Computerised tomography vs. pathological staging of laryngeal cancer: a 6-year completed audit cycle

Abstract

The aim of this audit was to examine the accuracy of computerised tomography (CT) staging of advanced laryngeal tumours. CT staging was evaluated against the T staging of laryngeal tumours as determined by pathological examination. Data from 38 patients, between 1996 and 2000 with laryngeal squamous cell cancer that fulfilled the audit criteria, were collected and compared. Subjects had to have a pre-operative CT scan of the larynx and a total laryngectomy specimen for pathological staging. The audit demonstrated that 45% of the patients were over staged and 10% were under staged using CT criteria as compared to pathological staging. Fourteen patients had been erroneously up staged to T4 on the basis of laryngeal cartilage invasion as judged by the radiological sign of cartilage sclerosis. While this radiological sign is used as a marker of neoplastic invasion in the literature, it was found to have a low sensitivity of 62% and low specificity of 42% in this study. Arytenoid cartilage sclerosis in isolation was no longer used as a radiological sign of neoplastic cartilage invasion. Following the change in practice, the CT staging of laryngeal cancer was re-evaluated in a second audit cycle. Correct CT staging of the tumour improved from 45 to 71%. Arytenoid cartilage sclerosis is no longer used as a sole CT criterion for predicting neoplastic cartilage invasion at our institution.

Laryngeal Cancer: Radiological Staging by Multislice Computed Tomography and Pathological Correlation

“…All clinical/endoscopic staging errors occured from underestimation caused by a failure to clinically identify invasion of the paraglottic and preepiglottic space and laryngeal cartilaginous structures. Agada et al reported the accuracy of CT staging compared with pathologic specimens, demonstrating that 45% of patients were overstaged and 10% were understaged by CT (24). In our study, overestimation of stage was present in 14.2 % of cases and underestimation in 3 %.…”

Staging of Laryngeal Cancer Using 64-Channel Multidetector Row CT: Comparison of Standard Neck CT with Dedicated Breath-Maneuver Laryngeal CT

“…5 Agada et al 6 reported the accuracy of CT staging compared with pathologic specimens, demonstrating that 45% of patients were overstaged and 10% were understaged by CT. Other studies have examined the potential benefits of smaller sections, by using coronal/sagittal and 3D reconstructions and having patients do a variety of breathing maneuvers, including quiet breathing, breath-holding, and modified Valsalva maneuvers. 7 Results in these studies varied, but most found that reconstructions are helpful and that breathing maneuvers improve imaging quality.…”

The Value of Routine Clinical and Radiologic Studies in Predicting Neoplastic Invasion of Cricoarytenoid Units

“…13 Other radiologic signs used to predict early cartilage invasion include cartilage sclerosis, intramedullary cartilaginous mass, cartilaginous explosion, cartilage lysis, and cartilage bowing. [14][15][16][17] Sclerotic changes in the laryngeal cartilage as a result of tumoral involvement are controversial. The ability of CT to detect neoplastic invasion of laryngeal cartilage varies widely, with reported sensitivities of 46%-66% and specificities of 84%-94%.…”