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Arora M, Thakker VD, Sindhwani G, Bhatt J, Gupta M, Shah J. Pretherapeutic Assessment by Multidetector Computed Tomography for Thyroid Cartilage Invasion in Laryngeal Cancer: A Double‑edged Sword. Indian J Med Paediatr Oncol 2021. [DOI: 10.4103/ijmpo.ijmpo_101_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Abstract
Introduction:Almost one-fourth of head and neck cancers in India are laryngeal cancers. Both conservative and surgical therapeutic approaches are available. According to present tumor-node-metastasis staging protocol, thyroid cartilage invasion is a crucial criterion for diagnosing advanced stages of the disease. A major cartilage invasion depicts T4A stage of disease for which surgical treatment is required. Aims: The present study aims to evaluate the accuracy of multidetector computed tomography (MDCT) in evaluation thyroid cartilage invasion in T3 and T4 stage of laryngeal cancers. Materials and Methods: It is a retrospective analysis done in the Department of Radiology, Pramukhswami Medical College, Anand, Gujarat, on 22 patients of T3 and T4 stage of laryngeal cancer who presented for pretherapeutic MDCT neck evaluation. The MDCT results were retrospectively reviewed and compared with postoperative histopathological results. Statistical analysis was done for each parameter as positive predictive value (PPV) (main statistical parameter), negative predictive value, sensitivity, and specificity. Results: MDCT showed a PPV of 60.00% in detecting any type of thyroid cartilage invasion, 66.66% for major and 33.33% for minor cartilage invasion. Extralaryngeal spread of disease was the most specific marker for cartilage involvement. In total, 31.8% of cases were downgraded in staging by pathology. Conclusion: Overestimation of thyroid cartilage invasion by MDCT is a reality which should be in mind before making final therapeutic decisions. Although crucial, it should not be the sole criteria preventing while making a surgical versus conservative therapeutic call.
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Affiliation(s)
- Manali Arora
- Department of Radio-Diagnosis, Pramukhswami Medical College, Anand, Gujarat, India
| | - Vishal D Thakker
- Department of Radio-Diagnosis, Pramukhswami Medical College, Anand, Gujarat, India
| | - Geetika Sindhwani
- Department of Radio-Diagnosis, Pramukhswami Medical College, Anand, Gujarat, India
| | - Jayesh Bhatt
- Department of Radio-Diagnosis, Pramukhswami Medical College, Anand, Gujarat, India
| | - Monica Gupta
- Department of Pathology, Pramukhswami Medical College, Anand, Gujarat, India
| | - Jay Shah
- Department of Radio-Diagnosis, Pramukhswami Medical College, Anand, Gujarat, India
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Benazzo M, Sovardi F, Preda L, Mauramati S, Carnevale S, Bertino G, Berton F, Meroni M, Herman I, Trisolini G, Morbini P. Imaging Accuracy in Preoperative Staging of T3-T4 Laryngeal Cancers. Cancers (Basel) 2020; 12:cancers12051074. [PMID: 32357419 PMCID: PMC7281313 DOI: 10.3390/cancers12051074] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/23/2020] [Accepted: 04/24/2020] [Indexed: 01/12/2023] Open
Abstract
Background: Preoperative imaging impacts treatment planning and prognosis in laryngeal cancers. We investigated the accuracy of standard computed tomography (CT) in evaluating tumor invasions at critical glottic areas. Methods: CT scans of glottic cancers treated by partial or total laryngectomy between Jan 2015 and Aug 2019 were reviewed to assess levels of tumor invasion at critical glottic subsites. CT accuracy in the identification of tumor extensions was determined against the gold standard of histopathological analysis of surgical samples. Results: This study included 64 patients. In the anterior commissure, CT showed high rates of false positives at all levels (sensitivity 56.2–70%, specificity 87.8–92.3%); in the anterior vocal fold, it overestimated the deep invasion (19.5% specificity, 90.3% sensitivity), while it underestimated the extralaryngeal spread (63.6% sensitivity, 98.1% specificity). In the posterior paraglottic space (pPGS), false negative results were more frequent for superficial extensions (25% sensitivity, 95.8% specificity) and deep invasions (58.8% sensitivity, 82.3% specificity). Shorter disease-specific and disease-free survivals were associated with pStage IV (p: 0.045 and 0.008) and with the pathological involvement of pPGS (p: 0.045 and 0.015). Conclusions: Negative prognostic correlation of pPGS involvement was confirmed on histopathological data. CT staging did not provide a satisfactory prognostic stratification and should be complemented with magnetic resonance imaging.
