Efficacy of clinical examination and computed tomography at T-staging of laryngeal carcinoma

Abstract

Objectives: The purpose of this study is to investigate the accuracy rates of tumor T-staging and the efficacy of methods used at T-staging. Patients and Methods: Forty-seven laryngeal carcinoma patients 6 females, 41 males; mean age 57.9±9.8 years; range 38 to 81 years who underwent surgery at Haydarpaşa Numune Education and Research Hospital 2. Ear Nose Throat Clinic between March 2003 and June 2008 were included in the study. T-staging of the tumors were separately determined according to their clinical examination, computed tomography CT findings, and their correlation between these methods. Staging according to histopathological examination was accepted as real accurate staging. Rates of accurate staging according to postoperative histopathological examination results were evaluated under guidance of the literature. Results: When their accuracy rates in determining histopathological T-stages of tumors were compared, there were no significant differences between the methods. The rates of accuracy in determining histopathologic T-stage of tumors were 40% by clinical examination; 66% by CT; and 76% when both methods were used together. The most successful results were obtained at the tumors of glottic region. Among the patients whose tumors had been staged inaccurately by clinical examination, 71% were underestimated while 29% were overestimated. Underestimation and overestimation of stagings were found to be 37% and 63%, respectively, with CT examination. Conclusion: Success of staging increases when clinical examination is used in together with CT. While there is a tendency towards underestimation of T-stage when staging is done only by means of clinical examination, this tendency is towards overestimation when CT is used alone. Thus, combination of clinical examination findings with CT is necessary for an accurate T-staging of a laryngeal cancer.

Keywords

• Computed tomography, laryngeal cancer, magnetic resonance imaging, TNM staging

Larenks kanseri T-evrelemesinde klinik muayene ve bilgisayarlı tomografinin etkinliği

Abstract

Amaç: Bu çalışmada tümör T-evresinin doğru tespit edilme oranları ve T-evresini belirlemede kullanılan yöntemlerin etkinliği araştırıldı.Hastalar ve Yöntemler: Mart 2003 - Haziran 2008 tarihleri arasında Haydarpaşa Numune Eğitim ve Araştırma Hastanesi 2. Kulak Burun Boğaz Kliniği’nde larenks kanseri nedeniyle ameliyat edilen 47 hasta 6 kadın, 41 erkek; ort. yaş 57.9±9.8 yıl; dağılım 38-81 yıl çalışmaya dahil edildi. Tümörlerin T-evrelemeleri; klinik muayene ve bilgisayarlı tomografi BT bulgularına ve bu yöntemlerin birbirleri ile ilişkilerine göre ayrı ayrı belirlendi. Histopatolojik inceleme sonuçlarına göre yapılan evreleme gerçek doğru evreleme olarak kabul edildi. Ameliyat sonrası histopatolojik inceleme sonuçlarına göre T-evresini doğru tespit etme oranları literatür eşliğinde değerlendirildi.Bulgular: Tümörün histopatolojik T-evresini doğru tespit etme oranları karşılaştırıldığında yöntemler arasında anlamlı farklılık gözlenmedi. Tümörün histopatolojik T-evresini doğru tespit etme oranları, klinik muayene ile %40, BT ile %66, her ikisi birlikte kullanıldığında ise %76 olarak saptandı. En başarılı sonuçlar glottik bölge tümörlerinde sağlandı. Klinik muayene ile T-evresi yanlış tespit edilen hastaların %71’i alt evre, %29’u üst evre, olarak değerlendirildi. Bilgisayarlı tomografi değerlendirmesinde alt evrelendirmeler ve üst evrelendirmeler sırasıyla %37 ve %63 olarak bulundu.Sonuç: Klinik muayene ve BT bulguları birlikte değerlendirildiğinde evrelemede başarı artmaktadır. Hastalar sadece klinik muayene ile değerlendirildiğinde T-evresi daha çok yanlış alt evrelerine çekilirken, yalnızca BT ile değerlendirildiğinde yanlış üst evrelere çekilebilmektedir. Bu nedenle klinik muayene bulgularının BT bulguları ile birlikte değerlendirilmesi larengeal kanserlerin doğru T-evrelemesi için gereklidir

