How reliably can computed tomography predict thyroid invasion prior to laryngectomy?

Area of Science:

• Otolaryngology
• Oncology
• Radiology

Background:

• Thyroidectomy during total laryngectomy lacks strong evidence and can cause hypothyroidism and hypoparathyroidism.
• Oncological control remains the priority in laryngeal cancer surgery.
• Accurate preoperative assessment of thyroid invasion is crucial to avoid unnecessary thyroid resection.

Purpose of the Study:

• To evaluate the utility of preoperative computed tomography (CT) in predicting thyroid gland invasion in patients undergoing total laryngectomy for squamous cell carcinoma.
• To determine the accuracy of CT findings, specifically extralaryngeal spread, in identifying thyroid involvement.

Main Methods:

• An ambispective cohort study included 79 patients who underwent total laryngectomy for squamous cell carcinoma between 2006 and 2016.
• Histological reports of thyroid invasion served as the gold standard.
• CT reports were analyzed for intralaryngeal, laryngeal cartilage, and extralaryngeal tumor spread.

Main Results:

• Nine patients (11.29%) had histologically confirmed thyroid invasion.
• CT demonstrated a 100% negative predictive value for extralaryngeal spread predicting thyroid involvement.
• CT also showed a 100% negative predictive value for ruling out thyroid invasion when extralaryngeal spread was absent.

Conclusions:

• Preoperative computed tomography is a valuable tool for excluding thyroid gland invasion in total laryngectomy candidates.
• The absence of extralaryngeal spread on CT scans is a highly specific and sensitive indicator, supporting the avoidance of routine thyroidectomy.