Prognostic Accuracy of Computed Tomography Findings for Patients With Laryngeal Cancer Undergoing Laryngectomy
Prognostic Accuracy of Computed Tomography Findings for Patients With Laryngeal Cancer Undergoing Laryngectomy
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DOI：
10.1200/jco.2009.24.7544
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发表时间：
2010-05-10
影响因子：
45.3
通讯作者：
Hudgins, Patricia A.
中科院分区：
文献类型：
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作者：
Beitler, Jonathan J.;Muller, Susan;Hudgins, Patricia A.
目的在喉癌治疗中进行前期喉切除术的适应症是无功能的喉和喉外延伸。实际上，临床医生依靠影像学来预测哪些患者将患有 T4 疾病。我们的目标是审查术前计算机断层扫描 (CT) 扫描的准确性，以确定晚期喉癌初次喉切除术的必要性。患者和方法总共审查了 107 个连续的未经治疗的喉切除标本，这些标本均具有由我们的神经放射科医生解释的高质量术前 CT 成像。放射学检查结果，包括硬化、侵袭、渗透、喉外扩散和声门下延伸，与病理结果相关。 CT 图像没有重新解释，因为我们的目的是评估原始解释。结果 CT 成像报告 23 例甲状软骨穿透和 27 例喉外扩散。病理报告甲状软骨侵犯12例，穿透29例，喉外病变45例。 CT 成像在 29 例病理记录的甲状软骨穿透病例中发现了 17 例（59%），在 45 例病理记录的喉外扩散病例中发现了 22 例（49%）。 45 例病例中有 18 例（40%）经病理证实发生喉外扩散但未穿透甲状软骨。甲状软骨穿透和喉外扩散的阳性预测值为74%和81%。硬化在预测甲状软骨侵袭或渗透方面的价值有限。环状软骨或杓状软骨破坏预测甲状软骨穿透的概率分别为57%和63%。结论CT成像在判断晚期喉癌是否有甲状软骨穿透或喉外扩散时具有明显的局限性。未穿透甲状软骨的喉外扩散比预期更为常见。需要替代的预处理评估方法。
PurposeThe 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.Patients and MethodsIn 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.ResultsCT 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%.ConclusionCT 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.