Abstract
Discrimination of the etiology of arytenoid fixation in cT3 laryngeal squamous cell carcinoma (SCC) is crucial for treatment planning. The aim of this retrospective study was to differentiate among possible causes of arytenoid fixation (edema, inflammation, mass effect, or tumor invasion) by analyzing related signal patterns of magnetic resonance (MR) in the posterior laryngeal compartment (PLC) and crico-arytenoid unit (CAU). Seventeen patients affected by cT3 glottic SCC with arytenoid fixation were preoperatively studied by state-of-the-art MR with surface coils. Different signal patterns were assessed in PLC subsites. Three MR signal patterns were identified: A, normal; B, T2 hyperintensity and absence of restriction on diffusion-weighted imaging (DWI); and C, intermediate T2 signal and restriction on DWI. Signal patterns were correlated with the presence or absence of CAU and PLC neoplastic invasion. Patients were submitted to open partial horizontal or total laryngectomy and surgical specimens were analyzed. Pattern A and B did not correlate with neoplastic invasion, while Pattern C strongly did (Spearman’s coefficient = 0.779, p < 0.0001; sensitivity: 100%; specificity: 78%). In conclusion, MR with surface coils is able to assess PLC/CAU involvement with satisfactory accuracy. In absence of Pattern C, arytenoid fixation is likely related to mass effect and/or inflammatory reaction and is not associated with neoplastic invasion.
Highlights
Endoscopic evaluation represents a paramount diagnostic and staging tool for the assessment of laryngeal tumors
This clinical sign has recently been better defined by Rosen et al [3] as “vocal fold immobility related to laryngeal malignant disease”
Area Under the Receiver Operating Curve (AUROC) was used to assess if the three scoresInfiltration had an association with histology and diagnostic performance using the best Patientsradiological and crico-arytenoid unit (CAU)/posterior laryngeal compartment (PLC)
Summary
Endoscopic evaluation represents a paramount diagnostic and staging tool for the assessment of laryngeal tumors. Leads to classification in the cT3 category according to the 7th Edition of the AJCC UICC TNM staging system (unchanged in the subsequent 8th Edition) [1,2] This clinical sign has recently been better defined by Rosen et al [3] as “vocal fold immobility related to laryngeal malignant disease”. Such a clinical diagnosis may either underestimate the true neoplastic extent Silent cartilage or extralaryngeal overestimate (e.g., infunction “simple”bypT2 when the pT2 when the invasion cricoarytenoid unit (CAU)spread) is only or impaired in its itnormal peritumoral cricoarytenoid unit (CAU). On the other immobility hand, from an of view, etiopathological point of view, vocal fold/arytenoid canetiopathological be related to point a number of vocal fold/arytenoid immobility can be related to a number of different factors: invasion of the CAU, different factors: invasion of the CAU, intrinsic laryngeal muscle involvement, infiltration of the intrinsic laryngeal muscle involvement, infiltration the intraand/or extralaryngeal changes
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