Authors’ reply to Jat et al.

We thank Jat et al.[1] for their comments on our recently published article, “A retrospective observational study to assess the accuracy of preoperative computed tomography scan for thyroid cartilage involvement and T-categorization in patients with carcinoma larynx undergoing total laryngectomy.”[2] Due to the rural setting, most of the study population presented with advanced disease; 14 of 18 patients (77.8%) had outer cortex of thyroid cartilage involvement along with extralaryngeal extension (ELE). Becker[3] in his study also used a combination of extralaryngeal tumor spread along with erosion/lysis and sclerosis for the evaluation of laryngeal cartilage. In our study, when only erosion/lysis of the outer cortex of the thyroid cartilage was taken as a criterion without considering ELE, the accuracy of computed tomography (CT) was found to be 93.3%. This might be due to the experience of the radiologist who was reevaluating the cases. Similarly, Atlanoğlu et al.[4] also found the accuracy of CT to be 96% for the detection of thyroid cartilage involvement. We fully agree with the authors’ comment on the role of radiomics; however, the sample size of our study was too small to conduct a radiomics-based analysis. Future prospective multicentric studies could be considered with study populations having disease limited to the outer cortex of the thyroid cartilage without ELE. The role of radiomics for thyroid cartilage involvement could also be elucidated in such a study. Further, in response to the authors’ question on organ preservation, all the patients with T2 and T3 disease who underwent total laryngectomy had either dysfunctional larynx or recurrence post-chemoradiation (CRT). Moreover, all the treatment decisions were taken after a multidisciplinary joint clinic discussion. In our study, there was no statistically significant difference in the diagnostic accuracy of the preoperative CT in post-CRT patients when compared to that in patients undergoing upfront total laryngectomy. However, no definite conclusion can be made as the number of patients who underwent CRT was small (n = 5). The role of fluorodeoxyglucose-positron emission tomography (FDG-PET) is well established in post-CRT cases,[5] although high cost and lack of availability in rural settings are deterrents. Magnetic resonance imaging (MRI) is less specific for thyroid cartilage involvement as edema (noted more in post-CRT patients) is difficult to differentiate from tumoral involvement; however, the sensitivity of MRI is high in such patients. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.