European Radiology

, Volume 16, Issue 11, pp 2386–2400 | Cite as

Staging of laryngeal and hypopharyngeal cancer: value of imaging studies

  • Robert HermansEmail author
Head and Neck


Imaging methods assist in the pre-treatment planning of laryngeal and hypopharyngeal neoplasms, by better defining the local extension of infiltrating tumours and by detecting subclinical neck adenopathies. Imaging has also an important role in excluding or detecting distant metastasis. Furthermore, there is evidence that several imaging-derived parameters can be used as predictors of locoregional control after radiotherapy, and this independently from the TN classification. Such prognostic information is helpful in determining the relative value of surgery and radiation therapy, in selecting patients who may benefit from adjuvant treatment, and in identifying patients at high risk for recurrence to be followed up more closely.


Larynx Cancer Hypopharynx Head and neck cancer Imaging 


  1. 1.
    Parkin DM, Pisani P, Ferlay J (1999) Global cancer statistics. CA Cancer J Clin 49:33–64PubMedGoogle Scholar
  2. 2.
    Blot WJ, McLaughlin JK, Winn DM et al (1988) Smoking and drinking in relation to oral and pharyngeal cancer. Cancer Res 48:3282–3287PubMedGoogle Scholar
  3. 3.
    Delaere PR (2006) Clinical and endoscopic examination of the head and neck. In: Hermans R (ed) Head and neck cancer imaging. Springer, Berlin Heidelberg New York, pp 17–29CrossRefGoogle Scholar
  4. 4.
    De Foer B, Hermans R, Van der Goten A, Delaere PR, Baert AL (1996) Imaging features in 35 cases of submucosal laryngeal mass lesions. Eur Radiol 6:913–919CrossRefPubMedGoogle Scholar
  5. 5.
    Hermans R, Horvath M, De Schrijver T, Lemahieu SF, Baert AL (1994) Extranodal non-Hodgkin lymphoma of the head and neck. J Belge Radiol 77:72–77PubMedGoogle Scholar
  6. 6.
    Hermans R (2004) Extranodal lymphoma-neck. Cancer Imaging 4:S113–S118Google Scholar
  7. 7.
    Rumboldt Z, Gordon L, Gordon L, Bonsall R, Ackermann S (2006) Imaging in head and neck cancer. Curr Treat Option Oncol 7:23–34Google Scholar
  8. 8.
    Keberle M, Tschammler A, Hahn D (2002) Single-bolus technique for spiral CT of laryngopharyngeal squamous cell carcinoma: comparison of different contrast material volumes, flow rates, and start delays. Radiology 224:171–176PubMedGoogle Scholar
  9. 9.
    Lell MM, Greess H, Hothorn T, Janka R, Bautz WA, Baum U (2004) Multiplanar functional imaging of the larynx and hypopharynx with multislice spiral CT. Eur Radiol 14:2198–2205CrossRefPubMedGoogle Scholar
  10. 10.
    Robert YH, Chevalier D, Rocourt NL et al (1993) Dynamic maneuver acquired with spiral CT in laryngeal disease. Radiology 189:298–299Google Scholar
  11. 11.
    Schmalfuss IM (2002) Imaging of the hypopharynx and cervical esophagus. Magn Reson Imaging Clin N Am 10:495–509CrossRefPubMedGoogle Scholar
  12. 12.
    Sigal R, Vogl T, Casselman J et al (2002) Lymph node metastases from head and neck squamous cell carcinoma: MR imaging with ultrasmall superparamagnetic iron oxide particles (Sinerem MR) — results of a phase-III multicenter clinical trial. Eur Radiol 12:1104–1113PubMedCrossRefGoogle Scholar
  13. 13.
    Mack MG, Balzer JO, Straub R et al (2002) Superparamagnetic iron oxide-enhanced MR imaging of head and neck lymph nodes. Radiology 222:239–244PubMedGoogle Scholar
  14. 14.
    Sumi M, Sakihama N, Sumi T et al (2003) Discrimination of metastatic cervical lymph nodes with diffusion-weighted MR imaging in patients with head and neck cancer. AJNR Am J Neuroradiol 24:1627–1634PubMedGoogle Scholar
  15. 15.
