Patterns of framework invasion in patients with laryngeal cancer: correlation of in vitro magnetic resonance imaging and pathological findings.

Total laryngectomy for laryngeal squamous cell carcinoma means a drastic change in the way of living for a patient. New surgical techniques such as laser surgery attempt to save the voice. To be oncologically correct, an accurate assessment of the tumor extent is necessary. Imaging is especially important in determining tumor extent in the regions where conventional and endoscopic ENT examinations are less accurate. Correlations of CT, in vivo MRI and pathological findings after surgery have demonstrated that MRI is more sensitive than CT, but that it overestimates the degree of cartilage invasion. Cartilage invasion is believed to be a contraindication to radiation therapy and voice-sparing surgery. In a prospective study, Gd-enhanced in vitro MRI of 10 total laryngectomy specimens was correlated with subsequent pathological examination. Good correlation of the anatomical relationships of the tumor between the in vitro images and gross pathology were found. Important is the absence of false negatives in our study, indicating that cartilage invasion can be ruled out when a normal signal intensity on in vitro MRI of the cartilage is seen. This has important oncological implications for partial voice-sparing laryngeal surgery.