Staging of laryngeal cancer: Endoscopy, computed tomography and magnetic resonance versus histopathology

Abstract

An accurate pretherapeutic staging of laryngeal cancer is required for optimal treatment planning and for evaluation and comparison of the results of different treatment modalities. In this study, 45 consecutive patients with neoplasms of the larynx, treated surgically, were included in a prospective pretherapeutic staging protocol that included indirect laryngoscopy, direct microlaryngoscopy, contrast-enhanced computed tomography (CT) and Gd-DTPA-enhanced magnetic resonance imaging (MRI). The surgical specimens were cut in whole-organ slices parallel to the plane of the axial CT and MR images. The histologic findings were then compared with clinical findings, CT and MRI. These findings showed that clinical evaluation failed to identify tumor invasion of the laryngeal cartilages and extralaryngeal soft tissues, resulting in a low staging accuracy (55%). Many pT4 tumors were clinically understaged. The combination of clinical/endoscopic evaluation and either CT or MRI resulted in a significantly improved staging accuracy (80% vs 87%, respectively). MRI was significantly more sensitive but less specific than CT in detecting neoplastic cartilage invasion. MRI tended to overestimate neoplastic cartilage invasion to possibly result in overtreatment, while CT was found to underestimate neoplastic cartilage invasion and could lead to inadequate therapeutic decisions.

Value of computed tomography for evaluating the subglottis in laryngeal and hypopharyngeal squamous cell carcinoma

“…It has to be considered that cricoid cartilage involvement, or invasion of deep tissues in the neck will necessitate total laryngectomy. [18][19][20] It is diffi cult or impossible for laryngoscopic examination to provide information about the subglottis and the deep structures of the larynx and hypopharynx. However, there is a great need to identify tumor extent in a very precise manner.…”

Laryngeal preneoplastic lesions and cancer: challenging diagnosis. Qualitative literature review and meta-analysis.

“…Moreover, it is less expensive, faster and less susceptible to motion artifacts.Sclerosis is the most sensitive criterion but this often corresponds to reactive inflammation, particularly with respect to the thyroid cartilage. For instance, CAT signs of erosion and extra-laryngeal tumor of the thyroid, cricoid and arytenoid cartilages together with sclerosis of the cricoid and arytenoid cartilages result in a sensitivity of 64-72% and specificity of 86-94% for cartilage involvement, with an accuracy value of approximately 80% (177,184,185).…”

“…MRI criteria for cartilage involvement by tumor are high signal on fat suppressed T2-w images and/or enhancement on post gadolinium fat suppressed T1-w images in the cartilage adjacent to the tumor, or the presence of extra-laryngeal tumor. The most recent studies describing radiological-pathological correlation demonstrated slightly improved sensitivity of 89-95% and reduced specificity of 74-84% relative to CAT; but accuracy still demonstrates value of about 80% as CAT (177,178,184,185). Moreover, MRI can be a lengthy and expensive procedure.…”

“…CAT continues to be widely used for diagnosing cartilage invasion. In fact, although MRI is significantly more sensitive, it is less specific than CAT in detecting neoplasm cartilage invasion (177,185). Advantages of MRI include superior soft tissue contrast and exact delineation of tumor margins (220,244), where the cartilage invasions is usually overestimated for anterior commissure tumor.…”

Accelerated radiotherapy for advanced laryngeal cancer

“…CT is the most specific of the two modalities (88 Á/94%), but has a lower sensitivity (64Á/66%) [25,26] which can result in understaging. MRI has a higher sensitivity (89Á/95%), but is less specific (76 Á/84%) [26,27] which leads to overstaging. T4 tumors should therefore not be excluded from RT purely on the basis of the T4 classification.…”