    Vandecaveye V, De Keyzer F, Vander Poorten V et al (2006) Evaluation of the larynx for tumour recurrence by diffusion-weighted MRI after radiotherapy: initial experience in four cases. Br J Radiol doi:10.1259/bjr/89661809Google Scholar
  16. 16.
    van den Brekel MW, Castelijns JA, Stel HV et al (1991) Occult metastatic neck disease: detection with US and US-guided fine-needle aspiration cytology. Radiology 180:457–461PubMedGoogle Scholar
  17. 17.
    Takes RP, Knegt P, Manni JJ et al (1996) Regional metastasis in head and neck squamous cell carcinoma: revised value of US with US-guided FNAB. Radiology 198:819–823PubMedGoogle Scholar
  18. 18.
    Takes RP, Righi P, Meeuwis CA et al (1998) The value of ultrasound with ultrasound-guided fine-needle aspiration biopsy compared to computed tomography in the detection of regional metastases in the clinically negative neck. Int J Radiat Oncol Biol Phys 40:1027–1032CrossRefPubMedGoogle Scholar
  19. 19.
    Rogers JW, Greven KM, McGuirt WF et al (2004) Can post-RT neck dissection be omitted for patients with head-and-neck cancer who have a negative PET scan after definitive radiation therapy? Int J Radiat Oncol Biol Phys 58:694–697CrossRefPubMedGoogle Scholar
  20. 20.
    Stuckensen T, Kovacs AF, Adams S, Baum RP (2000) Staging of the neck in patients with oral cavity squamous cell carcinomas: a prospective comparison of PET, ultrasound, CT and MRI. J Craniomaxillofac Surg 28:319–324PubMedGoogle Scholar
  21. 21.
    Zbären P, Becker M, Laeng H (1996) Pretherapeutic staging of laryngeal cancer: clinical findings, computed tomography and magnetic resonance imaging versus histopathology. Cancer 77:1263–1273CrossRefPubMedGoogle Scholar
  22. 22.
    Zbären P, Becker M, Lang H (1997) Pretherapeutic staging of hypopharyngeal carcinoma. Clinical findings, computed tomography, and magnetic resonance imaging compared with histopathologic evaluation. Arch Otolaryngol Head Neck Surg 123:908–913PubMedGoogle Scholar
  23. 23.
    Daisne JT, Duprez T, Weynand B et al (2004) Tumor volume in pharyngolaryngeal squamous cell carcinoma: comparison at CT, MR imaging, and FDG PET and validation with surgical specimen. Radiology 233:93–100PubMedGoogle Scholar
  24. 24.
    Becker M, Zbären P, Laeng H et al (1995) Neoplastic invasion of the laryngeal cartilage: comparison of MR imaging and CT with histopathologic correlation. Radiology 194:661–669PubMedGoogle Scholar
  25. 25.
    Becker M, Zbären P, Delavelle J et al (1997) Neoplastic invasion of the laryngeal cartilage: reassessment of criteria for diagnosis at CT. Radiology 203:521PubMedGoogle Scholar
  26. 26.
    Atula T, Markolla A, Leivo I, Makitie A (2001) Cartilage invasion of laryngeal cancer detected by magnetic resonance imaging. Eur Arch Otorhinolaryngol 258:272–275CrossRefPubMedGoogle Scholar
  27. 27.
    Castelijns JA, Becker M, Hermans R (1996) The impact of cartilage invasion on treatment and prognosis of laryngeal cancer. Eur Radiol 6:156–169CrossRefPubMedGoogle Scholar
  28. 28.
    Curtin HD, Ishwaran H, Mancuso AA et al (1998) Comparison of CT and MR imaging in staging of neck metastases. Radiology 207:123–130PubMedGoogle Scholar
  29. 29.
    Castelijns JA, van den Brekel MW (2002) Imaging of lymphadenopathy in the neck. Eur Radiol 12:727–738PubMedCrossRefGoogle Scholar
  30. 30.
    Ferlito A, Buckley JG, Rinaldo A et al (2001) Screening tests to evaluate distant metastases in head and neck cancer. ORL J Otorhinolaryngol Relat Spec 63:208–2110PubMedGoogle Scholar
  31. 31.
    Leon X, Quer M, Orus C et al (2000) Distant metastases in head and neck cancer patients who achieved loco-regional control. Head Neck 22:680–686CrossRefPubMedGoogle Scholar
  32. 32.
