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Pretherapeutic Staging of Hypopharyngeal Carcinoma: Clinical Findings, Computed Tomography, and Magnetic Resonance Imaging Compared With Histopathologic Evaluation

Pretherapeutic Staging of Hypopharyngeal Carcinoma: Clinical Findings, Computed Tomography, and... Abstract Objectives: To assess the accuracy of preoperative computed tomography (CT), magnetic resonance imaging (MRI), and clinical and endoscopic tumor evaluation and to analyze the impact of these diagnostic modalities on pretherapeutic staging of hypopharyngeal carcinoma. Design: Prospective study of 44 consecutive patients with hypopharyngeal carcinoma undergoing surgical resection. Setting: Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital, Bern, Switzerland. Methods: All patients underwent contrast-enhanced CT, MRI at 1.5 T, indirect laryngoscopy, and direct laryngoscopy. The surgical specimens were cut in whole-organ slices parallel to the plane of the axial CT and MRI scans. The histologic findings were compared with the findings of the different diagnostic modalities. Results: The main tumor site was misdiagnosed by endoscopy in 7 (16%) of 44 patients and by CT and MRI in 16 (36%) of 44 patients. Neoplastic invasion of cartilage was present in 21 (48%) of 44 laryngectomy specimens. Magnetic resonance imaging was more sensitive in detecting neoplastic invasion of cartilage than CT (97% vs 68%; P=.002). Magnetic resonance imaging was less specific than CT (62% vs 84%; P=.02), taking into account the thyroid and cricoid cartilages. There was no difference between the overall accuracy of CT and MRI in detecting neoplastic invasion of cartilage (78% vs 75%). Clinical and endoscopic evaluation failed to correctly stage 16 (36%) of 44 patients. Combined clinical and CT evaluation and combined clinical and MRI evaluation failed to correctly stage 12 and 13 of 44 patients, respectively. Conclusions: The assessment of tumor site is more accurate using endoscopic evaluation than CT or MRI. Magnetic resonance imaging is more sensitive in detecting neoplastic cartilage invasion than CT, whereas CT is more specific. Clinical and endoscopic evaluation of tumor stage alone fails to identify invasion of the laryngeal framework. Therefore, many tumors staged pT4 are clinically understaged. The preoperative staging accuracy was improved by combining the information gained using both clinical evaluation and CT or MRI. However, there was no difference in the staging accuracy between CT and MRI.Arch Otolaryngol Head Neck Surg. 1997;123:908-913 References 1. Archer CR, Yeager VL, Herbold DR. Computed tomography vs histology of laryngeal cancer: their value in predicting laryngeal cartilage invasion . Laryngoscope . 1983;93:140-147.Crossref 2. Hoover LA, Calcaterra TC, Walter GA, Larrson SG. Preoperative CT scan evaluation for laryngeal carcinoma: correlation with pathological findings . Laryngoscope . 1984;94:310-315.Crossref 3. Mafee MF, Schild JA, Valvassori GE, Capek V. Computed tomography of the larynx: correlation with anatomic and pathologic studies in cases of laryngeal carcinoma . Radiology . 1983;147:123-128.Crossref 4. Mancuso AA, Hanafee WN, Juillard GJF, Winter J, Calcaterra TC. The role of computed tomography in the management of cancer of the larynx . Radiology . 1977; 124:243-244.Crossref 5. Yeager VL, Lawson C, Archer CR. Ossification of laryngeal cartilages as it relates to computed tomography . Invest Radiol . 