Hale ASLAN, ERCAN PINAR, Sedat ÖZTÜRKCAN, İbrahim ALADAĞ, Nezahat Karaca ERDOĞAN, Demet ETİT, Bilge Demirkol TUNA, Abdulkadir İMRE, YÜKSEL OLGUN, Düzgün ATEŞ

İleri evre Iarenks kanserinde bilgisayarlı tomografideki potansiyel tuzaklar

İleri evre larenks kanserinde bilgisayarlı tomografideki potansiyel tuzaklar Amaç: Larenks kanserinde invazyonda en şüpheli alanlar preepiglottik boşluk (PEB), ön komissür (ÖK), tiroid kıkırdak (TK), subglottikbölge (SB) ve ekstralarengeal invazyon (ELY) varlığıdır. Çalışmadakiamacımız total ya da parsiyel larenjektomi için bu kritik bölgelerinpreoperatif bilgisayarlı tomografi (BT) incelemesi ve postoperatif histopatolojik analizinin karşılaştırılmasıdır. Yöntem:2005-2013 yılları arasında raporda skuamöz hücreli kansertanısı nedeniyle total larenjektomi uygulanan 89 larenks kanseri hastası retrospektif olarak incelendi. Hastaların hepsine başvuru sonrasıfleksibl laringoskopi, boyuna yönelik bilgisayarlı tomografi ve sonrasında direkt larengoskopi eşliğinde endoskopik biyopsi yapılarak totallarenjektomi uygulandı. Histopatolojik sonuçlar PEB, ÖK, TK, ELYve SB invazyonları operasyon öncesi BT raporlarındaki invazyon sonuçlarıyla karşılaştırıldı, spesifite, sensitivite, yalancı negatif ve yalancı pozitif sonuçlar ile doğruluk oranları belirlendi. Bulgular:Hastaların tümü erkekti ve yaş aralığı 48 ile 81 arasında oluportalama yaş 67 bulundu. Elli altı hasta T4 evre, 33 hasta T3 evre larenks kanseri idi. BT'de pozitif, histopatolojik olarak negatif saptananhastalar karşılaştırıldığında; PEB invazyonu 41/5 hasta, ÖK invazyonu38/15 hasta, TK invazyonu 28/16 hasta, SB invazyonu 49/9 hasta veELY 25/7 hastada görüldü. BT'nin bu bölgelerdeki doğruluk oranlarısırasıyla; %85, %64, %76, %79, %83 olarak bulundu. Özellikle tiroidkartilaj invazyonunda olmak üzere tüm sonuçlar istatistiksel olarak anlamlıydı. Sonuç:Çalışmamızda ileri evre larenks kanserinde BT'nin tüm bahsedilen bölgelerde tanısal değerinin düşük olduğunu gördük. Total yada parsiyel kararı vermede intraoperatif olarak histopatolojik değerlendirmenin altın standart olduğu kanaatindeyiz.

Potential pitfalls of computed tomography in advanced laryngeal cancer

Objective:In laryngeal cancer the most suspected regions of invasionare preepiglottic space (PES), anterior commissure (AC), thyroid cartilage (TC), subglottic region (SR) and extralaryngeal spread (ELS). Theobjective of this study is to compare the results of preoperative computed tomography (CT) with postoperative histopathologic analysis inthese critical regions for the total or partial laryngectomy. Methods:Eighty-nine patients, who had undergone total laryngectomy with a diagnosis of laryngeal cancer reported that squamous cellcancer (SCC) between 2005 and 2013, were reviewed retrospectively.All the patients, after the first application done total laryngectomybefore flexible laryngoscopy, computed tomography for the neck andendoscopic biopsy with direct laryngoscopy. Histopathological resultsof PES, AC, TC, ELS and SR invasion are compared to preoperativeCT findings and determined of specificity, sensitivity, false negativeand false positive results and rate of accuracy. Results: All the patients were male, median age was 67 (range: 48 to 81)years. Fifty-six patients were in T4 and 33 patients in T3 stage.Compared to results between positive CT findings and negativehistopathological examination; PES invasion in 41 patients/ 5 patients,AC invasion was found in 38/ 15 patients, TC invasion in 28/16 patients,SR invasion in 49/ 9 patients and ELS invasion in 25 /7 patients. Accuracyrate of computed tomography in these regions are 85%, 64%, 76%, 79%,and 83%, respectively. All the results especially thyroid cartilage invasionwere statistically significant. Conclusion:In all regions invasion, CT has a low diagnostic reliabilityin high-grade laryngeal cancer in our study. We suggested thathistopathological results are the gold standard intraoperatively for determining total or partial laryngectomy.

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