    de Bree R, Deurloo EE, Snow GB et al (2000) Screening for distant metastases in patients with head and neck cancer. Laryngoscope 110:397–401CrossRefPubMedGoogle Scholar
  33. 33.
    Johnson JT (2001) Proposal of standardization on screening tests for detection of distant metastases from head and neck cancer. ORL J Otorhinolaryngol Relat Spec 63:256–258PubMedGoogle Scholar
  34. 34.
    Leemans CR, Tiwari R, Nauta JJP et al (1993) Regional lymph node involvement and its significance in the development of distant metastases in head and neck carcinoma. Cancer 71:452–456PubMedCrossRefGoogle Scholar
  35. 35.
    Sauter ER, Nesbit M, Watson JC et al (1999) Vascular endothelial growth factor is a marker of tumor invasion and metastasis in squamous cell carcinomas of the head and neck. Clin Cancer Res 5:775–782PubMedGoogle Scholar
  36. 36.
    Kallmes DF, Phillips CD (1997) The normal anterior commissure of the glottis. AJR Am J Roentgenol 168:1317–1379PubMedGoogle Scholar
  37. 37.
    Mendenhall WM, Werning JW, Hinerman RW, Amdur RJ, Villaret DB (2004) Management of T1-T2 glottic carcinomas. Cancer 100:1786–1792CrossRefPubMedGoogle Scholar
  38. 38.
    Mendenhall WM, Parsons JT, Mancuso AA et al (1997) Definitive radiotherapy for T3 squamous cell carcinoma of the glottic larynx. J Clin Oncol 15:2394–2402PubMedGoogle Scholar
  39. 39.
    DeSanto LW (1984) T3 glottic cancer: options and consequences of the options. Laryngoscope 94:1311–1315PubMedCrossRefGoogle Scholar
  40. 40.
    Delaere PR, Hermans R (2003) Tracheal autotransplantation as a new and reliable technique for the functional treatment of advanced laryngeal cancer. Laryngoscope 113:1244–1251CrossRefPubMedGoogle Scholar
  41. 41.
    Million RR (1992) The to speak: everything I wanted to know about laryngeal cancer I learned in the last 32 years. Int J Radiation Oncology Biol Phys 23:691–704Google Scholar
  42. 42.
    Hinerman RW, Mendenhall WM, Amdur RJ et al (2002) Carcinoma of the supraglottic larynx: treatment results with radiotherapy alone or with planned neck dissection. Head Neck 24:456–467CrossRefPubMedGoogle Scholar
  43. 43.
    Milas L, Mason KA, Liao Z, Ang KK (2003) Chemoradiotherapy: emerging treatment improvement strategies. Head Neck 25:152–167CrossRefPubMedGoogle Scholar
  44. 44.
    Yousem DM, Hatabu H, Hurst RW et al (1995) Carotid artery invasion by head and neck masses: prediction with MR imaging. Radiology 195:715–720PubMedGoogle Scholar
  45. 45.
    Yu Q, Wang P, Shi H, Luo J (2003) Carotid artery and jugular vein invasion of oral-maxillofacial and neck malignant tumors: diagnostic value of computed tomography.Oral Surg Oral Med Oral Pathol Oral Radiol Endod 96:368–872PubMedCrossRefGoogle Scholar
  46. 46.
    Righi PD, Kelley DJ, Ernst R et al (1996) Evaluation of prevertebral muscle invasion by squamous cell carcinoma. Can computed tomography replace open neck exploration? Arch Otolaryngol Head Neck Surg 122:660–663PubMedGoogle Scholar
  47. 47.
    Hsu WC, Loevner LA, Karpati R et al (2005) Accuracy of magnetic resonance imaging in predicting absence of fixation of head and neck cancer to the prevertebral space. Head Neck 27:95–100CrossRefPubMedGoogle Scholar
  48. 48.
    Watkinson JC, Gaze MN, Wilson JA (2000) Stell & Maran’s Head & neck surgery, 4th edn. Butterworth Heinemann, Oxford 322, 338Google Scholar
  49. 49.
    Piccirillo JF, Lacy PD (2000) Classification and staging of laryngeal cancer. In: Ferlito A (ed) Diseases of the larynx. Arnold, London, pp 563–564, 574Google Scholar
  50. 50.
