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Studies on diagnostic value of ct images for hypopharyngeal cancer by comparing with sliced specimens



Studies on diagnostic value of ct images for hypopharyngeal cancer by comparing with sliced specimens



Otologia Fukuoka 34(SUPPL 3): 935-961



The diagnostic value of CT images for finding the extent of hypopharyngeal cancer was evaluated by comparing preoperative CT images with their corresponding slices of extirpated specimens in 11 cases. For this purpose, the following 4 factors were examined; demonstration of submucosal extension of the tumor on CT images, invasion into laryngeal cartilages, invasion into laryngeal muscles and paraglottic space as possible cause of vocal cord fixation, and extraluminal spread. The results were as follows; (1). It was relatively easy to identify the extent of the tumor into the submucosal fibrofatty tissue except when the tumor extended near to the laryngeal ventricle, which contains many mucous glands and is usually depicted as a somewhat dense shadow. (2). When the margin of the ossified cortex of the thyroid cartilage was irregular and surrounded by tumor shadow, or when the margin of the cricoid cartilage which was in contact with tumor shadow was irregular and accompanied by increased medullary concentration, the invasion of the tumor into these cartilages was histopathologically demonstrated. However, tumor extension next to these ossified cartilages did not indicate histopathological invasion of the tumor whenever their margins were smooth and regular. On the other hand, it was extremely difficult to estimate the invasion of tumor into these cartilages unless they were sufficiently ossified. (3). Each intrinsic laryngeal muscle and the inferior pharyngeal constrictor muscle were identified on CT images, and tumor extent into these muscles was well correlated to histopathologically demonstrated tumor invasion. CT images in cases with vocal cord fixation showed tumor extension either into paralaryngeal space, both paralaryngeal space and thyroarytenoid muscle or both paralaryngeal space and posterior cricoarytenoid muscle. (4). Extraluminal spread through the thyrohyoid membrane was demonstrated on CT images as distinctive shadows in the visceral space that surrounds the hypopharyngeal cavity. The evaluation of CT images of tumor invasion either into the submucosal layer, into muscles or into laryngeal cartilages, was often overestimated mainly because it was not possible to exactly discriminate between the tumor shadow and the surrounding fibrosis. However, the author considers that this overestimation may help to decide safer excision levels for this unexpectedly malignant tumor.

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Accession: 007831670

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