PRETHERAPEUTIC STAGING OF HYPOPHARYNGEAL CARCINOMA - CLINICAL FINDINGS, COMPUTED-TOMOGRAPHY, AND MAGNETIC-RESONANCE-IMAGING COMPARED WITH HISTOPATHOLOGIC EVALUATION

Objectives: To assess the accuracy of preoperative computed tomography (CT), magnetic resonance imaging (MRI), and clinical and endoscopic t umor evaluation and to analyze the impact of these diagnostic modaliti es on pretherapeutic staging of hypopharyngeal carcinoma. Design: Pros pective study of 44 consecutive patients with hypopharyngeal carcinoma undergoing surgical resection. Setting: Department of Otorhinolaryngo logy, Head and Neck Surgery, University Hospital, Bern, Switzerland. M ethods: All patients underwent contrast-enhanced CT, MRI at 1.5 T, ind irect laryngoscopy, and direct laryngoscopy. The surgical specimens we re cut in whole-organ slices parallel to the plane of the axial CT and MRI scans. The histologic findings were compared with the findings of the different diagnostic modalities. Results: The main tumor site was misdiagnosed by endoscopy in 7 (16%) of 44 patients and by CT and MRI in 16 (36%) of 44 patients. Neoplastic invasion of cartilage was pres ent in 21 (48%) of 44 laryngectomy specimens. Magnetic resonance imagi ng was more sensitive in detecting neoplastic invasion of cartilage th an CT (97% vs 68%; P=.002). Magnetic resonance imaging was less specif ic than CT (62% vs 83%; P=.02), taking into account the thyroid and cr icoid cartilages. There was no difference between the overall accuracy of CT and MRI in detecting neoplastic invasion of cartilage (78% vs 7 5%). Clinical and endoscopic evaluation failed to correctly stage 16 ( 36%) of 44 patients. Combined clinical and CT evaluation and combined clinical and MRI evaluation failed to correctly stage 12 and 13 of 44 patients, respectively. Conclusions: The assessment of tumor site is m ore accurate using endoscopic evaluation than CT or MRT. Magnetic reso nance imaging is more sensitive in detecting neoplastic cartilage inva sion than CT, whereas CT is more specific. Clinical and endoscopic eva luation of tumor stage alone fails to identify invasion of the larynge al framework. Therefore, many tumors staged pT4 are clinically underst aged. The preoperative staging accuracy was improved by combining the information gained using both clinical evaluation and CT or MRI. Howev er, there was no difference in the staging accuracy between CT and MRI .