Ultrasonography in laryngeal cancers

Evaluation of hypopharyngeal carcinoma using high-resolution ultrasound: comparison with CT

BACKGROUND

To evaluate the role of sonography (US) in assessing hypopharyngeal carcinoma when compared with CT.

METHODS

A randomized prospective study was performed on 40 biopsy-proven cases of hypopharyngeal carcinoma.Contrast-enhanced CT of the neck was performed in all patients, followed by US. Sonographic identification of any tumor extension into the extralaryngeal soft tissues, postcricoid space, subglottis, thyroid gland, esophagus, and across the midline was recorded. US observations and CT findings were compared and then correlated with the histopathologic findings in 14 operative cases. In the remaining 26 inoperable cases, US was compared only with CT.

RESULTS

Our cohort was composed of 38 men and 2 women ranging in age from 36 to 59 years. In a subset of 14 operative patients, US had a sensitivity of 71.4% (10/14), while CT achieved a sensitivity of 92.8% (13/14), and the difference was not statistically significant (p > 0.05). US and CT findings concurred in 67.5% (27/40) of cases.

CONCLUSIONS

Even though small tumors are difficult to visualize, US can play a significant role in the assessment of tumor extension within and beyond the larynx, especially when cross-sectional imaging is either unavailable or unaffordable.

Value of high resolution ultrasonography in assessment of laryngeal lesions

OBJECTIVE

The aim of this study is to evaluate the value of high resolution ultrasonography (HRUS) in diagnosis of various laryngeal lesions which already diagnosed with rigid endoscopy.

STUDY DESIGN

Prospective study with control group.

PATIENTS AND METHODS

Sixty-six patients were suffering from throat symptoms and pre-examined by rigid endoscopy under local anesthesia and diagnosed to have a laryngeal lesion and 32 volunteers compose the control group. All 98 persons (patients and control groups) were examined by HRUS.

RESULTS

HRUS was helpful in describing various laryngeal lesions, vocal fold polyps (17) 25.7%, glottic cancer (6) 9.1%, epiglottic enlargement (2) 3.1% and one patient had laryngocele (1.5%). HRUS was highly significant in diagnosis of subglottic lesions (10) 15.2%. Also vocal fold mobility can be demonstrated by HRUS. While interarytenoid lesions (17) 25.8% and small laryngeal lesions as vocal fold nodules (13) 19.6% were difficult to be described.

CONCLUSION

Rigid endoscopy in laryngeal examination gives us large, bright image but it is difficult to diagnose patients with a sensitive gag reflex, patients with neck or jaw diseases or stridor and very difficult in infants and children. HRUS is an alternative method in diagnosis of some laryngeal lesions, and it is superior in the diagnosis of small subglottic lesions.

Assessment of glottic squamous cell carcinoma: comparison of sonography and non-contrast-enhanced magnetic resonance imaging

OBJECTIVES

The purpose of this study was to compare the use of sonography and non-contrast-enhanced magnetic resonance imaging (MRI) for detection and staging of glottic carcinoma.

METHODS

In this study, 30 consecutive patients with glottic squamous cell carcinoma underwent high-frequency sonography and non-contrast-enhanced MRI before surgical treatment. Tumor detectability and imaging findings were evaluated independently and then compared with the surgical and postoperative pathologic findings.

RESULTS

Sonography showed a trend toward higher detectability than MRI in early (stage T1 and T2) glottic carcinoma (94.1% [16 of 17 patients] for sonography versus 76.5% [13 of 17 patients] for MRI; P = .335). With regard to T staging, the overall accuracy rates were 80.0% (24 of 30) for sonography and 76.7% (23 of 30) for MRI; the difference was not statistically significant (P > .99). Non-contrast-enhanced MRI was superior to sonography in showing tumor involvement in the retrolaryngeal extent of glottic carcinoma.

CONCLUSIONS

Sonography is suggested as a noninvasive complementary modality for detection and initial staging of glottic carcinoma.

[Ultrasound of the larynx, hypopharynx and upper esophagus]

Sonography is an integral part of the routine diagnosis of diseases of the head and neck area. Ultrasound plays an important role in particular in the diagnosis, treatment and follow-up of head and neck cancer. Sonographic imaging of the larynx, hypopharynx and upper esophagus is often difficult due to the anatomical conditions. Therefore, CT and MRI are performed as the imaging techniques of first choice for diseases of these organs. In addition to the well-established transcutaneous ultrasound, endoscopic endoluminal ultrasound has developed as a promising new technique in recent years. Hollow organs can be displayed in high resolution transcutaneously and endoluminally. Thus, the attending otolaryngologist can use endoscopy and ultrasonography for accurate surgical planning. The aim of the present paper is to present the possibilities and limitations of ultrasonography of the larynx, hypopharynx and upper esophagus.

