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. |
