Paolo Potepan MD, Presenter: Nothing to Disclose

Eros Montin Dipl Eng, PhD, Abstract Co-Author: Nothing to Disclose

Roberto Bianchi MD, Abstract Co-Author: Nothing to Disclose

Marco Guzzo MD, Abstract Co-Author: Nothing to Disclose

Luca Tommaso Mainardi PhD, Abstract Co-Author: Nothing to Disclose

Gabriele Scaramellini MD, Abstract Co-Author: Nothing to Disclose

To evaluate accuracy of magnetic resonance (MR) imaging in local extension of advanced laryngeal squamous cell carcinoma (T3-T4).

Eleven patients (M/F=10/1; median age: 60 years, range 40-74) affected by local advanced laryngeal carcinoma were evaluated with a preoperative MR using coupled phased array and surface coils with pre and post-contrast images. Seven patients had no previous therapy, 3 were relapses after laser cordectomy, 1 after radiotherapy. After total laryngectomy, formalin-fixed whole organ was dissected in axial planes parallel to the glottic plane, obtaining slices similar to MR imaging. Macroscopic tumor extension was identified and defined on the axial slices from the specimen and compared to the corresponding MR images. In each larynx 24 anatomical structures of clinical-surgical significance related to treatment choice were evaluated and comparison between RM imaging and sectional macroscopic pathology was obtained on a per-site analysis, furthermore parameters defining T4 stage: cartilage and extralaryngeal invasion; and subglottic extension were analyzed for sensibility and specificity, accuracy, positive predictive value (VPP), negative predictive value (VPN) ± 95% confidence interval (CI).

Sensibility, specificity and accuracy of MR calculated on the 264 laryngeal anatomical structures were 93% (± 3,06), 88% (± 3,9) and 91% (± 3,48) respectively. VPP and VPN were 91% (± 3,52) and 91% (± 3,41). MR sensibility, specificity and accuracy on thyroid cartilage invasion was 85%, 100% and 92%, VPP and VPN 100% and 87%. Sensibility, specificity and accuracy on extralaryngeal spread were 100%, 73% e 86%, VPP and VPN 79% e 100%. All values on subglottic extension resulted 100%.

RM allows optimal differentiation between neoplastic tissue and cartilage, muscle and adipose tissues of the larynx. It can be used as diagnostic tool for the correct therapeutical approach and to choose between conservative treatments or radical surgery. A limitation is the small number of patients and the generalized advanced T status.

Pretherapeutic local staging accuracy with MR with surface coils rises to 91% for advanced cases, improving T classification based on clinical and endoscopic criteria, imaging is always necessary.

Potepan, P, Montin, E, Bianchi, R, Guzzo, M, Mainardi, L, Scaramellini, G, Local Staging in Laryngeal Carcinoma: Radiologic-Pathologic Correlations—MR Imaging versus Histopathology.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9013959.html