Clinical staging in laryngeal cancer: accuracy of the 0- and 30-degree Hopkins rod-lens endoscope in measuring tumour extent: an experimental study with 23 volunteers: Our Experience

Abstract Purpose Accurate therapeutic management of the neck is a challenge in patients with supraglottic laryngeal cancer. Nodal metastasis is common at all disease stages, and treatment planning relies on clinical staging of the neck, for both surgical and non-surgical treatment. Here, we compared clinical and surgical staging results in supraglottic carcinoma patients treated with primary surgery to assess the accuracy of pre-therapeutic clinical staging and guide future treatment decisions. Methods Retrospective analysis of clinical, pathological, and oncologic outcome data of 70 patients treated with primary surgery and bilateral neck dissection for supraglottic laryngeal cancer. Patients where clinical and pathological neck staging results differed, were identified and analyzed in detail. Results On pathologic assessment, patients with early stage (pT1/2) primaries showed cervical lymph node metastases in 55% (n = 17/31) of cases, compared to 67% (n = 26/39) of patients with pT3/4 tumors. In 24% (n = 17/70) of all patients, cN status differed from pN status, resulting in an upstaging in 16% of cases (n = 11/70) and a downstaging in 9% (n = 6/70) of cases. 14% of patients with cN0 status had occult metastases (n = 5/30). As assessed by a retrospective tumor board, in case of a non-surgical treatment approach, the inaccurate clinical staging of the neck would have led to an over- or undertreatment of the neck in 20% (n = 14/70) of all patients. Conclusion Our data re-emphasize the high cervical metastasis rates of supraglottic laryngeal cancer across all stages. Inaccurate clinical staging of the neck is common and should be taken into consideration when planning treatment.

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What Have Whole Organ Sections Contributed to the Treatment of Laryngeal Cancer?

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348948909800901 ◽

1989 ◽

Vol 98 (9) ◽

pp. 661-667 ◽

Cited By ~ 82

Author(s):

John A. Kirchner

Keyword(s):

Magnetic Resonance Imaging ◽

Computed Tomography ◽

Magnetic Resonance ◽

Laryngeal Cancer ◽

Clinical Staging ◽

Partial Laryngectomy ◽

Resonance Imaging ◽

Early Stages ◽

Accurate Interpretation ◽

Reliable Basis

The study of whole organ sections of laryngectomy specimens has demonstrated the patterns by which cancer spreads from one part of the larynx and hypopharynx to another. These studies have also demonstrated the fibroelastic membranes and ligaments that form the boundaries of intralaryngeal compartments within which cancer is confined in its early stages. They thus have added support to the concept of partial laryngectomy for selected lesions and have illustrated the features of those types of laryngeal cancer that have not responded well to radiotherapy. Whole organ sections of laryngectomy specimens have allowed a more accurate interpretation of preoperative computed tomography and magnetic resonance imaging and have provided a reliable basis for clinical staging.

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The Degree to Which Accuracy of Preoperative Staging of Laryngeal Carcinoma has been Enhanced by Computed Tomography

Otolaryngology ◽

10.1177/019459988609500112 ◽

1986 ◽

Vol 95 (1) ◽

pp. 52-62 ◽

Cited By ~ 33

Author(s):

George P. Katsantonis ◽

Carol R. Archer ◽

Barry N. Rosenblum ◽

Vernon L. Yeager ◽

William H. Friedman

Keyword(s):

High Resolution ◽

Laryngeal Cancer ◽

Clinical Evaluation ◽

Preoperative Staging ◽

University Hospital ◽

Clinical Staging ◽

Partial Laryngectomy ◽

Glottic Carcinoma ◽

High Resolution Ct ◽

Pathologic Staging

In this retrospective study, the accuracy of preoperative staging by high-resolution CT and clinical evaluation (indirect-direct laryngoscopy) is compared to the postsurgical pathologic staging of laryngeal cancer. Forty-two patients who were admitted to St. Louis University Hospital between the years of 1978 to 1985 with diagnoses of laryngeal cancer were included. All patients received high-resolution CT scan of the larynx preoperatively and subsequently underwent total or partial laryngectomy. None of these patients received preoperative radiotherapy. The accuracy of the clinical vs. CT staging—as well as the accuracy of the staging by combination of the two modalities—was determined by comparison with the postsurgical pathologic staging. The accuracy was assessed separately for glottic, supraglottic, and transglottic carcinoma. The accuracy of CT staging for glottic carcinoma was 75%. However, clinical evaluation in this group of lesions was very reliable, offering 92.9% accuracy. The accuracy of CT staging increased in the supraglottic and transglottic lesions, to become superior to the clinical staging. With combined information gained by both examinations, the preoperative staging accuracy was 91.4% for supraglottic carcinoma and 87.5% for transglottic carcinoma. It is, therefore, recommended that high-resolution CT should be included in the preoperative staging of laryngeal cancer.

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END RESULTS OF RADIOTHERAPY IN LARYNGEAL CANCER BASED UPON CLINICAL STAGING BY THE T.N.M. SYSTEM

American Journal of Roentgenology ◽

10.2214/ajr.96.3.588 ◽

1966 ◽

Vol 96 (3) ◽

pp. 588-592 ◽

Cited By ~ 7

Author(s):

RALPH M. CAULK

Keyword(s):

Laryngeal Cancer ◽

Clinical Staging ◽

End Results

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Implications for clinical staging of metastatic cutaneous squamous carcinoma of the head and neck based on a multicenter study of treatment outcomes

The Journal of Laryngology & Otology ◽

10.1017/s0022215106002891 ◽

2005 ◽

pp. 1

Keyword(s):

Head And Neck ◽

Treatment Outcomes ◽

Multicenter Study ◽

Squamous Carcinoma ◽

Clinical Staging

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Experimental study on the restoration from a tilt-azimuth series for improvement in resolution

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s042482010013955x ◽

1995 ◽

Vol 53 ◽

pp. 636-637

Author(s):

Norio Baba ◽

Norihiko Ichise ◽

Syunya Watanabe

Keyword(s):

Experimental Study ◽

Spherical Aberration ◽

Incident Beam ◽

Optical Parameters ◽

Beam Tilting ◽

Illumination Method ◽

Restoration Method ◽

Illumination Mode

The tilted beam illumination method is used to improve the resolution comparing with the axial illumination mode. Using this advantage, a restoration method of several tilted beam images covering the full azimuthal range was proposed by Saxton, and experimentally examined. To make this technique more reliable it seems that some practical problems still remain. In this report the restoration was attempted and the problems were considered. In our study, four problems were pointed out for the experiment of the restoration. (1) Accurate beam tilt adjustment to fit the incident beam to the coma-free axis for the symmetrical beam tilting over the full azimuthal range. (2) Accurate measurements of the optical parameters which are necessary to design the restoration filter. Even if the spherical aberration coefficient Cs is known with accuracy and the axial astigmatism is sufficiently compensated, at least the defocus value must be measured. (3) Accurate alignment of the tilt-azimuth series images.

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