E2346. What Did You Say? Imaging Laryngeal Cancer and What the Surgeon Wants to Know
  1. Craig Tork; University of Wisconsin - Madison
  2. Greg Avey; University of Wisconsin - Madison
Laryngeal cancer is an extremely morbid malignancy; severely affecting quality of life by impeding the ability to communicate, swallow, and breathe, accounting for approximately 25% of head and neck cancers. Epidemiologic studies show a global increase in incidence and prevalence, most pronounced within Europe and the Americas. Ninety to 95% of laryngeal cancers are squamous cell in origin, with the strongest risk factors related to tobacco and alcohol use.

Educational Goals / Teaching Points
Patients often present clinically with hoarseness, stridor, hemoptysis, neck mass, dysphagia, throat pain, or otalgia. Initial clinical evaluation often includes laryngoscopy, assessing for mucosal lesions of the supraglottic, glottic, or subglottic tissues and vocal fold mobility. Imaging has a less key role in laryngeal cancer definitively confined to the mucosal surface, as clinical evaluation is more sensitive for the detection and evaluation of small mucosal lesions. However, T1 and T2 lesions may still be encountered as part of an initial evaluation or incidental presentation. Although laryngoscopy can determine the mucosal/superficial extent and size of a lesion, computed tomography (CT) and magnetic resonance imaging (MRI) are central in determining deep tissue extent, invasion into adjacent tissues (especially cartilaginous invasion), and evidence of nodal metastases.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Treatment options include surgical resection, chemotherapy, and/or chemoradiation therapy. Surgical options can be as limited as transoral laser microsurgery or as extensive as total laryngectomy, depending on tumor extent. In this setting the radiologist plays a vital role, as imaging interpretation will help determine the treatment regimen. Imaging findings largely dictate the T stage based on compartment/subsite location, additional subsite or adjacent tissue invasion, visible involvement of the vocal cord(s), and invasion beyond the larynx. Imaging is also key to the assessment for nodal or metastatic disease. CT and MRI are suitable for this evaluation, although MRI and dual energy CT have improved ability to evaluate for cartilage involvement.

Accurate staging is key, as overstaging could lead to unnecessary total laryngectomy, whereas understaging could lead to treatment failure. In this exhibit, we will discuss laryngeal anatomy as it relates to American Joint Committee on Cancer (AJCC) staging criteria with CT and MRI case examples to help improve initial detection and staging accuracy.