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Affiliation(s)
- Marco Benazzo
- Department of Otorhinolaryngology, University of Pavia, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy; (M.B.); (S.M.); (G.B.); (M.M.); (I.H.); (G.T.)
| | - Fabio Sovardi
- Department of Otorhinolaryngology, University of Pavia, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy; (M.B.); (S.M.); (G.B.); (M.M.); (I.H.); (G.T.)
- Correspondence: ; Tel.: +39-331-229-2171
| | - Lorenzo Preda
- Radiology Department, University of Pavia, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy; (L.P.); (F.B.)
| | - Simone Mauramati
- Department of Otorhinolaryngology, University of Pavia, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy; (M.B.); (S.M.); (G.B.); (M.M.); (I.H.); (G.T.)
| | - Sergio Carnevale
- Section of Anatomic Pathology, Cerba Healthcare Italia, 20139 Milan, Italy;
| | - Giulia Bertino
- Department of Otorhinolaryngology, University of Pavia, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy; (M.B.); (S.M.); (G.B.); (M.M.); (I.H.); (G.T.)
| | - Francesca Berton
- Radiology Department, University of Pavia, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy; (L.P.); (F.B.)
| | - Matteo Meroni
- Department of Otorhinolaryngology, University of Pavia, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy; (M.B.); (S.M.); (G.B.); (M.M.); (I.H.); (G.T.)
| | - Irene Herman
- Department of Otorhinolaryngology, University of Pavia, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy; (M.B.); (S.M.); (G.B.); (M.M.); (I.H.); (G.T.)
| | - Giuseppe Trisolini
- Department of Otorhinolaryngology, University of Pavia, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy; (M.B.); (S.M.); (G.B.); (M.M.); (I.H.); (G.T.)
| | - Patrizia Morbini
- Unit of Pathology, Department of Molecular Medicine, University of Pavia, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy;
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Cho SJ, Lee JH, Suh CH, Kim JY, Kim D, Lee JB, Lee MK, Chung SR, Choi YJ, Baek JH. Comparison of diagnostic performance between CT and MRI for detection of cartilage invasion for primary tumor staging in patients with laryngo-hypopharyngeal cancer: a systematic review and meta-analysis. Eur Radiol 2020; 30:3803-3812. [PMID: 32152744 DOI: 10.1007/s00330-020-06718-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 01/19/2020] [Accepted: 02/05/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To compare the diagnostic performance of contrast-enhanced CT with that of MRI in the detection of cartilage invasion in patients with laryngo-hypopharyngeal cancer. METHODS A systematic literature search in the Ovid-MEDLINE and EMBASE databases was performed for studies reporting diagnostic accuracy of CT and/or MRI in detecting cartilage invasion from laryngo-hypopharyngeal cancer between 2000 and 2018. The pooled sensitivity and specificity, and their 95% confidence intervals were calculated for CT and MRI using bivariate random effects modeling. Subgroup and meta-regression analyses were performed. Indirect comparison was also performed by univariable meta-regression. RESULT Fourteen articles including 776 patients were included in the systematic review and meta-analysis: eight for CT, and six for MRI. CT and MRI showed pooled sensitivities of 66% (95% CI, 49-80%) and 88% (95% CI, 79-93%), and pooled specificities of 90% (95% CI, 82-94%) and 81% (95% CI, 76-84%), respectively. MRI showed significantly higher sensitivity than CT (p = 0.02). The specificities showed no statistically significant difference between CT and MRI (p = 0.39). The CT studies showed heterogeneity and a threshold effect, while MRI showed neither heterogeneity nor threshold effect. In the meta-regression analysis for CT, the type of cartilage analyzed (thyroid only vs. thyroid/cricoid/arytenoid, p < 0.001) was a significant factor influencing the heterogeneity in the diagnostic performance of the CT studies. CONCLUSIONS In conclusion, MRI has significantly higher sensitivity than CT for detecting cartilage invasion in patients with laryngo-hypopharyngeal cancer, without a significant difference in the specificity. KEY POINTS • MRI has significantly higher sensitivity than CT for detecting cartilage invasion in patients with laryngo-hypopharyngeal cancer.
