Prediction of Posterior Paraglottic Space and Cricoarytenoid Unit Involvement in Endoscopically T3 Glottic Cancer with Arytenoid Fixation by Magnetic Resonance with Surface Coils

Abstract

Discrimination of the etiology of arytenoid fixation in cT3 laryngeal squamous cell carcinoma (SCC) is crucial for treatment planning. The aim of this retrospective study was to differentiate among possible causes of arytenoid fixation (edema, inflammation, mass effect, or tumor invasion) by analyzing related signal patterns of magnetic resonance (MR) in the posterior laryngeal compartment (PLC) and crico-arytenoid unit (CAU). Seventeen patients affected by cT3 glottic SCC with arytenoid fixation were preoperatively studied by state-of-the-art MR with surface coils. Different signal patterns were assessed in PLC subsites. Three MR signal patterns were identified: A, normal; B, T2 hyperintensity and absence of restriction on diffusion-weighted imaging (DWI); and C, intermediate T2 signal and restriction on DWI. Signal patterns were correlated with the presence or absence of CAU and PLC neoplastic invasion. Patients were submitted to open partial horizontal or total laryngectomy and surgical specimens were analyzed. Pattern A and B did not correlate with neoplastic invasion, while Pattern C strongly did (Spearman’s coefficient = 0.779, p < 0.0001; sensitivity: 100%; specificity: 78%). In conclusion, MR with surface coils is able to assess PLC/CAU involvement with satisfactory accuracy. In absence of Pattern C, arytenoid fixation is likely related to mass effect and/or inflammatory reaction and is not associated with neoplastic invasion.

Laryngeal Compartmentalization Does Not Affect the Prognosis of T3-T4 Laryngeal Cancer Treated by Upfront Total Laryngectomy

“…PGS involvement was retrospectively re-assessed according to previously published criteria, considering a frontal plane passing through the arytenoid vocal process and perpendicular to the ipsilateral thyroid lamina as the boundary between anterior vs. posterior PGS [ 10 , 11 , 12 ]. Laryngeal motility and involvement of the medial wall of the piriform sinus were also considered as ancillary signs for the definition of anterior vs. posterior topography of each tumor (T-topography).…”

“…To furtherly complicate this issue, the 8th Edition of the AJCC UICC TNM staging system includes a wide gamut of different lesions under the generic label of locally advanced LC, ranging from T3 with minimal vs. massive paraglottic space (PGS) involvement (with normal or impaired/fixed vocal cord and arytenoid mobility), T3 with pre-epiglottic space (PES) infiltration, T3 with inner cortex thyroid cartilage erosion, T4 with full-thickness infiltration of the laryngeal framework, and/or T4 with extra-laryngeal extension [ 7 ]. In fact, contemporary endoscopic [ 8 ] and radiologic [ 9 , 10 ] work-up have dramatically reduced the diagnostic uncertainty during pre-treatment evaluation, leading to better profiling of advanced LC subcategories, and allowing a more tailored treatment choice for each in terms of oncological and functional outcomes.…”

Open Partial Horizontal Laryngectomies for T3–T4 Laryngeal Cancer: Prognostic Impact of Anterior vs. Posterior Laryngeal Compartmentalization

“…In consideration of the confounding influence of inflammation on MR, patients receiving this kind of evaluation were assessed according to a standardized protocol, previously described in another paper [24]. In this view, MR proved to be extremely accurate in predicting posterior PGS involvement.…”

A Multidisciplinary Team Guided Approach to the Management of cT3 Laryngeal Cancer: A Retrospective Analysis of 104 Cases

“…In the latest version of the 8th Edition of the Union for International Cancer Control—American Joint Committee on Cancer (UICC-AJCC) TNM staging system, cT3 is defined as a tumor determining vocal fold and arytenoid fixation, invading the pre-epiglottic (PES) and/or paraglottic space (PGS) or minimally infiltrating the laryngeal framework [3]. Arytenoid fixation is considered the best predictive factor for posterior PGS involvement and cricoarytenoid unit (CAU) infiltration [4,5,6,7]. It is worth noting that, when the tumor involves the cricoarytenoid joint and adjacent intrinsic muscles, the recurrent nerve, branches of the inferior laryngeal artery, vein, and related lymphatic vessels may all represent possible pathways for extra-laryngeal tumor spread, causing a high rate of local recurrence and making surgical organ preservation a risky therapeutic option.…”

“…It is worth noting that, when the tumor involves the cricoarytenoid joint and adjacent intrinsic muscles, the recurrent nerve, branches of the inferior laryngeal artery, vein, and related lymphatic vessels may all represent possible pathways for extra-laryngeal tumor spread, causing a high rate of local recurrence and making surgical organ preservation a risky therapeutic option. This recently prompted a proposal of upstaging such posterior lesions to a higher-risk subgroup of cT3 (e.g., called cT3b) [5,6,7].…”