Early Glottic Cancer: Role of MRI in the Preoperative Staging

Eugenia Allegra,Orazio Trapuzzano,Antonio Barca,Stefania Tamburrini,Aldo Garozzo,Serena Trapasso,Pierpaolo Ferrise

doi:10.1155/2014/890385

Eugenia Allegra, Orazio Trapuzzano + Show 5 more

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https://doi.org/10.1155/2014/890385

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Abstract

Introduction. Clinical staging is the most important time in management of glottic cancer in early stage (I-II). We have conducted a prospective study to evaluate if magnetic resonance imaging (MRI) is more accurate than computed tomography (CT) about tumoral extension, to exactly choose the most appropriate surgical approach, from organ preservation surgery to demolitive surgery. Materials and Methods. This prospective study was conducted on 26 male patients, with suspected laryngeal neoplasia of glottic region. The images of MRI and CT were analyzed to define the expansion of glottic lesion to anterior commissure, laryngeal cartilages, subglottic and/or supraglottic site, and paraglottic space. The results of MRI and CT were compared with each other and with the pathology report. Results. CT accuracy was 70% with low sensitivity but with high specific value. MRI showed a diagnostic accuracy in 80% of cases, with a sensitivity of 100% and high specificity. Statistical analysis showed that MRI has higher correlation than CT with the pathology report. Conclusion. Our study showed that MRI is more sensitive than CT in the preoperative staging of early glottic cancer, to select exactly the eligible patients in conservative surgery of the larynx, as supracricoid laryngectomy and cordectomy by CO2 laser.

Highlights

Clinical staging is the most important time in management of glottic cancer in early stage (I-II)
A valuable aid is provided by computed tomography (MDCT) and magnetic resonance imaging (MRI) for the evaluation of deep structures, because the involvement of these areas is generally considered as a contraindication for radiotherapy and surgical conservative procedures
Patients were subjected to excisional biopsy with CO2 laser in two cases, cordectomy with CO2 laser in four cases (4 T1a without involvement of anterior commissure), supracricoid laryngectomy with CHEP and reconstruction of vocal cords in 10 cases (4 T1a, 4 T1b, and 2 T3), and total laryngectomy in four cases (4 T3)

Summary

Introduction

Clinical staging is the most important time in management of glottic cancer in early stage (I-II). The clinical staging with the assistance of diagnostic imaging is the most important time of therapeutic planning, which should ensure oncological radicality in respect of the clinical outcomes for patients For this reason, it is necessary to stage the laryngeal cancer in a correct way in order to choose the most correct therapeutic approach based on the available options, from organ preservation strategies (radiotherapy, partial resection/cordectomy with CO2 laser, and conservative partial reconstructive surgery) to demolitive surgery. A valuable aid is provided by computed tomography (MDCT) and magnetic resonance imaging (MRI) for the evaluation of deep structures, because the involvement of these areas is generally considered as a contraindication for radiotherapy and surgical conservative procedures It is not a formal contraindication, as supracricoid laryngectomies are still preservation surgery. Frontolateral vertical laryngectomy or vertical hemilaryngectomy or partial supracricoid laryngectomy with cricohyoidoepiglottopexy (CHEP) or cricohyoidopexy

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