Metastatic neck disease. Evaluation by computed tomography.

Computed tomographic (CT) scanning has been used in the preoperative examination of patients with head and neck cancer. Although early reports on the use of CT scanning for cervical lymphadenopathy were encouraging, the accuracy of CT in detecting nodal metastases has not been well established. Fifty consecutive patients underwent radical neck dissection and preoperative CT scanning. The clinical staging of the neck, CT diagnoses, and pathologic findings were correlated; CT accuracy was then compared with clinical accuracy. Our findings show the overall accuracy of CT diagnoses to be 90%. Comparison with clinical accuracy shows the CT scan to be superior to the clinical examination, particularly in detecting occult metastases.

Parathyroid localization by computed tomographic scanning.

Increased accuracy of parathyroid hormone assays has yielded an earlier diagnosis of primary hyperparathyroidism, often in an asymptomatic stage. Non-invasive modalities used to localize parathyroid abnormalities have not been accurate for small adenomas. Although arteriography has been shown to be accurate in detection of adenomas, the invasive nature of the study, as well as possible complications, minimizes its use in preoperative localization of parathyroid abnormalities. The computed tomographic (CT) scan was used preoperatively in eight patients to assess its accuracy in localizing parathyroid abnormalities. The radiographic findings were correlated with surgical and pathologic findings. The conditions of seven patients were correctly diagnosed preoperatively by the CT scan, including that of one patient with diffuse hyperplasia. With the increased accuracy attained by this noninvasive examination, we believe that CT scanning should be a routine part of the preoperative examination of patients with primary hyperparathyroidism.

Laryngotracheal invasion by thyroid-carcinoma.

Laryngotracheal invasion by well-differentiated thyroid carcinoma is an uncommon occurrence. Recommendations for therapy have primarily included total laryngectomy or shaving of the tumor from laryngeal or tracheal cartilages. Clear guidelines have not been established for the applicability of partial laryngeal resections. In a retrospective analysis of patients with thyroid carcinoma, 13 patients had airway invasion. Of the five patients with laryngeal involvement, three were treated by a partial laryngeal resection. An experimental study was undertaken to determine more precisely the amount of cricoid cartilage which could be resected without reconstruction. Varying amounts of cricoid cartilage were resected. The results indicate that 25% of the cricoid cartilage may be resected without appreciable airway narrowing. On the basis of the retrospective analysis and experimental study, we feel a partial laryngeal resection is possible in most cases of airway invasion by thyroid carcinoma.