Value of computed tomography for evaluating the subglottis in laryngeal and hypopharyngeal squamous cell carcinoma

Abstract

CONTEXT AND OBJECTIVE: Subglottic involvement in squamous cell carcinoma is a determining factor for contraindicating conservative partial surgery. The subglottis is easily identified by axial computed tomography sections. The present study aimed to evaluate the occurrence of false-negative and false-positive results, and the overall accuracy of staging by computed tomography, in order to detect the involvement of the subglottic laryngeal compartment, in cases of laryngeal and hypopharyngeal squamous cell carcinoma. DESIGN AND SETTING: Retrospective, non-randomized study of patients treated at Hospital Heliópolis, São Paulo, Brazil. METHODS: Computed tomography scans were performed on third-generation equipment with 5-mm slice thickness. Afterwards, all patients underwent surgical and anatomopathological examinations as the gold standard procedures. RESULTS: Among 60 patients, 14 were diagnosed with subglottic extension by surgical and histopathological examination. There were three false-negative and no false-positive results from computed tomography scans. The sensitivity and negative predictive value were 100.0%. Accuracy was 95.0%, specificity was 93.5% and positive predictive value was 82.4%. CONCLUSIONS: Computed tomography could serve as a powerful auxiliary method for staging laryngeal and hypopharyngeal cancer. However, precautions should be taken in analyzing computed tomography scan data, because vegetating lesions may also be projected into the subglottic compartment, without real involvement of the subglottis, which may cause a false-positive result.