Correlating laryngoscopic appearance of laryngeal lesions with histopathology

Abstract

Objectives/Hypothesis Meticulous scrutiny of laryngeal lesions with laryngoscopes and microscopes often identify angiogenic activity, one of the hallmarks of neoplastic and preneoplastic lesions. The aim of this study was to determine if there is an association between laryngoscopic appearance and histopathology of laryngeal lesions based on operative biopsies. Study Design Retrospective case‐control study. Methods One hundred forty‐four laryngeal biopsies from 92 patients between 2015 and 2017 met inclusion criteria. Cases were patients who had biopsy‐proven laryngeal dysplasia or malignancy. Controls were patients who had benign laryngeal pathology. All of the laryngeal lesions had either keratosis or vascular stippling, an indication of angiogenic activity. Medical records, videostroboscopies and operative findings of these patients were reviewed. Multivariable logistic regression was used to examine the correlation between laryngoscopic appearance of laryngeal lesions and presence or absence of dysplasia and invasive carcinoma. Results Fifty percent of the 144 laryngeal lesions were classified either as dysplastic or malignant by histopathology. Vascular stippling was present in 31% of all laryngeal lesions. On logistic regression, vascular stippling was significantly associated with dysplastic and malignant lesions (P = .0018). Overall sensitivity and specificity of vascular stippling and the presence of dysplasia and malignancy were 51% and 89%, respectively. Conclusions Laryngoscopic and microscopic appearance of vascular stippling could inform clinicians on diagnostic sampling of suspicious laryngeal lesions that reduces delay in diagnosis. The low sensitivity of vascular stippling underlies the importance of maintaining high clinical suspicion and proceeding to the operating theater for adequate tissue sampling. Level of Evidence 3 Laryngoscope, 129:1308–1312, 2019

Glottic Keratosis: Significance and Identification of Laryngoscopic Findings

“… 3 Keratosis is often used interchangeably with leukoplakia , even though the latter means “white patch.” Keratosis may be associated with phonotraumatic lesions, and these generally have low malignant potential. 4 - 6 All other glottic keratoses pose a difficult problem for clinical management. The histology and behavior of glottic keratosis can be frustratingly difficult to predict, as lesions can present on a spectrum anywhere from completely benign growth to invasive malignancy.…”

“… 10 - 12 The present study is predicated on the observation in our prior study that certain keratotic glottic lesions were found to harbor malignancy on histopathology despite having no vascular speckling. 5 In this study, we sought to determine the relative significance of different laryngoscopic findings based on their correlation with histopathology. The significant laryngoscopic findings could alert clinicians to lesions that need expedient biopsy and treatment.…”

Effect of a training course on the diagnosis of vocal fold leukoplakia by narrow-band imaging

“…proposed evaluation of only the roughness of leukoplakia, but not the mucosal red zone around it. In addition, previous studies have shown that under routine laryngoscopy, hyperaemia 13 and vascular stippling 4 are closely associated with dysplasia and the malignancy of vocal fold leukoplakia.…”

“…Laryngoscopy is a widely used examination method for the diagnosis of vocal fold leukoplakia. However, given the high similarity in manifestation of different pathological types of vocal fold leukoplakia, it is difficult to accurately evaluate the degree of dysplasia in vocal fold leukoplakia and to determine whether there is cancerisation by routine laryngoscopy 4 . This often results in over- or under-treatment due to misdiagnosis.…”

Triological Best Practice: When Is Surgical Intervention Indicated for Vocal Fold Leukoplakia?

“…A more recent study by Anis sought to further identify correlations between laryngoscopic appearances of lesions with histopathology. In this retrospective review of 144 laryngeal lesions from 92 patients, cases of patients with biopsy‐proven dysplasia or malignancy were compared to controls with benign pathology.…”