Staging of Laryngeal and Hypopharyngeal Cancer: Computed Tomography versus Histopathology

Computed tomography (CT) imaging is the choice of investigation for evaluation of extent of tumor under the mucosa, locally and regionally. This study was undertaken to assess the accuracy of preoperative CT imaging in the staging of carcinoma of the larynx and hypopharynx.

In this retrospective study, all cases who were clinically (c) staged T3-T4 and who underwent surgery were evaluated. The sensitivity (Sn), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), and accuracy (Ac) of a preoperative CT scan to detect cartilaginous penetration and spread outside the larynx was evaluated. Clinical T-stage by CT imaging was compared with postoperative histopathological T-stage.

There were 22 (96%) male patients and one (4%) female patient. Patients were aged from 48 to 64 years (mean, 56 years). Twenty (87%) patients had laryngeal carcinoma, whereas three (13%) had hypopharyngeal carcinoma. Four (17%) patients had T3 tumors and 19 (83%) had T4a lesions. Preoperative imaging over-staged one of five pathological (p) T3 cases and three out of three pT2 cases, and was accurate in the remaining 19 cases. In a comparison of the results of imaging with histopathological T-classification, T-staging was found to be 82.6% accurate.

CT is a precise and non-invasive imaging method with high sensitivity but relatively lower specificity because of increased false positives. CT imaging may be useful to guide the choice of surgical procedure, which can heavily impact a patients' quality of life.