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Comparison of diagnostic performance between CT and MRI for detection of cartilage invasion for primary tumor staging in patients with laryngo-hypopharyngeal cancer: a systematic review and meta-analysis

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Abstract

Objective

To compare the diagnostic performance of contrast-enhanced CT with that of MRI in the detection of cartilage invasion in patients with laryngo-hypopharyngeal cancer.

Methods

A systematic literature search in the Ovid-MEDLINE and EMBASE databases was performed for studies reporting diagnostic accuracy of CT and/or MRI in detecting cartilage invasion from laryngo-hypopharyngeal cancer between 2000 and 2018. The pooled sensitivity and specificity, and their 95% confidence intervals were calculated for CT and MRI using bivariate random effects modeling. Subgroup and meta-regression analyses were performed. Indirect comparison was also performed by univariable meta-regression.

Result

Fourteen articles including 776 patients were included in the systematic review and meta-analysis: eight for CT, and six for MRI. CT and MRI showed pooled sensitivities of 66% (95% CI, 49–80%) and 88% (95% CI, 79–93%), and pooled specificities of 90% (95% CI, 82–94%) and 81% (95% CI, 76–84%), respectively. MRI showed significantly higher sensitivity than CT (p = 0.02). The specificities showed no statistically significant difference between CT and MRI (p = 0.39). The CT studies showed heterogeneity and a threshold effect, while MRI showed neither heterogeneity nor threshold effect. In the meta-regression analysis for CT, the type of cartilage analyzed (thyroid only vs. thyroid/cricoid/arytenoid, p < 0.001) was a significant factor influencing the heterogeneity in the diagnostic performance of the CT studies.

Conclusions

In conclusion, MRI has significantly higher sensitivity than CT for detecting cartilage invasion in patients with laryngo-hypopharyngeal cancer, without a significant difference in the specificity.

Key Points

• MRI has significantly higher sensitivity than CT for detecting cartilage invasion in patients with laryngo-hypopharyngeal cancer.

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Abbreviations

AJCC:

American Joint Committee on Cancer

HSROC:

Hierarchical summary receiver operating characteristic

PRISMA :

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

QUADAS-2:

Quality Assessment of Diagnostic Accuracy Studies-2

References

  1. Amin MB, Greene FL, Edge SB et al (2017) The Eighth Edition AJCC Cancer Staging Manual: continuing to build a bridge from a population-based to a more “personalized” approach to cancer staging. CA Cancer J Clin 67:93–99

    PubMed  Google Scholar 

  2. Lefebvre JL, Ang KK (2009) Larynx preservation clinical trial design: key issues and recommendations--a consensus panel summary. Head Neck 31:429–441

    PubMed  Google Scholar 

  3. Knab BR, Salama JK, Solanki A et al (2008) Functional organ preservation with definitive chemoradiotherapy for T4 laryngeal squamous cell carcinoma. Ann Oncol 19:1650–1654

    CAS  PubMed  Google Scholar 

  4. Forastiere AA, Ismaila N, Lewin JS et al (2018) Use of larynx-preservation strategies in the treatment of laryngeal cancer: American Society of Clinical Oncology Clinical Practice Guideline Update. J Clin Oncol 36:1143–1169

    PubMed  Google Scholar 

  5. Liberati A, Altman DG, Tetzlaff J et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Ann Intern Med 151:W65–W94

    PubMed  Google Scholar 

  6. Whiting PF, Rutjes AW, Westwood ME et al (2011) QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med 155:529–536

    PubMed  Google Scholar 

  7. Kim KW, Lee J, Choi SH, Huh J, Park SH (2015) Systematic review and meta-analysis of studies evaluating diagnostic test accuracy: a practical review for clinical researchers-part I. general guidance and tips. Korean J Radiol 16:1175–1187

    PubMed  PubMed Central  Google Scholar 

  8. Lee J, Kim KW, Choi SH, Huh J, Park SH (2015) Systematic review and meta-analysis of studies evaluating diagnostic test accuracy: a practical review for clinical researchers-part II. Statistical methods of meta-analysis. Korean J Radiol 16:1188–1196

    PubMed  PubMed Central  Google Scholar 

  9. Suh CH, Park SH (2016) Successful publication of systematic review and meta-analysis of studies evaluating diagnostic test accuracy. Korean J Radiol 17:5–6

    PubMed  PubMed Central  Google Scholar 

  10. Deeks JJ, Macaskill P, Irwig L (2005) The performance of tests of publication bias and other sample size effects in systematic reviews of diagnostic test accuracy was assessed. J Clin Epidemiol 58:882–893

    PubMed  Google Scholar 

  11. Hoaglin DC (2016) Misunderstandings about Q and ‘Cochran’s Q test’ in meta-analysis. Stat Med 35:485–495

    PubMed  Google Scholar 

  12. Deville WL, Buntinx F, Bouter LM et al (2002) Conducting systematic reviews of diagnostic studies: didactic guidelines. BMC Med Res Methodol 2:9