Vascularity index of laryngeal cancer derived from 3-D ultrasound: a predicting factor for the in vivo assessment of cervical lymph node status

To demonstrate whether a calculated vascularity index (VI) can predict metastases of cervical lymph nodes, the VI values of the primary tumors were obtained by using 3-D sonography in 87 subjects with laryngeal cancer confirmed by laryngoscope and biopsy. N-staging of the subjects was determined by pathological nodal harvesting. The relationship between the VI and pathological N-staging was evaluated by correlation coefficient. To test the accuracy of the VI for predicting cervical lymph node involvement, a receiver operating characteristic (ROC) curve was constructed, and the best operating point was determined by Youden's index. For comparison, 2-D sonography was applied to detect metastatic cervical lymph nodes. The accuracy, sensitivity and specificity of the VI, 2-D sonography and a combination of the two methods for diagnosis of metastatic cervical lymph nodes were compared. There was a positive linear correlation between the VI and pN-staging (r=0.740, p<0.001). The area under the ROC curve for the VI was 0.919. The best operating point of the VI was 4.4565, which derived higher sensitivity than that of 2-D sonography (95% vs. 81%, p=0.031), but lower specificity (75% vs. 95%, p=0.012). The combination of the two methods yielded a higher accuracy (97% vs. 85% and 89%, p=0.002 and 0.016), a higher sensitivity to 2-D sonography (95% vs. 81%, p=0.031) and a higher specificity to VI (98% vs. 75%, p=0.002). The VI of laryngeal cancer can be a useful factor for predicting metastases of cervical lymph nodes.

Laryngeal cancer: how does the radiologist help?

The radiologist makes a valuable contribution to the staging of laryngeal cancer and this has a direct influence on treatment planning. This review focuses on the main anatomical concepts, patterns of tumour spread and how to detect this with optimal cross sectional imaging. Issues surrounding the relationship of tumour to the ventricular complex, submucosal laryngeal spaces, anteroposterior extension, laryngeal cartilage involvement and metastatic spread are discussed and illustrated. The impact of these imaging findings on the array of therapeutic options is described.

Value of ultrasonography in laryngeal and laryngopharyngeal cancers

High-resolution sonography has improved in the past few years and has become a very valuable tool in the diagnosis of diseases of the head and neck. Ultrasonography (US) is commonly the first imaging modality after clinical examination. It is inexpensive, noninvasive and is easily tolerated by patients. It provides valuable diagnostic information with a high degree of diagnostic accuracy. This article provides the most up-to-date information about the indications, findings and limitations of high-resolution sonography in the evaluation of laryngeal and laryngopharyngeal cancers.

Palpación y tc para evaluar las adenopatías cervicales en los tumores de cabeza y cuello

Lymphatic metastasis is an important prognostic factor in patients with head and neck squamous cell carcinomas. Diagnostic evaluation and treatment of this adenopathies is very important. We can use physical examination, computered tomography (CT), magnetic resonance, ultrasound... but none of these give us a 100% security. This study evaluates the accuracy of physical examination and CT in detecting cervical lymph nodes. 120 neck dissections were performed after palpation and CT of 72 patients with head and neck carcinoma. Sensitivity of palpation was 51.7 and specificity 96.7. CTs sensitivity was 65 and specificity 86.7. Both, physical examination and palpation have a high number of mistakes evaluating cervical nodes. N0 necks are still a problem for Head and Neck Surgeons.

The diagnostic value of ultrasonography to detect occult lymph node involvement at different levels in patients with squamous cell carcinoma in the maxillofacial region

The purpose of this study was to evaluate ultrasonography (US) and computed tomography (CT) in detecting lymphnodes of the neck affected with squamous cell carcinoma. From 1987 to 1999 the data from 203 untreated patients with a diagnosis of cancer in the maxillofacial have been investigated. Of these, 115 had a primary squamous-cell carcinoma. US diagnosis was made by an oral- and maxillofacial surgeon experienced in US of the head and neck. CT diagnosis was made by a well-experienced radiologist. The following lymph node levels were assesed: level I (submental and submandibular lymphnodes), level II (lymphnodes distal to level I and confined to the region above the skin crease at or just below the level of the thyroid notch), level III (lymphnodes distal to level II and confined to the anterior cervical triangle including those deep to the sternocleidomastoid muscle), and level IV (lymphnodes distal to level III and confined to the posterior cervical triangle). For all levels US yielded a sensitivity of 71%, and a specificity of 87%, while CT showed a sensitivity of 32% and a specificity of 96%. The sensitivity of US decreased from level I to level IV, whereas the specificity increased from level I to level IV. For lymphnode levels I and II US may be useful for the detection of local metastases while for the other levels the application of advanced techniques of US may have to be investigated.

