Evaluation of computerized tomography, cinelaryngoscopy, and laryngography in determining the extent of laryngeal disease

Computed tomography in patients with laryngeal carcinoma: a clinical perspective

Among the various diagnostic modalities that have been recommended for preoperative assessment of the patient with laryngeal carcinoma is computed tomography. While good overall correlation between CT findings and operative findings has been noted, a significant number of false positives and false negatives have been found, particularly with regard to cartilage invasion and lymphadenopathy. We compared the findings of direct laryngoscopy, palpation of the neck, and CT with pathologic specimens in 29 patients who underwent surgery for carcinoma of the larynx. We found that CT scanning underestimated the extent of neoplastic involvement in over half the cases. With respect to cartilage invasion we determined a significant number of false-negative findings. Computed tomographic scanning was equivalent to palpation in predicting cervical metastasis. Our findings indicate that the role of CT scanning may be more limited than previously acknowledged, particularly in patients for whom nonconservation surgery is planned.

The degree to which accuracy of preoperative staging of laryngeal carcinoma has been enhanced by computed tomography

In this retrospective study, the accuracy of preoperative staging by high-resolution CT and clinical evaluation (indirect-direct laryngoscopy) is compared to the postsurgical pathologic staging of laryngeal cancer. Forty-two patients who were admitted to St. Louis University Hospital between the years of 1978 to 1985 with diagnoses of laryngeal cancer were included. All patients received high-resolution CT scan of the larynx preoperatively and subsequently underwent total or partial laryngectomy. None of these patients received preoperative radiotherapy. The accuracy of the clinical vs. CT staging--as well as the accuracy of the staging by combination of the two modalities--was determined by comparison with the postsurgical pathologic staging. The accuracy was assessed separately for glottic, supraglottic, and transglottic carcinoma. The accuracy of CT staging for glottic carcinoma was 75%. However, clinical evaluation in this group of lesions was very reliable, offering 92.9% accuracy. The accuracy of CT staging increased in the supraglottic and transglottic lesions, to become superior to the clinical staging. With combined information gained by both examinations, the preoperative staging accuracy was 91.4% for supraglottic carcinoma and 87.5% for transglottic carcinoma. It is, therefore, recommended that high-resolution CT should be included in the preoperative staging of laryngeal cancer.

Obstructive airway disease in infants and children

Airway obstruction in infants and children can produce rapidly progressive life-threatening emergencies. An understanding of the common symptom complexes associated with regional obstructive abnormalities allows rapid evaluation and appropriate therapy. This article discusses the most common types of obstructive congenital and acquired airway anomalies, describes their symptomatology, and reviews the available diagnostic and treatment options.

Assessment of laryngeal function by digital subtraction laryngography

The evaluation of vocal cord function can be problematic in the presence of oropharyngeal tumors, hypopharyngeal tumors, and supraglottic lesions and in noncompliant adult and pediatric patients. The use of computer image subtraction techniques coupled with digital fluoroscopy has inherent high-quality resolution that can provide an excellent image of vocal cord symmetry and movement. The use of air as the contrast medium provides the ability to measure the extent of vocal cord excursion as well as the extent of piriform sinus lesions. In addition, it is a noninvasive procedure that requires a minimal imaging exposure time, with the result that the patient undergoes minimal radiation exposure.

Local control of T1 vocal cord cancer with radiation therapy: the importance of tumor character vs. treatment parameters

Ninety-one patients with T1 vocal cord carcinoma received primary irradiation treatment. The 5- and 10-year determinate disease-free survival was 80%; the 5- and 10-year determinate survival including surgical salvage was 92%. Tumors involving more than one-half of a vocal cord or involving the anterior commissure or exhibiting an exophytic growth pattern had numerically, but not statistically, higher local failure rates than tumors without these characteristics. Precise radiation treatment technique appears more important for local control (LC) than tumor character. The crucial treatment factors for high LC with few radiation complications are reproducible daily patient positioning, use of contour-compensating devices (wedges), field size of 5 X 5 cm, and a radiation prescription with a time-dose fractionation value of 101 to 106.

High-resolution computerized tomographic scans of the normal and abnormal ear

Possible applications of high-resolution computerized tomographic scans to otology are discussed. On the basis of examples, the authors illustrate the normal structure of the ear as well as possible pathologic conditions such as congenital abnormalities, cholesteatoma, neoplasms, trauma, and systemic diseases. The advantages of the current generation of computerized tomographic scanners are reviewed, notably contrast potentialities, radiation load, reconstitution of images at a later time, and storage of imaging data. Drawbacks include the high acquisition price of the equipment and the limited mobility of the scanning gantry.

