Imaging in laryngeal cancers

Abstract

Imaging plays an important complementary role to clinical examination and endoscopic biopsy in the evaluation of laryngeal cancers. A vast majority of these cancers are squamous cell carcinomas (SCC). Cross-sectional imaging with contrast-enhanced computed tomography (CT) and magnetic resonance (MR) imaging allows excellent depiction of the intricate anatomy of the larynx and the characteristic patterns of submucosal tumor extension. CT, MRI and more recently PET-CT, also provide vital information about the status of cervical nodal disease, systemic metastases and any synchronous malignancies. Additionally, certain imaging-based parameters like tumor volume and cartilaginous abnormalities have been used to predict the success of primary radiotherapy or surgery in these patients. Integration of radiological findings with endoscopic evaluation greatly improves the pretherapeutic staging accuracy of laryngeal cancers, and significantly impacts the choice of management strategies in these patients. Imaging studies also help in the post-therapeutic surveillance and follow-up of patients with laryngeal cancers. In this article, we review the currently used laryngeal imaging techniques and protocols, the key anatomic structures relevant to tumor spread and the characteristic patterns of submucosal extension and invasion of laryngeal cancer. The role of CT, MRI and PET-CT in the evaluation of patients with laryngeal SCC and the impact of imaging findings on prognosis and clinical management is also discussed.

Squamous Cell Carcinoma of the Larynx

“…[2][3][4]6 However, only a few articles have discussed the role of ultrasonography in the diagnosis and staging of laryngeal cancer. One of the main reasons many radiologists forego recommending ultrasound is because the vocal cords, where the majority of these tumors develop, are deep to the calcified cricoid cartilage.…”

“…The most significant risk factors for the development of laryngeal cancer are tobacco and alcohol use. 2 The larynx extends from the epiglottis to the inferiormost aspect of the cricoid cartilage. It is divided into 3 parts: the supraglottis, the glottis, and the subglottis.…”

Imaging for Head and Neck Cancer

“…Tumor volume, vocal cord mobility, and laryngeal cartilage sclerosis on CT as well as abnormal signal within the laryngeal cartilage on MRI are all important signs suggesting recurrence and have predictive value. 67,68 However, PET/CT is also a valuable tool in evaluating laryngeal and hypopharyngeal carcinomas when used for treatment response, residual, recurrent, or metastatic disease. As discussed earlier, these imaging studies are best performed about 3 months after radiation treatment.…”

“…Additionally, the metabolic tumor volume before treatment has also been implicated as an independent prognostic factor in patients with local or regionally advanced squamous cell carcinoma of the hypopharynx. 68,69 Restaging After Treatment Posttreatment imaging is used to detect residual, recurrent, or distant metastatic disease. Surgery and radiation therapy significantly alter the anatomy of the head and neck, creating great challenge for the interpreting radiologist.…”

AHNS Series: Do you know your guidelines? Review of current knowledge on laryngeal cancer

“…Fiberoptic office laryngoscopy with current technology allows for excellent visualization of the larynx, supraglottis, and subglottis with proper local anesthesia and has become the standard of care. Imaging studies vary from center to center, however, contrast‐enhanced CT is generally recommended . Organ‐sparing radiation and chemoradiation often result in posttherapy distortion of anatomy, pain, inflammation, and voice changes difficult to differentiate from recurrent disease, limiting the accuracy of these imaging modalities in surveillance .…”