Background: An accurate staging of laryngeal carcinoma is vital to decide the treatment options. Imaging plays integral part in staging of laryngeal cancer with computed tomography (CT) being among the most used modalities.With advance in CT manufacturing and widespread use of multidetector CT (MDCT), more accurate and dependable clinical application would be expected.
Objective: To evaluate the role of MDCT in the staging of laryngeal cancer and to compare the efficacy of MDCT in assessing laryngeal cancer with respect to clinical and histopathological TNMstaging.
Patients and methods: Twenty-four patients with endoscopically proven laryngeal carcinoma underwent MDCT examination during the period between February 2013 and October 2013at CT unit of Middle Euphrates Neurocenter in Al-Sadder Medical city, Al-Najaf city. Clinical and histopathological records of all patients were reviewed and compared with MDCT findings.
Results: Twenty-four patients were included, with male to female ratio of 3:1 (18 males, 6 females) with mean age of 62.58±12.98 years. Fifty percent (12) of cases were at TNM stage 3, while stage 2 and stage 4 constituted 25% (6 cases) for each equally. There was statistically significant relation between stage of the tumor and volume. Male gender had statistically significant association with higher TNM stage while clinical presentation had not.
Conclusion: MDCT has a crucial role in estimation of the TNM stage of laryngeal carcinoma.The TNM stage of the laryngeal carcinoma tends to be upgraded when following MDCT findings are present:heterogenous density of the mass, presence of cartilage destruction, presence of anterior commissure involvement and larger volume of the mass. However, presence of extra laryngeal extension on MDCT may have no significant relation to a higher TNM stage.
Laryngeal carcinoma; Multiple detector computed tomography; Density of the mass, Cartilage invasion
Laryngeal carcinoma is the eleventh-most common form of cancer among men worldwide and is the second-most common malignancy of the head and neck . The assessment of the laryngeal tumor is based upon inspection and palpation, when possible, and by both indirect mirror examination and direct endoscopy [2,3]. Examination under anesthesia should be performed to best assess the extent of the tumor, to look for synchronous primary tumors, and to take biopsies . Imaging studies, including computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET), may augment the physical exam and evaluation, particularly for assessing the degree of local invasion, involvement of regional lymph nodes, and the presence of distant metastases and second primary malignancies . Ideally, imaging should take place prior to biopsy, which may distort anatomy and create a false positive finding on PET scanning [4,5]. Multiple detector computed tomography or (MDCT) scanning is a rapid, painless diagnostic procedure that combines the use of computers and X-rays. Multiple images are acquired in a sequence by a rotating x-ray tube. The patient is lie still on a table for approximately 5 to 15 min, depending on the area of concern being covered. Images are acquired by the detectors that pick up the X-ray that passes through patient body. The images are reconstructed for the assessment. For Head and Neck cancers, it is particularly useful in upstaging cancers that have deeper local invasion or infiltration into adjacent structures that is difficult to detect on physical examination .