Computed tomography vs laryngography: a comparison of relative diagnostic value

The computed tomography (CT) scans and laryngograms of 25 patients with laryngeal cancer were compared and evaluated in an assessment of the diagnostic accuracy of each modality in the supraglottic, glottic, and subglottic regions. Fourth generation scanners were used in these patients, all of whom subsequently underwent laryngectomy or partial laryngectomy. The clinical superiority of CT scanning was evident in several areas--confirming clinical impressions that laryngography is not as accurate as CT, is frequently misleading, and offers no significant advantages over CT. In this regard, we now believe that computed tomography is the most important radiologic adjunct in the diagnosis of laryngeal cancer, and we no longer order the laryngogram on a routine basis.

Use of videotape in diagnosis and treatment of cancer of larynx

Sophisticated endoscopic techniques coupled with new developments in medical videotaping have made this combination a clinically useful technique in the diagnosis and management of laryngeal cancer. Preoperative tapings in the physician's office and taping at laryngoscopy and biopsy allow for better assessment and permanent record of size and location of lesion, location of biopsies, and physiologic impairment of laryngeal function. All personnel participating in treatment including radiotherapists, surgeons, pathologists, radiologists, chemotherapists, and speech therapists can clearly see the lesion and contribute more usefully to decisions regarding treatment. Videotaping during and after radiotherapy and chemotherapy and after partial laryngectomy can aid in assessing response to treatment, provide a permanent record for comparison, and aid in detecting treatment failure or recurrence. Finally, these techniques aid our educational process for future physicians by permanently and objectively recording the appearance of lesions, treatment, and outcome. (The presentation included actual videotape material used in the processes described.)

Computed tomography of the larynx: a clinical and pathologic study

Recent interest in the application of computed tomography (CT) to the evaluation of laryngeal tumors, and the fact that the larynx offers the unique opportunity of whole organ study after total laryngectomy, led to a prospective study of laryngoscopy, conventional tomography, and CT in relation to pathologic findings. The results showed that CT gives an exact assessment of laryngeal anatomy and tumor involvement, particularly in the paracordal and pre-epiglottic spaces. The laryngeal cartilages, which are not well demonstrated by any other means, are accurately delineated by CT. There is also good demonstration of the laryngeal surface of the epiglottis, including the anterior commissure, which is poorly shown by other radiologic methods and is sometimes poorly seen on laryngoscopy. Because CT and conventional tomography present images at 2 different planes, at right angles to each other, we believe that CT is entirely complementary to conventional tomography.

Management of early glottic cancer

A detailed retrospective analysis of 136 patients with early glottic cancer treated at the University of Louisville, Radiation Center from October, 1953 to December, 1975 was done. Majority of the patients were in the age range of 55 to 74 years. Of them, 89% were male and 85% were Caucasian. The most common histological type was squamous cell carcinoma. The adjusted 5-year survival rate was 84%, with a standard error of 3%. Of these patients, 18% had local failures, and 68% of which were salvaged by surgery. The overall local control rate was 93%. The median time to recurrence was 23 months. There was no case of laryngeal necrosis, and a good function of larynx was achieved in a majority of the patients. Eighteen second cancers were diagnosed in 17 patients during the follow-up. A brief review of the literature is also done in the paper.

Computerized axial tomography in the assessment of thyroid cartilage invasion by laryngeal carcinoma: a prospective study

The purpose of this study was to assess the value of computerized axial tomography (CAT) in canine larynges that exhibit controlled surgical defects, and in 18 patients with biopsy-proved epidermoid carcinoma of the larynx who were studied prospectively. Five canine larynges with sequential surgical defects of 0 mm, 5 mm, 10 mm, and 15 mm were studied by CAT in order to evaluate our ability to identify defects in the thyroid cartilage. A 5-mm collimator with overlapping sections at 3-mm intervals and a 13-mm collimator with 5-mm overlapping sections were both used for each stage of the experiment. Results show significantly improved resolution with the 5-mm collimator compared with the 13-mm unit. In the human study group, results demonstrated excellent (100%) soft-tissue tumor site correlation. It appears from this study that we still lack a highly reliable radiographic technique for evaluating preoperatively with accuracy the integrity of the thyroid cartilage in the patient with carcinoma of the larynx.