# Decoding Temporal Bone Carcinoma: The Role of CT and MRI in Precision Staging
## 3 Results  
The study group comprised 11 men and 4 women (Table 1). Patient ages ranged from 53 to 94, with a mean age of 76. The most common presenting symptoms were otorrhea (12 patients [80%]), otalgia (9 [60%]), and hearing loss (6 [40%]). Less commonly, patients presented with facial paralysis (2 [13%]) or dizziness (1 [7%]). Based on radiological interpretation, the maximal extent of the disease was found in the external auditory canal (EAC) in 8 (53%) of the 15 patients, in the mastoid in 5 (33%), in the middle ear in 1 (7%), and in the otic capsule in 1 (7%). Ten patients (66%) showed bone erosion in the EAC. Two patients (13%) had suspected cervical lymphadenopathy. The temporal bone CT report was used to determine the preoperative stage according to the Pittsburgh staging system for the SCC of the EAC. The final stage was determined by intraoperative findings and the final pathological report (Table 2). The preoperative radiological staging and the final pathological staging correlated in 11 (73%) of the 15 cases. The 73% correlation between radiologic and pathologic staging is remarkable and suggests a moderate level of reliability of the imaging modalities used. However, the discrepancies observed, particularly in cases where radiologic staging underestimated or overestimated pathologic findings, warrant further analysis. Factors such as the resolution limits of imaging techniques, variability in tumor presentation, radiologists' experience, or ambiguous tumor features (e.g., small erosions or subtle soft tissue involvement) could contribute to these discrepancies. This finding could underscore the need for improving imaging protocols and staging accuracy with grids of observations. Radiological staging underestimated the stage in two cases and overestimated it in two others (Table 3). Table 3 highlights the discrepancies between radiological and pathological staging, illustrating cases where imaging underestimated or overestimated \begin{table}
\begin{tabular}{l c c} \hline \hline  & **Variable** & **n (\%)** \\ \hline Sex & & \\  & Male & 11 (73\%) \\  & Female & 4 (15\%) \\ Symptoms & & \\  & Otorrhea & 12 (80\%) \\  & Otalgia & 9 (60\%) \\  & Hearing loss & 6 (40\%) \\ The maximal extent of the disease & & \\  & EAC & 8 (53\%) \\  & Mastoid & 5 (33\%) \\  & Middle ear & 1 (7\%) \\  & Otic capsule & 2 (7\%) \\ \hline \hline \end{tabular} Legend: EAC (external auditory canal).  
\end{table} 
Table 1: Patient characteristics. the tumor stage. These differences, seen in both T1-T2 and T3-T4 stages, emphasize the challenges in accurately determining tumor extent solely through imaging and underline the importance of multimodal evaluation to improve diagnostic precision (Figures 1 and 2). Radiological staging correlated more frequently with pathological staging for T3 and T4 tumors compared to T1 and T2 tumors (86% vs. 63%). The [PERSON]'s Kappa value for evaluating the agreement between radiological and pathological staging was 0.66, indicating substantial agreement. This suggests a significant level of concordance between the two staging methods. Discrepancies may be attributed to the complexity of visualizing tumor extension through imaging or the possibility that some details were not easily identifiable with the imaging techniques. Therefore, a multimodal diagnosis, combining imaging and pathological evaluation, is emphasized to achieve accurate staging of temporal bone SCC. Three patients with T4 disease diagnosed by CT underwent preoperative contrast-enhanced temporal bone MRI. The MRI results did not alter the preoperative staging but provided additional information on tumor extension into soft tissues. MRI showed dual enhancement in two patients and parotid involvement in one patient, which was not visible on CT. parotid involvement was suspected in one patient but confirmed in two (18%) of the eleven parotid specimens. Radical neck dissection was performed in six (40%) cases, with two (13%) showing lymphatic spread.