title: Prognostic accuracy of computed tomography findings for patients with laryngeal cancer undergoing laryngectomy.
abstract: OBJECTIVE
  The indications for upfront laryngectomy in the management of laryngeal cancer are a functionless larynx and extralaryngeal extension. Practically, clinicians rely on imaging to predict which patients will have T4 disease. Our goal was to review the accuracy of preoperative computed tomography (CT) scanning in determining the necessity for initial laryngectomy for advanced laryngeal cancer.
  
  
  METHODS
  In total, 107 consecutive untreated laryngectomy specimens with high-quality, preoperative CT imaging interpreted by our neuroradiologists were reviewed. Radiographic findings, including sclerosis, invasion, penetration, extralaryngeal spread, and subglottic extension were correlated with pathologic findings. CT images were not reinterpreted, since our purpose was to assess the original interpretations.
  
  
  RESULTS
  CT imaging reported 23 cases of thyroid cartilage penetration and 27 cases of extralaryngeal spread. Pathology reported 12 cases of thyroid cartilage invasion, 29 cases of penetration, and 45 cases of extralaryngeal disease. CT imaging identified 17 (59%) of 29 cases of pathologically documented thyroid cartilage penetration and 22 (49%) of 45 cases of pathologically documented extralaryngeal spread. Pathologically proven extralaryngeal spread without thyroid cartilage penetration occurred in 18 (40%) of 45 cases. The positive predictive values for thyroid cartilage penetration and extralaryngeal spread were 74% and 81%. Sclerosis was of limited value in predicting thyroid cartilage invasion or penetration. Cricoid or arytenoid destruction predicted for thyroid cartilage penetration at rates of 57% and 63%.
  
  
  CONCLUSIONS
  CT imaging has clear limitations when deciding whether there is thyroid cartilage penetration or extralaryngeal spread of advanced laryngeal cancer. Extralaryngeal spread without thyroid cartilage penetration was more common than expected. Alternate methods of pretreatment assessment are needed.
authors.affiliation: Department of Radiation Oncology, Emory University School of Medicine, 1365 Clifton Rd NE, Atlanta, GA 30322-1013, USA. jjbeitl@emory.edu
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Beitler
authors.forename: Susan
authors.initials: S
authors.lastname: Muller
authors.forename: William J
authors.initials: WJ
authors.lastname: Grist
authors.forename: Amanda
authors.initials: A
authors.lastname: Corey
authors.forename: Adam M
authors.initials: AM
authors.lastname: Klein
authors.forename: Michael M
authors.initials: MM
authors.lastname: Johns
authors.forename: Charles L
authors.initials: CL
authors.lastname: Perkins
authors.forename: Lawrence W
authors.initials: LW
authors.lastname: Davis
authors.forename: Unni
authors.initials: U
authors.lastname: Udayasanker
authors.forename: Jerome C
authors.initials: JC
authors.lastname: Landry
authors.forename: Dong M
authors.initials: DM
authors.lastname: Shin
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Hudgins
mesh_terms: D006801:Humans; D007817:Laryngeal Cartilages / Q000000981:diagnostic imaging* / Q000473:pathology; D007822:Laryngeal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D007825:Laryngectomy; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D018579:Patient Selection; D011237:Predictive Value of Tests; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012598:Sclerosis; D014057:Tomography, X-Ray Computed