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

Pathologic Assessment of Computerized Tomography Accuracy for the Evaluation of the Laryngeal Cartilaginous Frame Work in Laryngopharyngeal Carcinomas

Sixty-six whole-organ sectioned laryngopharyngectomy specimens removed for cancer during a seven-year period were uniformly examined to determine the accuracy of preoperative high resolution computerized tomography (CT) for detection of cartilaginous involvement. Our results indicate that CT has a high overall specificity (88.2%) but a low sensitivity (47.1 %); we observed a high false-negative rate (26.5%) and a fairly low false-positive rate (5.9%). Massive cartilage destruction was easily assessed by CT, whereas both small macroscopic and microscopic neoplastic foci of cartilaginous invasion were missed on CT scans. Moreover, false-positive cases were mainly due to proximity of the tumor to the cartilage. Clinical implications of these results are discussed.

Significance and means by which laryngeal cancer invades thyroid cartilage

Involvement of the thyroid cartilage attracts a high T rating in all systems of classification for carcinoma of the larynx. Evaluation of 145 patients with laryngeal cancer treated by total laryngectomy emphasizes the difficulties of preoperatively determining cartilage invasion. The operative specimen was serially sectioned and studied to determine the means by which ossified and nonossified thyroid cartilage is invaded by carcinoma. A minimum 5-year follow-up of these cases indicates the prognostic significance of such invasion.

Laryngeal malignancies and computerized tomography. A correlation of tomographic and histopathologic findings

We compared the anatomic structures, computerized tomographic (CT) scan images and the histopathologic findings after surgery in 15 patients with laryngeal epidermoid carcinoma. We examined the horizontal whole-mount histologic sections along with the preoperative CT and verified the preoperative impression of the soft tissue changes of preepiglottic space involvement; true cord, false cord and aryepiglottic fold invasion; or subglottic extension in all 15 patients. It was impossible to judge reliably the microscopic invasion of bone or cartilage with this method. Preoperative CT evaluation of carcinoma of the larynx was a reliable method for judging gross tumor size, though decisions regarding conservation surgery cannot be based on CT evaluation alone.