title: CT-scan prediction of thyroid cartilage invasion for early laryngeal squamous cell carcinoma.
abstract: Treatment choice for laryngeal cancer may be influenced by the diagnosis of thyroid cartilage invasion on preoperative computed tomography (CT). Our objective was to determine the predictive value of CT for thyroid cartilage invasion in early- to mid-stage laryngeal cancer. Retrospective study (1992-2008) of laryngeal squamous cell carcinoma treated with open partial laryngectomy and resection of at least part of the thyroid cartilage. Previous laser surgery, radiation therapy, chemotherapy and second primaries were excluded. CT prediction of thyroid cartilage invasion was determined by specialized radiologists. Tumor characteristics and pathologic thyroid cartilage invasion were compared to the radiologic assessment. 236 patients were treated by vertical (20 %), supracricoid (67 %) or supraglottic partial laryngectomy (13 %) for tumors staged cT1 (26 %), cT2 (55 %), and cT3 (19 %). The thyroid cartilage was invaded on pathology in 19 cases (8 %). CT's sensitivity was 10.5 %, specificity 94 %, positive predictive value 13 %, and negative predictive value 92 %. CT correctly predicted thyroid cartilage invasion in only two cases for an overall accuracy of 87 %. Among the false-positive CT's, tumors involving the anterior commissure were significantly over-represented (61.5 % vs. 27 %, p = .004). Tumors with decreased vocal fold (VF) mobility were significantly over-represented in the group of false-negatives (41 vs. 13 %, p = .0035). Preoperative CT was not effective in predicting thyroid cartilage invasion in these early- to mid-stage lesions, overestimating cartilage invasion for AC lesions and underestimating invasion for lesions with decreased VF mobility.
authors.affiliation: Department of Head and Neck Oncology, Institut Gustave Roussy, 114 rue Edouard Vaillant, 94805, Villejuif Cedex, France. dana.hartl@igr.fr
authors.forename: Dana M
authors.initials: DM
authors.lastname: Hartl
authors.forename: Guillaume
authors.initials: G
authors.lastname: Landry
authors.forename: François
authors.initials: F
authors.lastname: Bidault
authors.forename: Stéphane
authors.initials: S
authors.lastname: Hans
authors.forename: Morbize
authors.initials: M
authors.lastname: Julieron
authors.forename: Gérard
authors.initials: G
authors.lastname: Mamelle
authors.forename: François
authors.initials: F
authors.lastname: Janot
authors.forename: Daniel F
authors.initials: DF
authors.lastname: Brasnu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D007822:Laryngeal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D007825:Laryngectomy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013957:Thyroid Cartilage / Q000000981:diagnostic imaging / Q000473:pathology*; D014057:Tomography, X-Ray Computed