1982;17:11-19.Crossref 6. Castelijns JA, Gerritsen GJ, Kaiser MC, et al. Invasion of laryngeal cartilage by cancer: comparison of CT and MR imaging . Radiology . 1988;167:199-206.Crossref 7. Castelijns JA, Gerritsen GJ, Kaiser MC, et al. MRI of normal or cancerous laryngeal cartilages: histopathologic correlation . Laryngoscope . 1987;97:1085-1093.Crossref 8. Vogl J, Heger W, Grevers G, Schreiner M, Dressel S, Lissner J. MRI with Gd-DTPA in tumors of larynx and hypopharynx . Eur Radiol . 1991;1:58-64.Crossref 9. Phelps PD. Review: carcinoma of the larynx—the role of imaging in staging and pre-treatment assessments . Clin Radiol . 1992;46:77-83.Crossref 10. Curtin HD. Imaging of the larynx: current concepts . Radiology . 1989;173:1-11.Crossref 11. Curtin HD. The larynx . In: Som PM, Bergeron RT, eds. Head and Neck Imaging . 2nd ed. St Louis, Mo: Mosby-Year Book Inc; 1991:593-692. 12. Casselman JW. Imaging of laryngeal cancer . Acta Otorhinolaryngol Belg . 1992; 46:161-174. 13. Muños A, Ramos A, Ferrando J, et al. Laryngeal carcinoma: sclerotic appearance of the cricoid and arytenoid cartilage—CT-pathologic correlation . Radiology . 1993;189:433-437.Crossref 14. Vogl TJ, Steger W, Balzer JO, et al. MRI of the hypopharynx, larynx and neck . Eur Radiol . 1992;2:391-408. 15. Michaels L, Gregor RT. Examination of the larynx in the histopathology laboratory . J Clin Pathol . 1980;33:705-709.Crossref 16. Spiessl B, Beahrs OH, Hermanek P, et al. TNM Atlas: Illustrated Guide to the TNM/pTNM Classification of Malignant Tumors . 3rd ed. New York, NY: Springer Publishing Co Inc; 1992:28-31. 17. Hermanek P, Henson DE, Hutter RVP, Sobin LH. TNM Supplement: A Commentary on Uniform Use . New York, NY: Springer Publishing Co Inc; 1993. 18. Thabet HM, Sessions DG, Gado MH, Gnepp DA, Harvey JE, Talart M. Comparison of clinical evaluation and computed tomographic diagnostic accuracy for tumors of the larynx and hypopharynx . Laryngoscope . 1996;106:589-594.Crossref 19. Sulfaro S, Barzan L, Qurein F, Lutman M, Caruso G. T staging of the laryngohypopharyngeal carcinoma . Arch Otolaryngol Head Neck Surg . 1989;115:613-620.Crossref 20. Agresti A. Models for matched pairs . In: Agresti A, ed. Categorical Data Analysis . New York, NY: John Wiley & Sons Inc; 1990:347-350. 21. Hirano M, Kurita S, Matsuoka H, Tateishi M. Vocal fold fixation in laryngeal carcinomas . Acta Otolaryngol (Stockh) . 1991;111:449-454.Crossref 22. Deleyiannis FWB, Piccirillo JF, Kirchner JA. Relative prognostic importance of histologic invasion of the laryngeal framework by hypopharyngeal cancer . Ann Otol Rhinol . 1996;105:101-108. 23. Zbären P, Becker M, Läng H. Pretherapeutic staging of laryngeal cancer: clinical findings, computed tomography and magnetic resonance imaging versus histopathology . Cancer . 1996;77:1263-1273.Crossref 24. Becker M, Zbären P, Läng H, Stoupis C, Porcellini B, Vock P. Neoplastic invasion of the laryngeal cartilage: comparison of MR imaging and CT with histopathologic correlation . Radiology . 1995;194:661-669.Crossref 25. Piccirillo JF, Wells CK, Jasaki CT, Feinstein AR. New clinical severity staging system for cancer of the larynx . Ann Otol Rhinol Laryngol . 1994;103:83-92. 26. Ferlito A, Harrison DFN, Bailey BJ, De Santo LW. Are clinical classifications for laryngeal cancer satisfactory? Ann Otol Rhinol Laryngol . 1995;104:741-147. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Otolaryngology - Head & Neck Surgery American Medical Association

Pretherapeutic Staging of Hypopharyngeal Carcinoma: Clinical Findings, Computed Tomography, and Magnetic Resonance Imaging Compared With Histopathologic Evaluation

