Cartilage erosion in laryngeal and hypopharyngeal cancer correlation between radiology and histopathology
Keywords:Cartilage erosion, Contrast enhanced computed tomography, Magnetic resonance imaging, Laryngeal and hypopharyngeal cancer
Background: The aim of this study was to assess the accuracy of preoperative contrast enhanced computed tomography (CECT) of neck with or without magnetic resonance imaging (MRI) in determining cartilage erosion in patients with laryngeal and hypo pharyngeal cancers and correlate this with the final histopathology report (HPE).
Methods: Forty patients diagnosed clinically with stage 3 laryngeal and hypo pharyngeal cancer were subjected to flexible laryngoscopy and CECT of neck. Patients with doubtful cartilage erosion on CECT were subjected to additional MRI. Radiologic findings including cartilage sclerosis, invasion and penetration on CECT and MRI were then correlated with HPE in patients who underwent total laryngectomy.
Results: CECT scan showed cartilage invasion in 30 cases. There were ten patients with doubtful cartilage erosion on the CECT scan who were then subjected to additional limited MRI which was compared with CECT scan and operative findings. Thyroid cartilage erosion was confirmed on MRI in five of the ten cases where CECT scan findings were equivocal. CECT scan failed to predict cricoid and arytenoid cartilage invasion in five cases and six cases respectively. Though MRI was a problem-solving tool, it had one false positive result.
Conclusions: CECT scan helped to identify cartilage erosion in 91.3% of cases which immensely contributed to the staging and treatment planning of laryngeal and hypo pharyngeal cancers. When findings on CECT are equivocal, the addition of MRI improves the accuracy of detecting cartilage involvement.
Dutta R, Husain Q, Kam D, Dubal PM, Baredes S, Eloy JA. Laryngeal Papillary Squamous Cell Carcinoma: A Population-Based Analysis of Incidence and Survival. Otolaryngol Head Neck Surg. 2015;153(1):54-9.
Forastiere AA, Goepfert H, Maor M, et al. Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med. 2003;349:2091-8.
American Joint Committee on Cancer: Manual for Staging of Cancer (ed 3). Philadelphia, PA: J.B. Lippincott; 1988.
Beahrs OH, Henson DE, Hutter RVP, Kennedy BJ. Manual for Staging of Cancer (ed 3). Philadelphia, PA: J.B. Lippincott, 1988.
Greene FL, Page DL, Fleming ID, Fritz A, Balch CM, Haller DG, et al. CancerStaging Manual (ed 6). New York, NY: Springer-Verlag, 2002.
Castelijns JA, van den Brekel MW, Tobi H, Smit EM, Golding RP, van Schaik C, et al. Laryngeal carcinoma after radiation therapy: correlation of abnormal MR imaging signal patterns in laryngeal cartilage with the risk of recurrence. Radiology. 1996;198:151–5.
Becker M. Diagnosis and staging of laryngeal tumors with CT and MRI [In German]. Radiologe. 1998;38:93–100.
Becker M. Larynx and hypopharynx. Radiol Clin North Am. 1998;36:891–920.
Becker M, Zbaren P, Delavelle J, Kurt AM, Egger C, Rüfenacht DA, et al. Neoplastic invasion of the laryngeal cartilage: reassessment of criteria for diagnosis at CT. Radiology. 1997;203:521–32.
Hermans R. Staging of laryngeal and hypopharyngeal cancer: value of imaging studies. Eur Radiol. 2006;16(11):2386–400.
Castelijns JA, Gerritsen GJ, Kaiser MC, Valk J, van Zanten TE, Golding RG, et al. Invasion of laryngeal cartilage by cancer: comparison of CT and MR imaging. Radiology. 1988;167:199–206.