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Staging of laryngeal cancer: endoscopy, computed tomography and magnetic resonance versus histopathology

Zbären, P
Läng, H
Published in European archives of oto-rhino-laryngology. 1997, vol. 254 Suppl 1, p. S117-22
Abstract An accurate pretherapeutic staging of laryngeal cancer is required for optimal treatment planning and for evaluation and comparison of the results of different treatment modalities. In this study, 45 consecutive patients with neoplasms of the larynx, treated surgically, were included in a prospective pretherapeutic staging protocol that included indirect laryngoscopy, direct microlaryngoscopy, contrast-enhanced computed tomography (CT) and Gd-DTPA-enhanced magnetic resonance imaging (MRI). The surgical specimens were cut in whole-organ slices parallel to the plane of the axial CT and MR images. The histologic findings were then compared with clinical findings, CT and MRI. These findings showed that clinical evaluation failed to identify tumor invasion of the laryngeal cartilages and extralaryngeal soft tissues, resulting in a low staging accuracy (55%). Many pT4 tumors were clinically understaged. The combination of clinical/endoscopic evaluation and either CT or MRI resulted in a significantly improved staging accuracy (80% vs 87%, respectively). MRI was significantly more sensitive but less specific than CT in detecting neoplastic cartilage invasion. MRI tended to overestimate neoplastic cartilage invasion to possibly result in overtreatment, while CT was found to underestimate neoplastic cartilage invasion and could lead to inadequate therapeutic decisions.
Keywords AdultAgedAged, 80 and overClinical ProtocolsContrast MediaDecision MakingFemaleGadolinium/diagnostic useGadolinium DTPAHumansImage EnhancementLaryngeal Cartilages/pathologyLaryngeal Neoplasms/pathology/surgeryLaryngoscopyLarynx/pathologyMagnetic Resonance ImagingMaleMiddle AgedNeck/pathologyNeoplasm InvasivenessNeoplasm StagingOrganometallic Compounds/diagnostic usePatient Care PlanningPentetic Acid/analogs & derivatives/diagnostic useProspective StudiesRadiographic Image EnhancementTomography, X-Ray Computed
PMID: 9065644
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Research group Groupe Becker Minerva (imagerie ORL) (683)
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ZBÄREN, P, BECKER, Minerva, LÄNG, H. Staging of laryngeal cancer: endoscopy, computed tomography and magnetic resonance versus histopathology. In: European archives of oto-rhino-laryngology, 1997, vol. 254 Suppl 1, p. S117-22. doi: 10.1007/BF02439740 https://archive-ouverte.unige.ch/unige:39791

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