Ultrasonography of laryngeal masses in six cats and one dog

Ultrasonography of laryngeal abnormalities in small animals allows the identification of laryngeal masses because of the resulting distortion of normal structural/anatomical relationships. It also allows fine-needle aspirates to be taken with minimal risk of causing hemorrhage or edema affecting the already narrowed laryngeal lumen. Findings in six cats and one dog with laryngeal abnormalities are described.

Ultrasonographic imaging of the tongue and larynx in normal dogs

Ultrasonographic imaging of the tongue and larynx was performed in 10 dogs with no previous history of upper airway disease. The ultrasonographic findings were compared with the normal canine anatomy of this area and with the results described in the human literature. This study shows that the anatomical features of the canine larynx are adequately detectable using ultrasonography. This finding is in accordance with the findings described in the human literature. It is concluded that ultrasonography may offer a means of investigating canine laryngeal abnormalities.

Accuracy of clinical examination versus computed tomography in detecting occult lymph node involvement in patients with oral epidermoid carcinoma

PURPOSE

To determine the accuracy of clinical examination versus computed tomography (CT) scanning in detecting positive cervical lymph nodes (N) in patients with epidermoid carcinomas of the oral cavity, 27 patients with epidermoid carcinomas were reviewed.

PATIENTS AND METHODS

The patients underwent 40 neck dissections, 20 with N- and 20 with N+ necks histologically. All patients were examined by the same clinician, and all CT scans were read by the same radiologist. Patients with clinical and CT N- necks underwent neck dissection only if the neck had to be entered to resect the primary tumor or if the primary tumor was T3 or T4 with a high probability of microscopic metastasis.

RESULTS

Of the 20 necks that were histologically N-, 16 (80%) were clinically diagnosed as N- and 4 (20%) N+ versus 18 (90%) N- and 2 (10%) N+ diagnosed by CT scan. Of the 20 histologically N+ necks, 12 (60%) were clinically diagnosed as N+ and 8 (40%) N- versus 11 (55%) N+ and 9 (45%) N- diagnosed by CT scan. All lymph nodes diagnosed as N- by both clinical examination and CT scan were less than 1 cm in diameter. Overall, clinical examination of the neck was correct in 28 patients (70%) and the CT scan was correct in 29 patients (73%). Both clinical examination and CT scan were more accurate in diagnosis of N- necks. In 31 necks (78%), the CT and clinical examination were in agreement. Of these, 10 of 10 (100%) were correctly positive. Of the 21 in which both were negative, 14 were histologically N-, and 14 (67%) were correct. Overall, in those cases in which both CT and clinical examination were in agreement, the diagnosis was correct in 24 of 31 (77%).

CONCLUSION

These results suggest that there is no significant difference in the accuracy of clinical examination versus CT scanning in detecting both positive and negative cervical nodes. When both CT and clinical examination agree, positive cervical nodes are almost always correctly diagnosed. However, one third of the negative cervical nodes were incorrectly diagnosed. Improved methods for detecting occult disease are still needed.

Ultrasound imaging in laryngeal cancer: a preliminary study

High resolution ultrasound is a promising technique in the assessment of laryngeal carcinoma, yet few published studies have appeared concerning its use. We set out to assess if ultrasound could correctly identify the site and size of known lesions, if unsuspected extralaryngeal spread or nodal involvement could be shown and if the results could be used to influence patient management. Fourteen patients with advanced laryngeal cancer (Stage T2 or above) were prospectively evaluated by systematic ultrasound technique, with the sonologist blind to the clinical findings. The results were correlated with clinical assessment and with histopathological findings in six patients who subsequently underwent surgery. Eleven of 14 tumours were visible on ultrasound and the site and size correctly identified in each. Unsuspected extralaryngeal spread was found in four cases increasing the tumour stage to T4; spread to the pre-epiglottic space was also shown in four cases. Nodal staging was correctly raised in two cases and incorrectly in one. Patient management was significantly influenced in 8/14 cases. Ultrasound can identify the majority of laryngeal tumours of Stage T2 and above, and detect extralaryngeal spread. Small tumours may not be visible but in this preliminary study, ultrasound complemented the clinical assessment and was useful in patient management.