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Aktuelle Bildgebung bei Diagnostik und Therapieplanung des Larynxkarzinoms

Current diagnostic imaging and treatment planning for laryngeal cancer

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Zusammenfassung

Klinisches/methodisches Problem

Das Larynxkarzinom ist das dritthäufigste Malignom im Kopf-Hals-Bereich. Endoskopische Laryngoskopie mit Beurteilung der Stimmlippenfunktion, Mikrolaryngoskopie mit Biopsie und Computertomographie/Magnetresonanztomographie bilden die Grundpfeiler der klinischen Diagnostik. Im Rahmen der Therapieplanung kommt der Berücksichtigung individueller funktioneller und sozioökonomischer Aspekte eine wesentliche Bedeutung zu.

Radiologische Standardverfahren

Aufgrund der kurzen Akquisitionszeit und der Möglichkeit funktionelle Manöver durchzuführen stellt die CT das Mittel der Wahl dar. Die MRT erlaubt eine bessere Weichteildifferenzierung, ist jedoch anfälliger für Bewegungsartefakte und wird durch krankheitsspezifische Symptome erschwert. Die Wahl des Untersuchungsverfahrens ist daher von der Belastbarkeit des Patienten abhängig.

Leistungsfähigkeit

Je nach Studie schwanken die Angaben zur Sensitivität der CT bezüglich der Frage einer Knorpelinfiltration zwischen 62 und 87 % bei einer Spezifität zwischen 75 und 98 %. Für die MRT wird eine Sensitivität zwischen 64 und 95 % und eine Spezifität zwischen 56 und 88 % angegeben.

Bewertung

Die Synthese der Befunde aus Spiegeluntersuchung, Mikrolaryngoskopie, Histologie und Schnittbilddiagnostik stellt die Voraussetzung für die Einleitung einer stadiengerechten Therapie dar. Hierbei ist die Kenntnis der anatomischen Landmarken essenziell. Doch auch die Beurteilung posttherapeutischer Veränderungen stellt den Radiologen vor eine Herausforderung.

Empfehlung für die Praxis

Der regelmäßige interdisziplinäre Dialog zwischen Radiologen, HNO-Ärzten und Strahlentherapeuten im Rahmen der Primärdiagnostik, Therapieplanung und Nachsorge ist unerlässlich.

Abstract

Clinical/methodical issue

Laryngeal cancer is the third most common malignancy in the head and neck region. Endoscopic laryngoscopy with assessment of vocal fold function, microlaryngoscopy with biopsy and computed tomography (CT)/magnetic resonance imaging (MRI) remain the cornerstones of diagnostic workup. Thus, in the context of therapy planning, consideration of individual functional and socioeconomic aspects is of major importance.

Standard radiological methods

Due to the short acquisition time and the possibility to perform functional maneuvers, CT is the tool of choice. MRI allows better soft tissue differentiation, but is more susceptible to movement artifacts and is complicated by disease-specific symptoms. The choice of examination method therefore depends on the patient’s physical resilience.

Performance

Depending on the study, the information on the sensitivity of CT with regard to the question of cartilage infiltration varies between 62 and 87% with a specificity between 75 and 98%. For MRI, sensitivity between 64 and 95% and specificity between 56 and 88% are stated.

Achievements

The synthesis of the findings from endoscopy, biopsy and imaging is prerequisite for initiation of stage-appropriate treatment. For image interpretation, knowledge of the anatomical landmarks is essential. However, the assessment of posttherapeutic changes also poses a challenge for the radiologist.

Practical recommendations

Regular interdisciplinary dialogue between radiologists, otorhinolaryngologists and radiotherapists in the context of primary diagnostics, therapy planning and aftercare is essential.

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Authors and Affiliations

  1. Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum des Saarlandes, Kirrbergerstraße Gebäude 6, 66421, Homburg, Deutschland

    A. Bozzato, L. Pillong & B. Schick

  2. Institut für Radiologie und Nuklearmedizin, Klinikum Nürnberg, Paracelsus Medical University, Nürnberg, Deutschland

    M.M. Lell

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  1. A. Bozzato
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  2. L. Pillong
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  4. M.M. Lell
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Correspondence to L. Pillong.

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Interessenkonflikt

A. Bozzato, L. Pillong, B. Schick und M. Lell geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Bozzato, A., Pillong, L., Schick, B. et al. Aktuelle Bildgebung bei Diagnostik und Therapieplanung des Larynxkarzinoms. Radiologe 60, 1026–1037 (2020). https://doi.org/10.1007/s00117-020-00757-4

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