Reliability Of CT And MR Imaging For Assessment Of Laryngeal Malignancy
|Full paper||Not Available|
Objectives : Tins study was designed to evaluate the accuracy of computed tomography (CT) and Magnetic Resonance (MR) imaging as modalities for pretreatment assessment and staging of laryngeal tumors in comparison to clinical and instrumental examination using the surgical findings and the results of histopathological examination of excised specimens as a gold standard for comparison. Patients & Methods : The study comprised 29 patients attended with laryngeal squameous cell carcinoma (LSCC); 22 males and 7 females with mean age 53.3 12.2 years. After full history taking otorhinolaryngeal examination; direct laryngoscopy was performed for clinical staging to determine the full extent of the local spread of the tunwrand to obtain tissue biopsy. All patients underwent preoperative CT and/or MR1 scanning and then had surgical exploration and excised specimens were examined histopathologically. Results : According to clinical staging, 22 patients had stage 1 lesions, 3 and 5 (17.3%) Itad lesions of stages II and III, respectively. Tliere were 24 (82.8%) glottic, 2 (6.9%) supraglottic and 3 (10.3%) subglottic lesions and 23 (79.3%) lesions were polypoid and 6 (20.7%) were ulcerative. According to WHO histopathological grading 14 specimens WHO type 1, 9 specimens of WHO type 2 and 6 specimens were WHO type 3. Clinical and instrumental examination could identify the site of all lesions, whereas one glottic lesion was non-visualized using either CT or MRl with a sensitivity rate of 96.6% as a preliminary diagnostic modality for the site of laryngeal lesions. For accuracy of identification of lesion site, clinical examination could accurately identify the site of 17 tumors (58.6%), CT could identify the site of 25 lesions (86.2%) and MRl identified the site of 28 lesions (96.6%) with a significant (P<0.05) difference in favor of CT and MRl. Histopathological examination of excised specimen confirmed tlie results of both CT and MRl as regards identification of invasion of both laryngeal space and cartilages with accuracy rate of 100%. Clinical examination accurately staged 9 cases (31%), CT accurately staged 24 cases (78.6%) but MRl accurately staged 24 cases (82.8%), but CT and MRl showed the same accuracy in lymph node staging with a significant difference (p < 0.05) in accuracy rate ot staging using CT (80%) and MRl (83.3%) in comparison to accuracy rate of clinical staging. Conclusion: It could be concluded thai both CT and MRl showed high accuracy in assessment and staging at laryngeal tumors in comparison with clinical staging and both modalities could identify invasion of laryngeal spaces and cartilage, extralaryngeal spread and lymph node staging witli 100% accuracy.