…Additionally, three cases only received CT scans of the thorax/abdomen neglecting areas where the tumor dimensions were not distinctively definable. Nevertheless, according to our findings, imaging checklists should be developed and implemented similar to the novel European Laryngological Society proposal for laryngeal carcinomas before transoral laser microsurgery (Chiesa-Estomba et al 2020). Therefore, the results of this study offer a basis for further investigations.…”

Section: Discussionmentioning

confidence: 79%

Rational surgical neck management in total laryngectomy for advanced stage laryngeal squamous cell carcinomas

Böttcher

Betz

Bartels

et al. 2020

J Cancer Res Clin Oncol

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Purpose Controversies exist in regard to surgical neck management in total laryngectomies (TL). International guidelines do not sufficiently discriminate neck sides and sublevels, or minimal neck-dissection nodal yield (NY). Methods Thirty-seven consecutive primary TL cases from 2009 to 2019 were retrospectively analyzed in terms of local tumor growth using a previously established imaging scheme, metastatic neck involvement, and NY impact on survival. Results There was no case of level IIB involvement on any side. For type A and B tumor midline involvement, no positive contralateral lymph nodes were found. Craniocaudal tumor extension correlated with contralateral neck involvement (OR: 1.098, p = 0.0493) and showed increased involvement when extending 33 mm (p = 0.0134). Using a bilateral NY of ≥ 24 for 5-year overall survival (OS) and ≥ 26 for 5-year disease-free survival (DFS) gave significantly increased rate advantages of 64 and 56%, respectively (both p < 0.0001). Conclusions This work sheds light on regional metastatic distribution pattern and its influence on TL cases. An NY of n ≥ 26 can be considered a desirable benchmark for bilateral selective neck dissections as it leads to improved OS and DFS. Therefore, an omission of distinct neck levels cannot be promoted at this time.

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“…We must reflect on surveillance and the need for early regulated radiological control in the first postoperative months in order to improve the organ preservation rate. 9,14,19 Likewise, Piazza et al emphasized the need for more detailed staging of early glottic cancer into 6 subcategories to better cope with the wide spectrum of distinct local tumor spread. For this purpose, they classified the range from tumors infiltrating 1 vocal cord to those with horizontal spread to the vocal muscle/paraglottic space, or those with a vertical trans-AC extension with an invasion of the anterior pre-epiglottic/paraglottic space.…”

Section: Discussionmentioning

confidence: 99%

“…Inclusion criteria were to have a confirmed diagnosis, with anatomopathological and computed tomography scan radiological study, 14 of primary pT1bN0M0 glottic carcinoma based on the Seventh Edition of the American Joint Committee on Cancer TNM classification system. 4 Patients were grouped according to the existence of ACI or not.…”

Section: Study Design and Data Collectionmentioning

confidence: 99%

T1b Glottic Tumor and Anterior Commissure Involvement: Is the Transoral CO₂ Laser Microsurgery a Safe Option?

et al. 2020

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Objectives: Transoral CO2 laser therapy represents the treatment of choice for early-stage laryngeal tumors. The anterior commissure involvement (ACI) is related to a worse local control and a lower rates of organ preservation. The objective of this study is to analyze the differences in survival, local control, and organ preservation in T1b glottic patients according to the presence of ACI. Methods: Observational prospective study in pT1b treated with transoral CO2 laser between 2009 and 2014. Results: Forty patients (37 male and 3 female) with a mean age of 66.43 ± 8.16 years were recruited. Anterior commissure involvement was present in 70% of the patients. The 5-year specific cause survival was 91.66%, with 32.50% of local recurrences. Laryngeal preservation was 80%, being lower in the group with local recurrence ( P < .000). The involvement of the anterior commissure does not influence the organ preservation ( P = .548), the appearance of local recurrences ( P = .391), or the survival ( P = .33). Conclusions: Transoral CO2 laser therapy is an effective and reproducible treatment for early-stage laryngeal tumors. The results obtained are similar to previous studies, although they present discrepancies in relation to the role of the ACI. Prospective randomized trials are required focusing also on the patients’ quality of life and functional outcome in order to clarify the role of the ACI and the need to implement changes in its evaluation, staging, and evolution.

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Imaging checklist for preoperative evaluation of laryngeal tumors to be treated by transoral microsurgery: guidelines from the European Laryngological Society

Cited by 16 publications

References 13 publications

Imaging Accuracy in Preoperative Staging of T3-T4 Laryngeal Cancers

Imaging Accuracy in Preoperative Staging of T3-T4 Laryngeal Cancers

Rational surgical neck management in total laryngectomy for advanced stage laryngeal squamous cell carcinomas

T1b Glottic Tumor and Anterior Commissure Involvement: Is the Transoral CO₂ Laser Microsurgery a Safe Option?

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Imaging checklist for preoperative evaluation of laryngeal tumors to be treated by transoral microsurgery: guidelines from the European Laryngological Society

Cited by 16 publications

References 13 publications

Imaging Accuracy in Preoperative Staging of T3-T4 Laryngeal Cancers

Imaging Accuracy in Preoperative Staging of T3-T4 Laryngeal Cancers

Rational surgical neck management in total laryngectomy for advanced stage laryngeal squamous cell carcinomas

T1b Glottic Tumor and Anterior Commissure Involvement: Is the Transoral CO2 Laser Microsurgery a Safe Option?

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T1b Glottic Tumor and Anterior Commissure Involvement: Is the Transoral CO₂ Laser Microsurgery a Safe Option?