Zbären P, Becker M, Läng H
Department of Otorhinolaryngology, University Hospital, Bern, Switzerland.
Arch Otolaryngol Head Neck Surg. 1997 Sep;123(9):908-13. doi: 10.1001/archotol.1997.01900090016003.
To assess the accuracy of preoperative computed tomography (CT), magnetic resonance imaging (MRI), and clinical and endoscopic tumor evaluation and to analyze the impact of these diagnostic modalities on pretherapeutic staging of hypopharyngeal carcinoma.
Prospective study of 44 consecutive patients with hypopharyngeal carcinoma undergoing surgical resection.
Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital, Bern, Switzerland.
All patients underwent contrast-enhanced CT, MRI at 1.5 T, indirect laryngoscopy, and direct laryngoscopy. The surgical specimens were cut in whole-organ slices parallel to the plane of the axial CT and MRI scans. The histologic findings were compared with the findings of the different diagnostic modalities.
The main tumor site was misdiagnosed by endoscopy in 7 (16%) of 44 patients and by CT and MRI in 16 (36%) of 44 patients. Neoplastic invasion of cartilage was present in 21 (48%) of 44 laryngectomy specimens. Magnetic resonance imaging was more sensitive in detecting neoplastic invasion of cartilage than CT (97% vs 68%; P = .002). Magnetic resonance imaging was less specific than CT (62% vs 84%; P = .02), taking into account the thyroid and cricoid cartilages. There was no difference between the overall accuracy of CT and MRI in detecting neoplastic invasion of cartilage (78% vs 75%). Clinical and endoscopic evaluation failed to correctly stage 16 (36%) of 44 patients. Combined clinical and CT evaluation and combined clinical and MRI evaluation failed to correctly stage 12 and 13 of 44 patients, respectively.
The assessment of tumor site is more accurate using endoscopic evaluation than CT or MRI. Magnetic resonance imaging is more sensitive in detecting neoplastic cartilage invasion than CT, whereas CT is more specific. Clinical and endoscopic evaluation of tumor stage alone fails to identify invasion of the laryngeal framework. Therefore, many tumors staged pT4 are clinically understaged. The preoperative staging accuracy was improved by combining the information gained using both clinical evaluation and CT or MRI. However, there was no difference in the staging accuracy between CT and MRI.
评估术前计算机断层扫描（CT）、磁共振成像（MRI）以及临床和内镜下肿瘤评估的准确性，并分析这些诊断方式对下咽癌治疗前分期的影响。
对44例连续接受手术切除的下咽癌患者进行的前瞻性研究。
瑞士伯尔尼大学医院头颈外科耳鼻喉科。
所有患者均接受增强CT、1.5T MRI、间接喉镜检查和直接喉镜检查。手术标本沿与轴向CT和MRI扫描平面平行的方向切成全器官切片。将组织学检查结果与不同诊断方式的结果进行比较。
44例患者中，7例（16%）的主要肿瘤部位经内镜误诊，16例（36%）经CT和MRI误诊。44例喉切除标本中有21例（48%）存在肿瘤侵犯软骨。MRI在检测肿瘤侵犯软骨方面比CT更敏感（97%对68%；P = 0.002）。考虑到甲状腺和环状软骨，MRI的特异性低于CT（62%对84%；P = 0.02）。CT和MRI在检测肿瘤侵犯软骨方面的总体准确性无差异（78%对75%）。临床和内镜评估未能正确对44例患者中的16例（36%）进行分期。临床与CT联合评估以及临床与MRI联合评估分别未能正确对44例患者中的12例和13例进行分期。
使用内镜评估对肿瘤部位的评估比CT或MRI更准确。MRI在检测肿瘤侵犯软骨方面比CT更敏感，而CT更具特异性。单纯的临床和内镜肿瘤分期评估无法识别喉支架的侵犯情况。因此，许多被分期为pT4的肿瘤在临床上分期不足。通过结合临床评估和CT或MRI获得的信息，术前分期准确性得到提高。然而，CT和MRI在分期准确性方面没有差异。
