The role of computed tomography in the staging of infrahyoid neck tumours

Abstract

Cancers of the upper aerodigestive tract, collectively known as head and neck cancers, can arise in several locations, are often preventable, and if diagnosed early are usually curable. However, most patients present late. These tumours are mostly squamous cell carcinomas. Clinical examination and endoscopy, with biopsy of the mucosal surface has been the mainstay of pre-treatment assessment. Cross-sectional imaging by computed tomography (CT) has been proven to provide valuable additional diagnostic information. The main objective was to determine the role of computed tomography in staging of infrahyoid neck tumours at the Kenyatta National Hospital. Fifty-one consecutive patients who were discussed at the ENT surgery Tumour Board, with tumours of the larynx and hypopharynx were included in this study. The extent of the tumour was staged clinically using clinical methods, including physical examination, routine biopsy and direct laryngoscopy and pharyngoscopy. On discussion after CT scans, the new T-stage of the tumour was agreed upon and the new staging used by the surgeons to plan the patient's management. The study population consisted of 46 male and 5 female patients, with an average age of 54.88 years. Two-thirds of them were above 50 years of age. Forty-two patients had tumours originating in the larynx, 82.4 % and 9 (17.6 %) had hypopharyngeal cancer. Clinical T-staging was found to underestimate the extent of the tumour in 22 patients, all of which had extension to the laryngeal cartilage, with the thyroid cartilage being the most frequently involved. Computed tomography was a useful modality in the pre-treatment evaluation of the patients with infrahyoid neck cancers, showing more local extension than noted by clinical examination, altering the T-staging in 43.14%, nodal staging in 15.7 %, and management in a substantial number of those patients.