The Discussion Of CT Alone And Combination With Clinical Endoscope In The Preoperative T-staging Of Laryngocarcinoma

Objective:Discussing of the application vavle of CT alone and combination with white light endoscopy,NBI endoscopy in preoperative T-staging of laryngocarcinoma. The purpose of to provide clinical basis for preoperative staging of laryngocarcinoma.Methods:56 cases of laryngeal cancer patients who were confirmed by surgery and pathology in our hospital from February,2013 through December,2015 were retrospectively reviewed.The study group comprised 78 men and 5 women,from 45 years old to 78 years old.with a mean age(±standard deviation)of 57.14±7.26 years.All the patients could endure the operation with a good body condition.we rule out the cases who were diagnosed of liver,lung and other distant metastatis preoperatively and contraindiant by the endoscopy and enhanced CT examination.All the patients were confirmed by CT,white light endoscopy,narrow band imaging endoscopy before operation,analysing the T-staging of CT alone and the combination with endoscope,take it as the basis of the operation.Analysing the T-staging again according to the postoperative laryngeal specimens and pathological results,and taking it as the diagnosic “gold standard”.we analysed the accuracy of the T-staging with the preoperative methods.In our study,patients with conventional line scan CT examination,enhanced CT if necessary.Results: ?Of all the 56 laryngeal cancers,11 cases in supraglottis,of which the majority with epiglottis carcinoma(6cases).operation methods:total laryngectomy in7 cases,level half laryngectomy in 4 cases.2 cases with total laryngectomy for the reason of thyroid cartilage destruction by CT,but the pathologic examination revealed thyroid cartilage were negative.We should have level half laryngectomy for the 2 cases.All the patients were undergo lymph node dissection. The glottis type were 30 cases(account 53.6%),operation:16 cases in total laryngectomy,6 in vertical partial laryngectomy,2 in CO2 laser surgery,6cases in laryngofissure.19 of all the patients were undergo lymph node dissection.2 cases in subglottic type and 13 cases across glottis type were with total laryngectomy and lymph node dissection. T-staging according to pathology: T1stage:10cases, T2 stage:20cases T3 stage:14cases and T4 stage:12cases.?T-staging according to CT:T0 stage:2 cases,T1 stage:9 cases, T2 stage:16 cases T3 stage:17 cases T4 stage:12cases.Comparing with pathologic results,the accuracy of CTis T1:60.0%(6/10),T2:65.0%(13/20),T3:78.6%(11/14),T4:83.3%(10/12) respective.And T:71.4%(40/56) in total.?T-staging according to CT combined with white light endoscopy: T1 stage:10 cases, T2 stage:19 cases T3 stage:15 cases T4 stage:12cases.Comparing with pathologic results,the accuracy of CT is T1:90.0%(9/10), T2:85.0%(17/20), T3:85.7%(12/14), T4:91.7%(11/12) respectively,T:87.5%(49/56) in total.?T-staging according to CT combined with white light endoscopy and NBI:T1stage:11cases,T2stage:18cases,T3stage:15cases,T4stage:12cases.Comparin g with pathologicresults,the accuracy of CT is T1:100%(10/10),T2:90%(18/20),T3: :92.9%(13/14), T4:91.7%(11/12) respectively,T:92.9%(52/56) in total. ?The difference between CT and CT combined with white light endoscopy had statistic meaning(P?0.05). ?The difference between CT and CT combined with white light endoscopy,NBI endoscopy have statistic meaning(P?0.05). ?The difference between CT, white light endoscopy and CT combined with white light endoscopy,NBI endoscopy doesn?t have statistic meaning(P?0.05). Conclusions: ?the combined application of CT and white light endoscopy can obviously improve the accuracy of laryngeal cancer preoperative T-staging.?NBI endoscopy could clearly show the border of the lesion by identifying the change of pathological mucosal and superficial vessels,it is able to differentiate hyperplasia,dropsy from tutor lesion.It has reference vavle in clinical T stage?The combination of CT,white light endoscopy,NBI endoscopy,had proved to improve the accuracy of T-staging compared with the combination of CT and white light endoscopy.In some cases,the combination of NBI can change the initial T-staging.Although the difference doesn?t have statistic meaning,we still need a large sample of clinical research and summary to confirm its value.