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Publisher
American Medical Association
Copyright
Copyright © 1997 American Medical Association. All Rights Reserved.
ISSN
0886-4470
eISSN
1538-361X
DOI
10.1001/archotol.1997.01900090016003
Publisher site
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Abstract

Abstract Objectives: To assess the accuracy of preoperative computed tomography (CT), magnetic resonance imaging (MRI), and clinical and endoscopic tumor evaluation and to analyze the impact of these diagnostic modalities on pretherapeutic staging of hypopharyngeal carcinoma. Design: Prospective study of 44 consecutive patients with hypopharyngeal carcinoma undergoing surgical resection. Setting: Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital, Bern, Switzerland. Methods: All patients underwent contrast-enhanced CT, MRI at 1.5 T, indirect laryngoscopy, and direct laryngoscopy. The surgical specimens were cut in whole-organ slices parallel to the plane of the axial CT and MRI scans. The histologic findings were compared with the findings of the different diagnostic modalities. Results: The main tumor site was misdiagnosed by endoscopy in 7 (16%) of 44 patients and by CT and MRI in 16 (36%) of 44 patients. Neoplastic invasion of cartilage was present in 21 (48%) of 44 laryngectomy specimens. Magnetic resonance imaging was more sensitive in detecting neoplastic invasion of cartilage than CT (97% vs 68%; P=.002). Magnetic resonance imaging was less specific than CT (62% vs 84%; P=.02), taking into account the thyroid and cricoid cartilages. There was no difference between the overall accuracy of CT and MRI in detecting neoplastic invasion of cartilage (78% vs 75%). Clinical and endoscopic evaluation failed to correctly stage 16 (36%) of 44 patients. Combined clinical and CT evaluation and combined clinical and MRI evaluation failed to correctly stage 12 and 13 of 44 patients, respectively. Conclusions: The assessment of tumor site is more accurate using endoscopic evaluation than CT or MRI. Magnetic resonance imaging is more sensitive in detecting neoplastic cartilage invasion than CT, whereas CT is more specific. Clinical and endoscopic evaluation of tumor stage alone fails to identify invasion of the laryngeal framework. Therefore, many tumors staged pT4 are clinically understaged. The preoperative staging accuracy was improved by combining the information gained using both clinical evaluation and CT or MRI. However, there was no difference in the staging accuracy between CT and MRI.Arch Otolaryngol Head Neck Surg. 1997;123:908-913 References 1. Archer CR, Yeager VL, Herbold DR. Computed tomography vs histology of laryngeal cancer: their value in predicting laryngeal cartilage invasion . Laryngoscope . 1983;93:140-147.Crossref 2. Hoover LA, Calcaterra TC, Walter GA, Larrson SG. Preoperative CT scan evaluation for laryngeal carcinoma: correlation with pathological findings . Laryngoscope . 1984;94:310-315.Crossref 3. Mafee MF, Schild JA, Valvassori GE, Capek V. Computed tomography of the larynx: correlation with anatomic and pathologic studies in cases of laryngeal carcinoma . Radiology . 1983;147:123-128.Crossref 4. Mancuso AA, Hanafee WN, Juillard GJF, Winter J, Calcaterra TC. The role of computed tomography in the management of cancer of the larynx . Radiology . 1977; 124:243-244.Crossref 5. Yeager VL, Lawson C, Archer CR. Ossification of laryngeal cartilages as it relates to computed tomography . Invest Radiol . 