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Affiliation(s)
- Se Jin Cho
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
| | - Jeong Hyun Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea.
| | - Chong Hyun Suh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
| | - Jung Youn Kim
- Department of Radiology, Sungkyunkwan University School of Medicine, Samsung Medical Center Kangbuk Samsung Hospital29, Saemunan-ro, Jongno-gu, Seoul, Republic of Korea
| | - Donghyun Kim
- Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, 75, Bokji-ro, Busanjin-gu, Busan, 47392, Republic of Korea
| | - Jung Bin Lee
- Department of Radiology, Soonchunhyang University Buchoen Hospital, 170, Jomaru-ro, Bucheon-si, Gyeonggi-do, Republic of Korea
| | - Min Kyoung Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
| | - Sae Rom Chung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
| | - Young Jun Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
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Weselik L, Majchrzak E, Ibbs M, Lewandowski A, Marszałek A, Machczyński P, Golusiński W. Assessment of cartilage invasion in case of laryngeal cancer by means of longitudinal sectioning for histopathology - Clinical implications. Rep Pract Oncol Radiother 2019; 24:443-449. [PMID: 31388338 DOI: 10.1016/j.rpor.2019.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 05/25/2019] [Accepted: 07/06/2019] [Indexed: 12/24/2022] Open
Abstract
Aim The aim of the study was to assess the accuracy of radiological diagnosis of laryngeal cartilage infiltration by histopathological examination of laryngeal specimen after total laryngectomy. Background Despite the development of new medical technologies and significant clinical advances allowing early diagnosis and treatment of laryngeal cancer, mortality is still on the rise. Neoplastic infiltration of the laryngeal cartilages is the most common source of error in the assessment of cancer staging. Furthermore, cartilage invasion is listed as a contraindication to partial surgical techniques as well as radiotherapy. Materials and methods The study was carried out on 21 larynges following total laryngectomy. Before taking the decision to perform surgery, high-resolution CT scans were performed in all cases. An extended histopathological examination was conducted using a unique vertical cross-section of the whole larynx. Results Pathology reported 2 cases of arytenoid cartilage invasion, 5 cases of cricoid cartilage invasion, 12 cases of thyroid cartilage penetration, 1 case of internal cortex invasion and 9 cases of extra-laryngeal spread. CT imaging identified 8 of 13 cases (61.5%) of pathologically proven invasion of thyroid cartilage and only 2 cases (2/9, 22%) of extra-laryngeal spread. According to CT results, arytenoid cartilage invasion was correctly identified in 2 cases, cricoid cartilage invasion in 4 (4/5, 80%). The positive predictive values for thyroid, cricoid and arytenoid cartilage invasion and penetration were 80%, 66.7% and 50%, respectively. In case of pre-laryngeal spread the positive predictive value was 100%. Conclusion Despite increasingly advanced methods involved in the diagnosis of laryngeal cancer, many discrepancies may be observed between the radiological and histopathological assessments. CT imaging has limitations especially in thyroid cartilage penetration and extra-laryngeal spread assessment in advanced laryngeal cancer cases. An extended histopathological examination, involving vertical cross-sections of the whole larynx is a very precise study that allows a precise determination of local cancer staging (T).
