Laryngeal cancer: is computed tomography a valuable imaging technique? A retrospective analysis.

OBJECTIVE

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.

METHODS

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.

RESULTS

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.

CONCLUSION

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.