1982;17:11-19.Crossref 6. Castelijns JA, Gerritsen GJ, Kaiser MC, et al. Invasion of laryngeal cartilage by cancer: comparison of CT and MR imaging . Radiology . 1988;167:199-206.Crossref 7. Castelijns JA, Gerritsen GJ, Kaiser MC, et al. MRI of normal or cancerous laryngeal cartilages: histopathologic correlation . Laryngoscope . 1987;97:1085-1093.Crossref 8. Vogl J, Heger W, Grevers G, Schreiner M, Dressel S, Lissner J. MRI with Gd-DTPA in tumors of larynx and hypopharynx . Eur Radiol . 1991;1:58-64.Crossref 9. Phelps PD. Review: carcinoma of the larynx—the role of imaging in staging and pre-treatment assessments . Clin Radiol . 1992;46:77-83.Crossref 10. Curtin HD. Imaging of the larynx: current concepts . Radiology . 1989;173:1-11.Crossref 11. Curtin HD. The larynx . In: Som PM, Bergeron RT, eds. Head and Neck Imaging . 2nd ed. St Louis, Mo: Mosby-Year Book Inc; 1991:593-692. 12. Casselman JW. Imaging of laryngeal cancer . Acta Otorhinolaryngol Belg . 1992; 46:161-174. 13. Muños A, Ramos A, Ferrando J, et al. Laryngeal carcinoma: sclerotic appearance of the cricoid and arytenoid cartilage—CT-pathologic correlation . Radiology . 1993;189:433-437.Crossref 14. Vogl TJ, Steger W, Balzer JO, et al. MRI of the hypopharynx, larynx and neck . Eur Radiol . 1992;2:391-408. 15. Michaels L, Gregor RT. Examination of the larynx in the histopathology laboratory . J Clin Pathol . 1980;33:705-709.Crossref 16. Spiessl B, Beahrs OH, Hermanek P, et al. TNM Atlas: Illustrated Guide to the TNM/pTNM Classification of Malignant Tumors . 3rd ed. New York, NY: Springer Publishing Co Inc; 1992:28-31. 17. Hermanek P, Henson DE, Hutter RVP, Sobin LH. TNM Supplement: A Commentary on Uniform Use . New York, NY: Springer Publishing Co Inc; 1993. 18. Thabet HM, Sessions DG, Gado MH, Gnepp DA, Harvey JE, Talart M. Comparison of clinical evaluation and computed tomographic diagnostic accuracy for tumors of the larynx and hypopharynx . Laryngoscope . 1996;106:589-594.Crossref 19. Sulfaro S, Barzan L, Qurein F, Lutman M, Caruso G. T staging of the laryngohypopharyngeal carcinoma . Arch Otolaryngol Head Neck Surg . 1989;115:613-620.Crossref 20. Agresti A. Models for matched pairs . In: Agresti A, ed. Categorical Data Analysis . New York, NY: John Wiley & Sons Inc; 1990:347-350. 21. Hirano M, Kurita S, Matsuoka H, Tateishi M. Vocal fold fixation in laryngeal carcinomas . Acta Otolaryngol (Stockh) . 1991;111:449-454.Crossref 22. Deleyiannis FWB, Piccirillo JF, Kirchner JA. Relative prognostic importance of histologic invasion of the laryngeal framework by hypopharyngeal cancer . Ann Otol Rhinol . 1996;105:101-108. 23. Zbären P, Becker M, Läng H. Pretherapeutic staging of laryngeal cancer: clinical findings, computed tomography and magnetic resonance imaging versus histopathology . Cancer . 1996;77:1263-1273.Crossref 24. Becker M, Zbären P, Läng H, Stoupis C, Porcellini B, Vock P. Neoplastic invasion of the laryngeal cartilage: comparison of MR imaging and CT with histopathologic correlation . Radiology . 1995;194:661-669.Crossref 25. Piccirillo JF, Wells CK, Jasaki CT, Feinstein AR. New clinical severity staging system for cancer of the larynx . Ann Otol Rhinol Laryngol . 1994;103:83-92. 26. Ferlito A, Harrison DFN, Bailey BJ, De Santo LW. Are clinical classifications for laryngeal cancer satisfactory? Ann Otol Rhinol Laryngol . 1995;104:741-147.

Journal

Archives of Otolaryngology - Head & Neck SurgeryAmerican Medical Association

Published: Sep 1, 1997

References