Staging of Laryngeal and Hypopharyngeal Cancer: Computed Tomography versus Histopathology

Document Type: Original


Department of Otorhinolaryngology, Kasturba Medical College, Mangalore, MAHE. India.


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.
Materials and Methods:
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.


Main Subjects

1. Hoffman HT, Karnell LH, Funk GF, Robinson RA Menck HR. The National Cancer Data Base report on cancer of the head and neck. Arch Otolaryngol Head Neck Surg. 1998;124:951–62.

2. Chu EA, Kim YJ. Laryngeal cancer: diagnosis and preoperative work-up. Otolaryngol Clin North Am. 2008;41: 673–95.

3. Shah JP, Karnell LH, Hoffman HT,   Ariyan S,   Brown GS, Fee WE, et al. Patterns of care for cancer of the larynx in the United States. Arch Otolaryngol Head Neck Surg. 1997; 123:475–83.

4.  Pignon JP, Bourhis J, Domenge C,  Designé BSc L.  Chemotherapy added to locoregional treatment for head and neck squamous-cell carcinoma: three meta-analyses of updated individual data. MACH-NC Collaborative Group. Meta-Analysis of Chemotherapy on Head and Neck Cancer. Lancet. 2000; 355:949–55.

5. Connor S. Laryngeal cancer: How does the radiologist help? Cancer Imaging. 2007;7:93–103.

6. Zbaren P, Becker M, Läng H. Pretherapeutic staging of laryngeal carcinoma: Clinical findings, CT and MRI with histopathology. Cancer. 1996; 77:1263–73.

7. Becker M, Zbären P, Delavelle J, Kurt AM, Egger C, Rüfenacht DA, et al. Neoplastic invasion of laryngeal cartilage: Reassessment of criteria for diagnosis at CT. Radiology. 1997;203(2):521–32.

8. Wolf GT. Routine computed tomography scanning for tumor staging in advanced laryngeal cancer: implications for treatment selection. J Clin Oncol. 2010; 28:2315–17.

9. Keberle M, Sandstede J, Hoppe F, Fischer M, Hahn D. Diagnostic impact of Multiplanar Reformations in Multi-Slice CT of laryngeal and hypopharyngeal carcinomas. Fortschr Röntenstr. 2003; 175:1079–85.

10. Thabet HM, Sessions DG, Gado MH, Gnepp DA, Harvey JE, Talaat M. Comparison of clinical evaluation and computed tomographic diagnostic accuracy for tumors of the larynx and hypopharynx. Laryngoscope. 1996;106 (5 Pt 1): 589–94.

11. Dullerud R, Johansen JG, Dahl T, Faye-lund H. Influence of CT on tumor classification of laryngeal carcinomas. Acta Radiologica. 1992; 33: 314–18.

12. Ferri T, Thomasis G, Quaranta N, Bacchi G, Bottazzi D. The value of CT scans in improving laryngoscopy in patients with laryngeal cancer. Eurp Arch Otorhinolaryngol. 1999;256:395–9.

13. Zinreich SJ. Imaging in Laryngeal cancer: computed tomography, magnetic resonance imaging, positron emission tomography. Otolaryngologic Clinics North Am.2002;35:971-91.

14. Bertrand MTollard EFrançois A, Bouchetetemble P Marie PJ Dehesdin D, et al. CT scan, MR imaging and anatomopathologic correlation in the glottic carcinoma T1-T2. Rev Laryngol Otol Rhinol. 2010; 131:51–7.

15. Atlanoğlu S, Kezban-Gürbüz MK, Açıkalın M, Adapınar B, Özüdoğru E. Laryngeal cancer: Radiological Staging by Multislice Computed Tomography and Pathological Correlation. Osmangazi J Med. 2016; 38.

16. Beitler JJ, Muller S, Grist WJ, Corey A, Klein AM, Johns MM, et al. Prognostic accuracy of CT findings for patients with laryngeal cancer undergoing laryngectomy. J Clin Oncol. 2010; 28: 2318–22.

17. Hartl DM, Landry G, Bidault F et al. CT-scan prediction of thyroid cartilage invasion for early laryngeal squamous cell carcinoma. Eur Arch Otorhinolaryngol. 2013; 270:287–91.

18. Ryu IS, Lee JH, Jong-Lyel R, Seung-Ho C, Nam SY, Kim SY, Kyung-Ja C. Clinical implication of computed tomography findings in patients with locally advanced squamous cell carcinoma of the larynx and hypopharynx. Eur Arch Otorhinolaryngol 2015; 272:2939–45.

19. Agada FO, Nix PA, Salvage D, Stafford ND. Computerized tomography vs. pathological staging of laryngeal cancer: a 6-year completed audit cycle. Int J Clin Pract 2004;58:714–16.

20. Allegra E, Ferrise P, Trapasso S et al. Early Glottic Cancer: Role of MRI in the Preoperative Staging. BioMed Res Int. 2014, Article ID 890385.