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Affiliation(s)
- Liucija Weselik
- Department and Clinic of Head & Neck Surgery and ENT Oncology, K. Marcinkowski University of Medical Sciences, Poznań, Maria Skłodowska-Curie Greater Poland Cancer Centre, Poznań, Poland
| | - Ewa Majchrzak
- Department and Clinic of Head & Neck Surgery and ENT Oncology, K. Marcinkowski University of Medical Sciences, Poznań, Maria Skłodowska-Curie Greater Poland Cancer Centre, Poznań, Poland
| | - Matthew Ibbs
- Department and Unit of Cancer Pathology and Prevention, K. Marcinkowski University of Medical Sciences, Poznań, Maria Skłodowska-Curie, Greater Poland Cancer Centre, Poznań, Poland
| | - Adam Lewandowski
- Radiology Unit, Maria Skłodowska-Curie Greater Poland Cancer Centre, Poznań, Poland
| | - Andrzej Marszałek
- Department and Unit of Cancer Pathology and Prevention, K. Marcinkowski University of Medical Sciences, Poznań, Maria Skłodowska-Curie, Greater Poland Cancer Centre, Poznań, Poland
| | - Piotr Machczyński
- Department and Clinic of Head & Neck Surgery and ENT Oncology, K. Marcinkowski University of Medical Sciences, Poznań, Maria Skłodowska-Curie Greater Poland Cancer Centre, Poznań, Poland
| | - Wojciech Golusiński
- Department and Clinic of Head & Neck Surgery and ENT Oncology, K. Marcinkowski University of Medical Sciences, Poznań, Maria Skłodowska-Curie Greater Poland Cancer Centre, Poznań, Poland
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Locatello LG, Pietragalla M, Taverna C, Bonasera L, Massi D, Mannelli G. A Critical Reappraisal of Primary and Recurrent Advanced Laryngeal Cancer Staging. Ann Otol Rhinol Laryngol 2018; 128:36-43. [DOI: 10.1177/0003489418806915] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Objectives: Laryngeal squamous cell carcinoma (LSCC) can involve different anatomic subunits with peculiar surgical and prognostic implications. Despite conflicting outcomes for the same stage of disease, the current staging system considers different lesions in a single cluster. The aim of this study was to critically discuss clinical and pathologic staging of primary and recurrent advanced LSCC in order to define current staging pitfalls that impede a precise and tailored treatment strategy. Methods: Thirty patients who underwent total laryngectomy in the past 3 years for primary and recurrent advanced squamous cell LSCC were analyzed, comparing endoscopic, imaging, and pathologic findings. Involvement of the different laryngeal subunits, vocal-fold motility, and spreading pattern of the tumor were blindly analyzed. The diagnostic accuracy and differences between clinicoradiologic and pathologic findings were studied with standard statistical analysis. Results: Discordant staging was performed in 10% of patients, and thyroid and arytenoid cartilage were the major diagnostic pitfalls. Microscopic arytenoid involvement was significantly more present in case of vocal-fold fixation ( P = .028). Upstaging was influenced by paraglottic and pre-epiglottic space cancer involvement, posterior commissure, subglottic region, arytenoid cartilage, and penetration of thyroid cartilage; on the contrary, involvement of the inner cortex or extralaryngeal spread tended to be down-staged. Radiation-failed tumors less frequently involved the posterior third of the paraglottic space ( P = .022) and showed a significantly worse pattern of invasion ( P < .001). Conclusions: Even with the most recent technologies, 1 in 10 patients with advanced LSCC in this case series was differently staged on clinical examination, with cartilage involvement representing the main diagnostic pitfall.
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Affiliation(s)
- Luca Giovanni Locatello
- Division of Otorhinolaryngology, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Michele Pietragalla
- Division of Radiology, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Cecilia Taverna
- Institute of Pathology, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Luigi Bonasera
- Division of Radiology, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Daniela Massi
- Institute of Pathology, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Giuditta Mannelli
- Division of Otorhinolaryngology, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
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Juliano A, Moonis G. Computed Tomography Versus Magnetic Resonance in Head and Neck Cancer: When to Use What and Image Optimization Strategies. Magn Reson Imaging Clin N Am 2017; 26:63-84. [PMID: 29128007 DOI: 10.1016/j.mric.2017.08.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This article provides a practical overview of head and neck cancers, outlining an approach to evaluating these lesions and optimizing imaging strategies. Recognition of key anatomic landmarks as suggested by American Joint Committee on Cancer (AJCC) tumor, node, metastasis (TNM) criteria is emphasized. Further, the recently updated eighth edition of the AJCC staging manual has introduced some modifications that influence the TNM staging. These modifications are discussed throughout the article to provide an updated review on head and neck cancer.
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Affiliation(s)
- Amy Juliano
- Department of Radiology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles Street, Boston, MA 02114, USA.
| | - Gul Moonis
- Department of Radiology, Columbia University Medical Center, 622 West 168th Street, New York, NY 10032, USA
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New Developments in Imaging of Laryngeal Cancer. CURRENT OTORHINOLARYNGOLOGY REPORTS 2017. [DOI: 10.1007/s40136-017-0145-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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