Avaliação por tomografia computadorizada do envolvimento loco-regional do carcinoma espinocelular de corda vocal

Abstract

No período de 1992 a 1998, foram avaliados, retrospectivamente, exames de tomografia computadorizada e prontuários de 22 pacientes com carcinoma espinocelular de corda vocal. Avaliou-se a concordância entre observadores para todos os casos e a acurácia e concordância entre os métodos para os casos operados, utilizando-se o índice kappa. A concordância foi excelente para o comprometimento tumoral das cartilagens tireóide, cricóide, extensão extralaríngea e estadiamento linfonodal; ótima para o envolvimento tumoral das cordas vocais, comissura posterior e espaço paraglótico; boa para o envolvimento tumoral da supraglote, subglote e estadiamento tumoral; regular para o envolvimento tumoral da comissura anterior e cartilagem aritenóide. A utilização simultânea da avaliação clínica e tomográfica para o estadiamento T obteve acurácia e concordância com achados patológicos de 89,47% e 84,9%, respectivamente, sendo superior à análise clí-nica isolada ou tomográfica. A acurácia e concordância patológica da tomografia computadorizada para o estadiamento N foi de 100%, sendo superior à avaliação clínica. Unitermos: Carcinoma espinocelular. Corda vocal. Tomografia computadorizada.Computed tomography evaluation of loco-regional involvement of squamous cell carcinoma of the vocal cord. We reviewed the case notes and computed tomography scans of 22 patients with squamous cell carcinoma of the vocal cord, in the period between 1992 and 1998. Interobserver concordance for all cases and accuracy and concordance between the methods for the operated patients were evaluated using the kappa test. Concordance was classified as follows: excellent for evaluating tumoral involvement of the thyroid and cricoid cartilages, extralaryngeal extension and lymph node staging; very good for tumoral involvement of vocal cords, posterior commissure and paraglottic space; good for tumoral involvement of the supraglottic and subglottic regions and tumoral staging; regular for tumoral involvement of the anterior commissure and arytenoid cartilage. The combination of clinical and computed tomography evaluation for T staging resulted in an accuracy and concordance with the pathological results of 89.47% and 84.9%, respectively, which were superior to isolated clinical or computed tomography analysis. The accuracy and pathological concordance of computed tomography for N staging was 100%, which was superior to clinical evaluation. nóstico dos pacientes(1) . É desejável, especialmente nestes casos, além do tratamento apropriado objetivando a cura oncológica, oferecer a capacidade de fonação e deglutição de modo razoável. A avaliação clínico-endoscópica e os mé-todos de imagem têm a responsabilidade de demonstrar, da forma mais precisa possível, a real extensão neoplásica, avaliando o possível comprometimento de estruturas relevantes ao planejamento terapêutico (2) . É função do radiologista avaliar adequadamente a extensão tumoral, contribuindo com informações importantes. O comprometimento linfonodal cervical também influencia a conduta e o prognóstico...

Comparative analysis of perceptual evaluation, acoustic analysis and indirect laryngoscopy for vocal assessment of a population with vocal complaint

“…Interobserver studies should be developed to assess the level of agreement between examiners, a topic developed in some medical areas 10 , 11 , 12 . In our area, there are some studies along these lines, especially on interobserver assessment with different levels of knowledge and professional experience, as well as professionals from different countries; however, the authors did not find high levels of disagreement, pointing to perceptual scale as an excellent clinical instrument 13 , 14 .…”

Contribuição da tomografia computadorizada no estadiamento do carcinoma de células escamosas da supraglote

“…An excellent interobserver agreement was found in the evaluation of vocal folds and subglottic space. A previous study has also demonstrated a good interobserver agreement for supraglottic and subglottic spaces, and very good for vocal folds (26) .…”

Análise comparativa entre avaliação fonoaudiológica perceptivo-auditiva, análise acústica e laringoscopias indiretas para avaliação vocal em população com queixa vocal

“…Interobserver studies should be developed to assess the level of agreement between examiners, a topic [10][11][12] . In our area, there are some studies along these lines, especially on interobserver assessment with different levels of knowledge and professional experience, as well as professionals from different countries; however, the authors did not find high levels of disagreement, pointing to perceptual scale as an excellent clinical instrument 13,14 .…”