Differentiating Laryngeal Carcinomas from Precursor Lesions by Diffusion-Weighted Magnetic Resonance Imaging at 3.0 T: A Preliminary Study

Abstract

BackgroundDiffusion-weighted magnetic resonance imaging (DWI) has been introduced in head and neck cancers. Due to limitations in the performance of laryngeal DWI, including the complex anatomical structure of the larynx leading to susceptibility effects, the value of DWI in differentiating benign from malignant laryngeal lesions has largely been ignored. We assessed whether a threshold for the apparent diffusion coefficient (ADC) was useful in differentiating preoperative laryngeal carcinomas from precursor lesions by turbo spin-echo (TSE) DWI and 3.0-T magnetic resonance.MethodsWe evaluated DWI and the ADC value in 33 pathologically proven laryngeal carcinomas and 17 precancerous lesions.ResultsThe sensitivity, specificity, and accuracy were 81.8%, 64.7%, 76.0% by laryngostroboscopy, respectively. The sensitivity, specificity, and accuracy of conventional magnetic resonance imaging were 90.9%, 76.5%, 86.0%, respectively. Qualitative DWI analysis produced sensitivity, specificity, and accuracy values of 100.0, 88.2, and 96.0%, respectively. The ADC values were lower for patients with laryngeal carcinoma (mean 1.195±0.32×10−3 mm2/s) versus those with laryngeal precancerous lesions (mean 1.780±0.32×10−3 mm2/s; P<0.001). ROC analysis showed that the area under the curve was 0.956 and the optimum threshold for the ADC was 1.455×10−3 mm2/s, resulting in a sensitivity of 94.1%, a specificity of 90.9%, and an accuracy of 92.9%.ConclusionsDespite some limitations, including the small number of laryngeal carcinomas included, DWI may detect changes in tumor size and shape before they are visible by laryngostroboscopy. The ADC values were lower for patients with laryngeal carcinoma than for those with laryngeal precancerous lesions. The proposed cutoff for the ADC may help distinguish laryngeal carcinomas from laryngeal precancerous lesions.

Clinical features and hypoxic marker expression of primary sinonasal and laryngeal small-cell neuroendocrine carcinoma: a small case series

“…An MRI scan improves differentiation between inflammatory reaction, tumor, and liquid retention. The combination of DWI and ADC may differentiate malignant tumors from precancerous lesions and benign tumors [18]. In the present study, the T1-weighted signals and the T2-weighted signals were hyperintense.…”

Can videostroboscopy predict early glottic cancer? A systematic review and meta-analysis

“…This study did not meet our inclusion criteria, because it only involved patients with premalignant lesions. Correspondingly, Shang et al reported superior accuracy of diffusion‐weighted magnetic resonance imaging compared to VS (96% vs. 76%, respectively) in differentiating laryngeal cancer from precursor lesions, but missing details concerning VS findings and histopathological evaluation prevented inclusion in the present study. Furthermore, patients with nonglottic laryngeal cancers were included in the study population, and those were impossible to exclude from the reported data.…”

“…For years, VS has been recommended for assessing vocal cord lesions, especially when invasive lesions are suspected . However, the value of VS in predicting the degree of dysplasia or malignant invasion has recently been questioned . Colden et al described a normal VS evaluation in only two of 28 vocal cord lesions with not more than intraepithelial atypia.…”

“…2,3,14,15 However, the value of VS in predicting the degree of dysplasia or malignant invasion has recently been questioned. 6,7,16 Colden et al 7 described a normal VS evaluation in only two of 28 vocal cord lesions with not more than intraepithelial atypia. Additionally, a substantial inter-rater variability in the stroboscopic evaluation was noted.…”

Systematic review of the diagnostic value of laryngeal stroboscopy in excluding early glottic carcinoma

“…No other articles were excluded based on language. Eventually, 10 studies were eligible for critical appraisal. Cross‐reference checking of these studies on PubMed and Scopus did not reveal any relevant studies.…”