Staging of Laryngeal Cancer Endoscopy & Radiology Versus Histopathology

BACKGROUND: clinical staging with the help of history, examination and video direct laryngoscopy have not been able to be accurate. Gross underestimation of cases and small percent of over estimation of staging occurs. This leads to inappropriate management of cases . With the help of CT underestimation of cases have lowered down considerably and a proper management protocol could be arrived. OBSERVATION AND RESULTS : Clinical staging accuracy is only 33% and CT staging accuracy with clinical staging is 83%. Thyroid cartilage involvement is identified accurately in 73% by CT. Anterior commissure involvement is identified in 100 % of cases. No early nodal metastasis is identified in clinically NO neck which have produced recurrence. CONCLUSION: The accuracy of clinical staging in our study of advanced stage laryngeal tumours decreased from supraglottic to glottic to transglottic tumours. Conversely, the staging accuracy of sectional imaging is best in transglottic tumours and similar supraglottic tumours and glottic tumours. There is gross underestimation of T4a cases clinically, almost 67% . With the help of CT underestimation of T4a cases have come down to 17%. CT therefore prevented most of the clinically underestimated cases from undergoing unnecessary organ preservation modalities like chemoradiotherapy and then salvage Total Laryngectomy. Further CT helped in identifying thyroid cartilage invasion accurately in 73% of cases which has aided immensely in treatment planning. With addition of MRI, accuracy could still improve and aid in reducing underestimation of cases. Early nodal metastasis is missed by CT