Tumor staging of laryngeal and hypopharyngeal carcinomas with functional spiral CT: Comparison with nonfunctional CT, histopathology, and microlaryngoscopy

Purpose: The purpose of this work was to compare nonfunctional and functional spiral CT in the tumor (T) staging of laryngeal and hypopharyngeal tumors and to correlate the CT results with microlaryngoscopy and postoperative pathology. Method: Twenty-six patients (3 women, 23 men) with clinically suspected laryngeal and hypopharyngeal tumors underwent both nonfunctional CT during quiet breathing and functional spiral CT during either a modified Valsalva (n = 19) or E phonation (n = 7) maneuver. CT slice thickness was 3 mm, table feed was 3 mm, and 40-80 ml of intravenous contrast material was administered at a flow of 1.5 ml/s. T stages as determined by nonfunctional and functional CT were compared and correlated with postoperative pathology or microlaryngoscopy. Results: The T stages determined with functional CT were better correlated with postoperative pathology (r(S) = 0.88, p = 0.001) and microlaryngoscopy (r(S) = 0.77, p = 0.008) than T stages determined with nonfunctional CT (r(S) = 0.80, p = 0.001; and r(S) = 0.51, p = 0.13, respectively). Twelve of 26 patients (46%) had a lower T stage on functional than on nonfunctional CT. In 14 of 26 patients (54%), the T stage was identical with both modalities. In no patients was the T stage increased by functional CT. Conclusion: Functional CT appears to be more accurate than nonfunctional CT in the T staging of laryngeal and hypopharyngeal carcinomas. Functional CT also results in lower T stages than nonfunctional CT in a substantial number of patients.