open access

Vol 24, No 5 (2019)
Original research articles
Published online: 2019-09-01
Submitted: 2018-07-31
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Assessment of cartilage invasion in case of laryngeal cancer by means of longitudinal sectioning for histopathology – Clinical implications

Liucija Weselik, Ewa Majchrzak, Matthew Ibbs, Adam Lewandowski, Andrzej Marszałek, Piotr Machczyński, Wojciech Golusiński
DOI: 10.1016/j.rpor.2019.07.002
·
Rep Pract Oncol Radiother 2019;24(5):443-449.

open access

Vol 24, No 5 (2019)
Original research articles
Published online: 2019-09-01
Submitted: 2018-07-31

Abstract

Aim

The aim of the study was to assess the accuracy of radiological diagnosis of laryngeal cartilage infiltration by histopathological examination of laryngeal specimen after total laryngectomy.

Background

Despite the development of new medical technologies and significant clinical advances allowing early diagnosis and treatment of laryngeal cancer, mortality is still on the rise. Neoplastic infiltration of the laryngeal cartilages is the most common source of error in the assessment of cancer staging. Furthermore, cartilage invasion is listed as a contraindication to partial surgical techniques as well as radiotherapy.

Materials and methods

The study was carried out on 21 larynges following total laryngectomy. Before taking the decision to perform surgery, high-resolution CT scans were performed in all cases. An extended histopathological examination was conducted using a unique vertical cross-section of the whole larynx.

Results

Pathology reported 2 cases of arytenoid cartilage invasion, 5 cases of cricoid cartilage invasion, 12 cases of thyroid cartilage penetration, 1 case of internal cortex invasion and 9 cases of extra-laryngeal spread. CT imaging identified 8 of 13 cases (61.5%) of pathologically proven invasion of thyroid cartilage and only 2 cases (2/9, 22%) of extra-laryngeal spread. According to CT results, arytenoid cartilage invasion was correctly identified in 2 cases, cricoid cartilage invasion in 4 (4/5, 80%). The positive predictive values for thyroid, cricoid and arytenoid cartilage invasion and penetration were 80%, 66.7% and 50%, respectively. In case of pre-laryngeal spread the positive predictive value was 100%.

Conclusion

Despite increasingly advanced methods involved in the diagnosis of laryngeal cancer, many discrepancies may be observed between the radiological and histopathological assessments. CT imaging has limitations especially in thyroid cartilage penetration and extra-laryngeal spread assessment in advanced laryngeal cancer cases. An extended histopathological examination, involving vertical cross-sections of the whole larynx is a very precise study that allows a precise determination of local cancer staging (T).

Abstract

Aim

The aim of the study was to assess the accuracy of radiological diagnosis of laryngeal cartilage infiltration by histopathological examination of laryngeal specimen after total laryngectomy.

Background

Despite the development of new medical technologies and significant clinical advances allowing early diagnosis and treatment of laryngeal cancer, mortality is still on the rise. Neoplastic infiltration of the laryngeal cartilages is the most common source of error in the assessment of cancer staging. Furthermore, cartilage invasion is listed as a contraindication to partial surgical techniques as well as radiotherapy.

Materials and methods

The study was carried out on 21 larynges following total laryngectomy. Before taking the decision to perform surgery, high-resolution CT scans were performed in all cases. An extended histopathological examination was conducted using a unique vertical cross-section of the whole larynx.

Results

Pathology reported 2 cases of arytenoid cartilage invasion, 5 cases of cricoid cartilage invasion, 12 cases of thyroid cartilage penetration, 1 case of internal cortex invasion and 9 cases of extra-laryngeal spread. CT imaging identified 8 of 13 cases (61.5%) of pathologically proven invasion of thyroid cartilage and only 2 cases (2/9, 22%) of extra-laryngeal spread. According to CT results, arytenoid cartilage invasion was correctly identified in 2 cases, cricoid cartilage invasion in 4 (4/5, 80%). The positive predictive values for thyroid, cricoid and arytenoid cartilage invasion and penetration were 80%, 66.7% and 50%, respectively. In case of pre-laryngeal spread the positive predictive value was 100%.

Conclusion

Despite increasingly advanced methods involved in the diagnosis of laryngeal cancer, many discrepancies may be observed between the radiological and histopathological assessments. CT imaging has limitations especially in thyroid cartilage penetration and extra-laryngeal spread assessment in advanced laryngeal cancer cases. An extended histopathological examination, involving vertical cross-sections of the whole larynx is a very precise study that allows a precise determination of local cancer staging (T).

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Keywords

Laryngeal cancer; Total laryngectomy; Histopathological examination; Cartilage infiltration

About this article
Title

Assessment of cartilage invasion in case of laryngeal cancer by means of longitudinal sectioning for histopathology – Clinical implications

Journal

Reports of Practical Oncology and Radiotherapy

Issue

Vol 24, No 5 (2019)

Pages

443-449

Published online

2019-09-01

DOI

10.1016/j.rpor.2019.07.002

Bibliographic record

Rep Pract Oncol Radiother 2019;24(5):443-449.

Keywords

Laryngeal cancer
Total laryngectomy
Histopathological examination
Cartilage infiltration

Authors

Liucija Weselik
Ewa Majchrzak
Matthew Ibbs
Adam Lewandowski
Andrzej Marszałek
Piotr Machczyński
Wojciech Golusiński

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