Neoplastic invasion of the laryngeal cartilage: reassessment of criteria for diagnosis at CT.
OBJECTIVE
To evaluate eight different diagnostic criteria to help detect neoplastic invasion of laryngeal cartilage at computed tomography (CT).


METHODS
In a prospective series, 111 patients with carcinoma of the larynx or hypopharynx underwent thin-section, contrast material-enhanced CT before total or partial laryngectomy. The following CT criteria were evaluated: extralaryngeal tumor, sclerosis, tumor adjacent to nonossified cartilage, serpiginous contour, erosion or lysis, obliteration of marrow space, cartilaginous blowout, and bowing. Histologic findings were correlated with findings on CT scans obtained at each level.


RESULTS
Histologically, 122 of 412 cartilages were invaded. Depending on the diagnostic criteria and each specific cartilage, there was great variation in sensitivity (7%-83%) and specificity (40%-100%). Sclerosis was the most sensitive criteria in all cartilages but often corresponded to reactive inflammation in the thyroid cartilage. Extralaryngeal tumor and erosion or lysis yielded the highest specificity. Tumor adjacent to nonossified cartilage, serpiginous contour, and obliteration of marrow space were specific although not sensitive signs of invasion in the arytenoid and cricoid cartilage and were nonspecific in the thyroid cartilage. Blowout and bowing were not useful. Selection of the appropriate combination of criteria enabled an overall sensitivity of 91% (associated specificity, 68%) or an overall specificity of 79% (associated sensitivity, 82%).


CONCLUSIONS
Detection of neoplastic cartilage invasion with CT greatly depended on the appropriate use of individual and combined CT criteria.
Becker
M
M
Department of Radiology, Geneva University Hospital, Switzerland.
Zbären
P
P
Delavelle
J
J
Kurt
A M
AM
Egger
C
C
Rüfenacht
D A
DA
Terrier
F
F
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001193:Arytenoid Cartilage / Q000000981:diagnostic imaging; D003413:Cricoid Cartilage / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D007013:Hypopharynx; D007817:Laryngeal Cartilages / Q000000981:diagnostic imaging* / Q000473:pathology; D007822:Laryngeal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000000981:diagnostic imaging* / Q000473:pathology; D010610:Pharyngeal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology; D011446:Prospective Studies; D012598:Sclerosis; D012680:Sensitivity and Specificity; D013957:Thyroid Cartilage / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed