Bloom C, Just N, Remy H, Black M, Rossignol M
Department of Radiology, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, Que.
Can Assoc Radiol J. 1998 Dec;49(6):370-7.
Our objectives were threefold: to evaluate the sensitivity and specificity of laryngeal computed tomography (CT) in the evaluation of laryngeal cancer, to determine the positive and negative predictive values of CT in assessing laryngeal cancer with respect to patient outcome, and to compare the CT staging of laryngeal cancer with endoscopy.
We reviewed the records of 77 consecutive patients with endoscopically proven laryngeal cancer. All patients underwent nonhelical CT evaluation of the larynx, with 23 subsequently undergoing surgery and 54 undergoing radiotherapy. The CT findings in the surgical cohort were compared with the pathologic analysis of resected specimens and with endoscopic data using a predetermined checklist of 14 regions of surgical interest. All the CT data in the radiotherapy cohort were compared with patient outcome in an attempt to define regions of tumour involvement that may predict disease recurrence after radiotherapy.
CT evaluation of laryngeal cancer had an overall sensitivity of 74% and a specificity of 93%. In the radiotherapy cohort, CT had an overall positive predictive value of 51% and a negative predictive value of 62% for disease recurrence after radiotherapy. Compared with endoscopic examination, CT resulted in upgrading of clinical staging in 43% of patients in the surgical cohort and 33% of patients in the radiotherapy cohort.
Our findings suggest that, despite the superiority of CT over endoscopy in the assessment of laryngeal cancer, this imaging technique is weak in staging advanced laryngeal cancer and is poor in predicting clinical outcome following radiotherapy.
我们的目标有三个：评估喉部计算机断层扫描（CT）在评估喉癌方面的敏感性和特异性，确定CT在评估喉癌患者预后方面的阳性和阴性预测值，并将喉癌的CT分期与内镜检查结果进行比较。
我们回顾了77例经内镜证实为喉癌患者的记录。所有患者均接受了喉部非螺旋CT评估，其中23例随后接受了手术，54例接受了放射治疗。将手术队列中的CT检查结果与切除标本的病理分析以及使用14个手术感兴趣区域的预定检查表得出的内镜数据进行比较。对放疗队列中的所有CT数据与患者预后进行比较，以试图确定可能预测放疗后疾病复发的肿瘤累及区域。
CT对喉癌的评估总体敏感性为74%，特异性为93%。在放疗队列中，CT对放疗后疾病复发的总体阳性预测值为51%，阴性预测值为62%。与内镜检查相比，CT使手术队列中43%的患者和放疗队列中33%的患者的临床分期得到了升级。
我们的研究结果表明，尽管CT在评估喉癌方面优于内镜检查，但这种成像技术在晚期喉癌分期方面存在不足，并且在预测放疗后的临床结局方面表现不佳。
