Pretherapeutic Assessment by Multidetector Computed Tomography for Thyroid Cartilage Invasion in Laryngeal Cancer: A Double‑edged Sword

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.

Keywords

Glottic oncology - infrahyoid neck imaging - neck imaging

Publication History

Article published online:
23 June 2021

• References

• 1 Bobdey S, Jain A, Balasubramanium G. Epidemiological review of laryngeal cancer: An Indian perspective. Indian J Med Paediatr Oncol 2015; 36: 154-60
• 2 Joshi VM, Wadhwa V, Mukherji SK. Imaging in laryngeal cancers. Indian J Radiol Imaging 2012; 22: 209-26
• 3 Pfister DG, Strong E, Harrison L, Haines IE, Pfister DA, Sessions R. et al. Larynx preservation with combined chemotherapy and radiation therapy in advanced but resectable head and neck cancer. J Clin Oncol 1991; 9: 850-9
• 4 Beitler JJ, Muller S, Grist WJ, Corey A, Klein AM, Johns MM. et al. Prognostic accuracy of computed tomography findings for patients with laryngeal cancer undergoing laryngectomy. J Clin Oncol 2010; 28: 2318-22
• 5 Sheahan P. Management of advanced laryngeal cancer. Rambam Maimonides Med J 2014; 5: e0015
• 6 Karatzanis AD, Psychogios G, Waldfahrer F, Kapsreiter M, Zenk J, Velegrakis GA. Management of locally advanced laryngeal cancer. J Otolaryngol Head Neck Surg 2014; 43: 4
• 7 Connor S. Laryngeal cancer: How does the radiologist help?. Cancer Imaging 2007; 7: 93-103
• 8 Li B, Bobinski M, Gandour-Edwards R, Farwell DG, Chen AM. Overstaging of cartilage invasion by multidetector CT scan for laryngeal cancer and its potential effect on the use of organ preservation with chemoradiation. Br J Radiol 2011; 84: 64-9
• 9 Sharif KS, Malek M, Mazaher H, Sharifi anH. The diagnostic accuracy of computed tomography in neoplastic invasion of the laryngeal cartilage. Iran J Radiol 2008; 5: 11-17
• 10 Becker M, Zbären 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
• 11 Hartl DM, Landry G, Bidault F, Hans S, Julieron M, Mamelle G. et al. CT-scan prediction of thyroid cartilage invasion for early laryngeal squamous cell carcinoma. Eur Arch Otorhinolaryngol 2013; 270: 287-91
• 12 Adolphs AP, Boersma NA, Diemel BD, Eding JE, Flokstra FE, Wegner I. et al. Asystematic review of computed tomography detection of cartilage invasion in laryngeal carcinoma. Laryngoscope 2015; 125: 1650-5
• 13 Koopmann M, Weiss D, Steiger M, Elges S, Rudack C, Stenner M. Thyroid cartilage invasion in laryngeal and hypopharyngeal squamous cell carcinoma treated with total laryngectomy. Eur Arch Otorhinolaryngol 2016; 273: 3789-94
• 14 Fernandes R, Gopalan P, Spyridakou C, Joseph G, Kumar M. Predictive indicators for thyroid cartilage involvement in carcinoma of the larynx seen on spiral computed tomography scans. J Laryngol Otol 2006; 120: 857-60
• 15 Scarfe WC, Farman AG. Soft tissue calcifi cations in the neck: Maxillofacial CBCT presentation and signifi cance. Austr Dent Pract 2008; 19: 102-8
• 16 Zbären P, Becker M, Läng H. Staging of laryngeal cancer: Endoscopy, computed tomography and magnetic resonance versus histopathology. Eur Arch Otorhinolaryngol 1997; 254 Suppl 1: S117-22
• 17 Jain SN, Varma R. Imaging in laryngeal tumors. Otorhinolaryngol Clin Int J 2010; 2: 167-74
• 18 Kuno H, Onaya H, Iwata R, Kobayashi T, Fujii S, Hayashi R. Evaluation of cartilage invasion by laryngeal and hypopharyngeal squamous cell carcinoma with dual-energy CT. Radiology 2012; 265: 488-96