    PubMed  PubMed Central  Google Scholar 

  13. Beitler JJ, Chen SA, Shin DM, Chen AY, Muller S, Hudgins PA (2010) Seventy-five percent of extralaryngeal larynx cancers respect the thyroid cartilage: a modern clinicopathologic review of 89 total laryngectomy specimens show new patterns of spread. Int J Radiat Oncol Biol Phys 78:S176–S177

    Google Scholar 

  14. Dadfar N, Seyyedi M, Forghani R, Curtin HD (2015) Computed tomography appearance of normal nonossified thyroid cartilage: implication for tumor invasion diagnosis. J Comput Assist Tomogr 39:240–243

    PubMed  Google Scholar 

  15. Forghani R, Levental M, Gupta R, Lam S, Dadfar N, Curtin HD (2015) Different spectral hounsfield unit curve and high-energy virtual monochromatic image characteristics of squamous cell carcinoma compared with nonossified thyroid cartilage. AJNR Am J Neuroradiol 36:1194–1200

    CAS  PubMed  PubMed Central  Google Scholar 

  16. Hartl DM, Landry G, Hans S, Marandas P, Brasnu DF (2010) Organ preservation surgery for laryngeal squamous cell carcinoma: low incidence of thyroid cartilage invasion. Laryngoscope 120:1173–1176

    PubMed  Google Scholar 

  17. Wagner MM, Cure JK, Caudell JJ et al (2012) Prognostic significance of thyroid or cricoid cartilage invasion in laryngeal or hypopharyngeal cancer treated with organ preserving strategies. Radiat Oncol 7:219

    PubMed  PubMed Central  Google Scholar 

  18. Wu JH, Zhao J, Li ZH et al (2016) Comparison of CT and MRI in diagnosis of laryngeal carcinoma with anterior vocal commissure involvement. Sci Rep 6:30353

    CAS  PubMed  PubMed Central  Google Scholar 

  19. Kinshuck AJ, Goodyear PW, Lancaster J et al (2012) Accuracy of magnetic resonance imaging in diagnosing thyroid cartilage and thyroid gland invasion by squamous cell carcinoma in laryngectomy patients. J Laryngol Otol 126:302–306

    CAS  PubMed  Google Scholar 

  20. Harris AS, Passant CD, Ingrams DR (2018) How reliably can computed tomography predict thyroid invasion prior to laryngectomy? Laryngoscope 128:1099–1102

    PubMed  Google Scholar 

  21. Cagli S, Ozturk M, Yuce I, Deniz K, Guney E (2009) The value of routine clinical and radiologic studies in predicting neoplastic invasion of cricoarytenoid units. AJNR Am J Neuroradiol 30:1936–1940

    CAS  PubMed  PubMed Central  Google Scholar 

  22. Banko B, Dukic V, Milovanovic J, Kovac JD, Artiko V, Maksimovic R (2011) Diagnostic significance of magnetic resonance imaging in preoperative evaluation of patients with laryngeal tumors. Eur Arch Otorhinolaryngol 268:1617–1623

    PubMed  Google Scholar 

  23. Lu YH, Lirng JF, Yang CM, Chang FC, Guo WY (2014) Hypopharyngeal cancer preoperative imaging and pathological staging correlation. Neuroradiology 56:189

    Google Scholar 

  24. Tatlipinar A, Dursun G, Dizbay Sak S, Yaǧci C (2012) Comparison of Videolaryngostroboscopy and computed tomography findings with histopathological results in larynx cancers. Turkiye Klinikleri J Med Sci 32:104–111

    Google Scholar 

  25. Thoeny HC, Delaere PR, Hermans R (2005) Correlation of local outcome after partial laryngectomy with cartilage abnormalities on CT. AJNR Am J Neuroradiol 26:674–678

    PubMed  PubMed Central  Google Scholar 

  26. Poirier JB, Nguyen F, Bélair M, Moubayed SP, Ayad T (2011) Predictive value of laryngeal cartilage sclerosis on CT-scan. Otolaryngol Head Neck Surg 145:175

    Google Scholar 

  27. Kuno H, Onaya H, Iwata R et al (2012) Evaluation of cartilage invasion by laryngeal and hypopharyngeal squamous cell carcinoma with dual-energy CT. Radiology 265:488–496

    PubMed  Google Scholar 

  28. Arora M, Thakker V, Sindhwani G, Bhatt J, Gupta M, Shah J (2018) Pretherapeutic assessment by multidetector computed tomography for thyroid cartilage invasion in laryngeal cancer: a double-edged sword. Indian J Med Paediatr Oncol 39:196–202

    Google Scholar 

  29. Beitler JJ, Muller S, Grist WJ et al (2010) Prognostic accuracy of computed tomography findings for patients with laryngeal cancer undergoing laryngectomy. J Clin Oncol 28:2318–2322