Keywords

• Bilgisayarlı tomografi, larenks kanseri, manyetik rezonans görüntüleme, TNM sınıflaması

References

1. Greene FL, Page DL, Fleming ID, Fritz AG, Balch CM, Haller DG, et al. AJCC Cancer Staging Manual. 6th ed. New York: Springer; 2002.
2. Sobin LH, Wittekind CH. International union against cancer. TNM classification of malignant tumours. 6th ed. New York: John Wiley & Sons; 2002.
3. Zbären P, Becker M, Läng H. Pretherapeutic staging of laryngeal carcinoma. Clinical findings, computed tomography, and magnetic resonance imaging com- pared with histopathology. Cancer 1996;77:1263-73.
4. Thabet HM, Sessions DG, Gado MH, Gnepp DA, Harvey JE, Talaat M. Comparison of clinical evaluation and computed tomographic diagnostic accuracy for tumors of the larynx and hypopharynx. Laryngoscope 1996;106:589-94.
5. Katsantonis GP, Archer CR, Rosenblum BN, Yeager VL, Friedman WH. The degree to which accuracy of preoperative staging of laryngeal carcinoma has been enhanced by computed tomography. Otolaryngol Head Neck Surg 1986;95:52-62.
6. Oktay MF, Cüreoğlu S, Bükte Y, Yılmaz F, Tekin M, Osma Ü, et al. The diagnostic accuracy of the clinical examination and the computed tomography findings in patients with laryngeal carcinoma who undergone total laryngectomy. Türk Otolarengoloji Arşivi 2002; 40:189-95.
7. Agada FO, Nix PA, Salvage D, Stafford ND. Computerised tomography vs. pathological staging of laryngeal cancer: a 6-year completed audit cycle. Int J Clin Pract 2004;58:714-6.
8. Aydın Ö, Üstündağ E, Şengör A. Larenk kanserlerinde tumor yayılımının rijit endoskoplarla değerlendiril- mesi. Türk Otolarengoloji Arşivi 2002;40:185-88.

9. Yuen A, Medina JE, Goepfert H, Fletcher G. Management of stage T3 and T4 glottic carcinomas. Am J Surg 1984;148:467-72.
10. Pillsbury HR, Kirchner JA. Clinical vs histopathologic staging in laryngeal cancer. Arch Otolaryngol 1979; 105:157-9.
11. Sulfaro S, Barzan L, Querin F, Lutman M, Caruso G, Comoretto R, et al. T staging of the laryngo- hypopharyngeal carcinoma. A 7-year multidisci- plinary experience. Arch Otolaryngol Head Neck Surg 1989;115:613-20.
12. Becker M, Zbären P, Laeng H, Stoupis C, Porcellini B, Vock P. Neoplastic invasion of the laryngeal cartilage: comparison of MR imaging and CT with histopatho- logic correlation. Radiology 1995;194:661-9.
13. Nakayama M, Brandenburg JH. Clinical underestima- tion of laryngeal cancer. Predictive indicators. Arch Otolaryngol Head Neck Surg 1993;119:950-7.
14. Hoover LA, Calcaterra TC, Walter GA, Larrson SG. Preoperative CT scan evaluation for laryngeal carcinoma: correlation with pathological findings. Laryngoscope 1984;94:310-5.
15. Castelijns JA, Gerritsen GJ, Kaiser MC, Valk J, van Zanten TE, Golding RG, et al. Invasion of laryngeal cartilage by cancer: comparison of CT and MR imag- ing. Radiology 1988;167:199-206.
16. Gilbert K, Dalley RW, Maronian N, Anzai Y. Staging of laryngeal cancer using 64-channel multidetector row CT: comparison of standard neck CT with dedi- cated breath-maneuver laryngeal CT. AJNR Am J Neuroradiol 2009. [Epub ahead of print]
17. Veit-Haibach P, Luczak C, Wanke I, Fischer M, Egelhof T, Beyer T, et al. TNM staging with FDG-PET/CT in patients with primary head and neck cancer. Eur J Nucl Med Mol Imaging 2007;34:1953-62.