    Hermans R, Van den Bogaert W, Rijnders A, Doornaert P, Baert AL (1999) Predicting the local outcome of glottic cancer treated by definitive radiation therapy: value of computed tomography determined tumor parameters. Radiother Oncol 50:39–46CrossRefPubMedGoogle Scholar
  51. 51.
    Hermans R, Van den Bogaert W, Rijnders A, Baert AL (1999) Value of computed tomography determined tumor parameters as outcome predictor of supraglottic cancer treated by definitive radiation therapy. Int J Radiat Oncol Biol Phys 44:755–765CrossRefPubMedGoogle Scholar
  52. 52.
    Mancuso AA, Mukherji SK, Schmalfuss I et al (1999) Preradiotherapy computed tomography as a predictor of local control in supraglottic carcinoma. J Clin Oncol 17:631–637PubMedGoogle Scholar
  53. 53.
    Pameijer FA, Mancuso AA, Mendenhall WM, Parsons JT, Kubilis MS (1997) Can pretreatment computed tomography predict local control in T3 squamous cell carcinoma of the glottic larynx treated with definitive radiotherapy? Int J Radiat Oncol Biol Phys 37:1011–1021CrossRefPubMedGoogle Scholar
  54. 54.
    Pameijer FA, Mancuso AA, Mendenhall WM et al (1998) Evaluation of pretreatment computed tomography as a predictor of local control in T1/T2 piriform sinus carcinoma treated with definitive radiotherapy. Head Neck 20:159–168CrossRefPubMedGoogle Scholar
  55. 55.
    Lloyd GAS, Michaels L, Phelps PD (1981) The demonstration of cartilaginous involvement in laryngeal carcinoma by computerized tomography. Clin Otolaryngol 6:171–177PubMedGoogle Scholar
  56. 56.
    Castelijns JA, Golding RP, van Schaik C, Valk J, Snow GB (1990) MR findings of laryngeal cartilage invasion by laryngeal cancer: value in predicting outcome of radiation therapy. Radiology 174:669–673PubMedGoogle Scholar
  57. 57.
    Isaacs JH, Mancuso AA, Mendenhall WM, Parsons JT (1988) Deep spread patterns in CT staging of T2–4 squamous cell laryngeal carcinoma. Otolaryngol Head Neck Surg 99:455–464PubMedGoogle Scholar
  58. 58.
    Silverman PM (1985) Medullary space involvement in laryngeal carcinoma. Arch Otolaryngol 111:541–542PubMedGoogle Scholar
  59. 59.
    Million RR (1989) The myth regarding bone or cartilage involvement by cancer and the likelihood of cure by radiotherapy. Head Neck 11:30–40PubMedGoogle Scholar
  60. 60.
    Castelijns JA, van den Brekel MWM, Tobi H et al (1996) Laryngeal carcinoma after radiation therapy: correlation of abnormal MR imaging signal pattern in laryngeal cartilage with the risk of recurrence. Radiology 198:151–155PubMedGoogle Scholar
  61. 61.
    Ljumanovic R, Langendijk JA, Schenk B et al (2004) Supraglottic carcinoma treated with curative radiation therapy: identification of prognostic groups with MR imaging. Radiology 232:440–448PubMedGoogle Scholar
  62. 62.
    Tart RP, Mukherji SK, Lee WR, Mancuso AA (1994) Value of laryngeal cartilage sclerosis as a predictor of outcome in patients with stage T3 glottic cancer treated with radiation therapy. Radiology 192:567–570PubMedGoogle Scholar
  63. 63.
    Thoeny HC, Delaere PR, Hermans R (2005) Correlation of local outcome after partial laryngectomy with cartilage abnormalities on CT. AJNR Am J Neuroradiol 26:674–678PubMedGoogle Scholar
  64. 64.
    Hermans R, Pameijer FA, Mancuso AA et al (2000) Laryngeal or hypopharyngeal squamous cell carcinoma: can follow-up CT after definitive radiotherapy be used to detect local failure earlier than clinical examination alone? Radiology 214:683–687PubMedGoogle Scholar
  65. 65.
    UICC, International Union Against Cancer (2002) TNM classification of malignant tumors, 6th edn. Wiley-Liss, New YorkGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  1. 1.Department of RadiologyUniversity Hospitals K.U. LeuvenLeuvenBelgium

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