    PubMed  Google Scholar 

  30. Dankbaar JW, Oosterbroek J, Jager EA et al (2017) Detection of cartilage invasion in laryngeal carcinoma with dynamic contrast-enhanced CT. Laryngoscope Investig Otolaryngol 2:373–379

    PubMed  PubMed Central  Google Scholar 

  31. Han MW, Kim SA, Cho KJ et al (2013) Diagnostic accuracy of computed tomography findings for patients undergoing salvage total laryngectomy. Acta Otolaryngol 133:620–625

    PubMed  Google Scholar 

  32. Kashany SS, Malek M, Mazaher H, Sharifian H (2008) The diagnostic accuracy of computed tomography in neoplastic invasion of the laryngeal cartilage. Iran J Radiol 5:11–18

    Google Scholar 

  33. Koopmann M, Weiss D, Steiger M, Elges S, Rudack C, Stenner M (2016) Thyroid cartilage invasion in laryngeal and hypopharyngeal squamous cell carcinoma treated with total laryngectomy. Eur Arch Otorhinolaryngol 273:3789–3794

    PubMed  Google Scholar 

  34. Li B, Bobinski M, Gandour-Edwards R, Farwell DG, Chen AM (2011) Overstaging of cartilage invasion by multidetector CT scan for laryngeal cancer and its potential effect on the use of organ preservation with chemoradiation. Br J Radiol 84:64–69

    CAS  PubMed  PubMed Central  Google Scholar 

  35. Ryu IS, Lee JH, Roh JL et al (2014) Clinical implication of computed tomography findings in patients with locally advanced squamous cell carcinoma of the larynx and hypopharynx. Eur Arch Otorhinolaryngol. https://doi.org/10.1007/s00405-014-3249-2

  36. Atula T, Markkola A, Leivo I, Makitie A (2001) Cartilage invasion of laryngeal cancer detected by magnetic resonance imaging. Eur Arch Otorhinolaryngol 258:272–275

    CAS  PubMed  Google Scholar 

  37. Becker M, Zbaren P, Casselman JW, Kohler R, Dulguerov P, Becker CD (2008) Neoplastic invasion of laryngeal cartilage: reassessment of criteria for diagnosis at MR imaging. Radiology 249:551–559

    PubMed  Google Scholar 

  38. Carriero A, Scarabino T, Vallone A, Cammisa M, Salvolini U, Bonomo L (2000) MRI T-staging of laryngeal tumours: role of contrast medium. Neuroradiology 42:66–71

    CAS  PubMed  Google Scholar 

  39. Preda L, Conte G, Bonello L et al (2017) Diagnostic accuracy of surface coil MRI in assessing cartilaginous invasion in laryngeal tumours: do we need contrast-agent administration? Eur Radiol 27:4690–4698

  40. Taha MS, Hassan O, Amir M, Taha T, Riad MA (2014) Diffusion-weighted MRI in diagnosing thyroid cartilage invasion in laryngeal carcinoma. Eur Arch Otorhinolaryngol 271:2511–2516

    PubMed  Google Scholar 

  41. Kuno H, Sakamaki K, Fujii S et al (2018) Comparison of MR imaging and dual-energy ct for the evaluation of cartilage invasion by laryngeal and hypopharyngeal squamous cell carcinoma. AJNR Am J Neuroradiol 39:524–531

    CAS  PubMed  PubMed Central  Google Scholar 

  42. Becker M, Zbaren P, Laeng H, Stoupis C, Porcellini B, Vock P (1995) Neoplastic invasion of the laryngeal cartilage: comparison of MR imaging and CT with histopathologic correlation. Radiology 194:661–669

    CAS  PubMed  Google Scholar 

  43. Maroldi R, Ravanelli M, Farina D (2014) Magnetic resonance for laryngeal cancer. Curr Opin Otolaryngol Head Neck Surg 22:131–139

    PubMed  Google Scholar 

Download references

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The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea

    Se Jin Cho, Jeong Hyun Lee, Chong Hyun Suh, Min Kyoung Lee, Sae Rom Chung, Young Jun Choi & Jung Hwan Baek

  2. Department of Radiology, Sungkyunkwan University School of Medicine, Samsung Medical Center Kangbuk Samsung Hospital29, Saemunan-ro, Jongno-gu, Seoul, Republic of Korea

    Jung Youn Kim

  3. Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, 75, Bokji-ro, Busanjin-gu, Busan, 47392, Republic of Korea

    Donghyun Kim

  4. Department of Radiology, Soonchunhyang University Buchoen Hospital, 170, Jomaru-ro, Bucheon-si, Gyeonggi-do, Republic of Korea

    Jung Bin Lee

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Cho, S.J., Lee, J.H., Suh, C.H. et al. Comparison of diagnostic performance between CT and MRI for detection of cartilage invasion for primary tumor staging in patients with laryngo-hypopharyngeal cancer: a systematic review and meta-analysis. Eur Radiol 30, 3803–3812 (2020). https://doi.org/10.1007/s00330-020-06718-8

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