Relationship between laryngoscopic and pathological characteristics of vocal cords leukoplakia

Zhang, Na; Cheng, Lei; Chen, Min; Chen, Jian; Yang, Yue; Xie, Mao; Li, Cai; Chen, Xiaoling; Zhou, Liang; Wu, Haitao

doi:10.1080/00016489.2017.1347826

Cited by 15 publications

(28 citation statements)

References 16 publications

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“… 8 Another study with similar morphologic characterization of 1635 glottic keratosis found that the rate of cancerization among rough keratotic lesions was 2.7 to 7.9 times higher than among smooth keratotic lesions. 9 Other signs of increased malignant potential of glottic keratosis include presence of erythroplakia, surface granularity, keratosis morphology of increased keratin thickness and increased size, recurrence after conservative removal, and long duration. 1 , 3 , 7 In particular, erythroplakia, which means “red patch,” is considered the most important clinical predictor for either presence of malignancy or progression toward carcinoma.…”

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confidence: 99%

Glottic Keratosis: Significance and Identification of Laryngoscopic Findings

et al. 2021

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Objective Glottic keratosis poses a challenge because a decision to biopsy must weigh the likelihood of dysplasia and cancer against the voice outcome after biopsy. We determined the significance of laryngoscopic findings and agreement among clinicians to identify those specific findings. Study Design Retrospective case-control study. Setting Tertiary care university hospital. Methods Adults with glottic keratosis with preoperative office laryngoscopies were included. Preoperative videostroboscopies were reviewed by a blinded reviewer. Multivariable logistic regression was used to examine the correlation between laryngoscopic appearance of glottic keratosis and presence or absence of high-grade dysplasia or carcinoma on biopsies. Consensus among head and neck cancer surgeons to detect specific laryngoscopic findings was evaluated by presenting representative laryngoscopies to a blinded cohort. Interrater reliability was calculated using Fleiss’s κ. Results Sixty glottic keratotic lesions met inclusion criteria. On logistic regression, both erythroplakia and aberrant microvasculature like vascular speckling were significantly associated with high-grade dysplasia and carcinoma, P = .002 and P = .03, respectively. Interrater reliability among clinicians to identify erythroplakia and aberrant microvasculature was minimal, κ = 0.35 and κ = 0.29, respectively. Interrater reliability was improved with the use of virtual chromoendoscopy. Conclusion The presence of erythroplakia and aberrant microvasculature in glottic keratosis is associated with the presence of high-grade dysplasia or carcinoma. Virtual chromoendoscopy can be used to improve reliability for detecting erythroplakia and vascular speckling, and this is a potential area for practice-based learning. Clinicians should identify and consider immediate diagnostic biopsy of suspicious glottic keratosis.

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confidence: 99%

Glottic Keratosis: Significance and Identification of Laryngoscopic Findings

et al. 2021

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“…Of note, most retreated lesions were small and lacked more concerning characteristics, and a recent report of over 1600 vocal folds with leukoplakia described as “flat and smooth” found cancer in only 1% of pathologic specimens. 32 Nonetheless, local control and disease-free survival without confirmed pathological diagnoses risks mis-representation, and this lack of pathology on all recurrent lesions is a limitation of this study. However, important information can still be gleaned from reported recurrences and re-treatments.…”

Section: Discussionmentioning

confidence: 88%

KTP Laser Treatment of Early Glottic Cancer: A Multi-Institutional Retrospective Study

Parker

Weidenbecher

Friedman

et al. 2020

Ann Otol Rhinol Laryngol

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Objectives: The primary objectives were to report oncologic outcomes of transoral laser microsurgery with potassium-titanyl-phosphate (KTP) laser (TLM-KTP) ablation of early glottic cancer (EGC). The secondary objectives were to report vocal outcomes and to analyze factors that might influence outcomes. Methods: A multi-institutional, retrospective analysis of consecutive patients treated for T1 or T2 glottic squamous cell carcinoma undergoing TLM-KTP ablation with at least 2 years of follow-up was performed. Patients with prior radiation or surgery for laryngeal disease were excluded. Primary outcome measures included: surgical failures requiring radiation or laryngectomy, disease-specific survival (DSS), and overall survival (OS). Secondary outcome measures included: pre- and postoperative Voice Handicap Index-10 (VHI-10) scores. The effects of smoking status, stage, and anterior commissure involvement on outcomes were analyzed. Results: Overall 88 patients met inclusion criteria (83% male, 79.5% current or former smokers). Mean age was 68 (standard deviation (SD): 12). Mean follow-up was 39.5 months (SD: 15.3). Staging included 50 T1a, 21 T1b, and 20 T2 tumors, including three metachronous second primaries. Radiation and/or laryngectomy avoidance was achieved in 87/88 (98.9%) of patients, inclusive of 24 patients requiring KTP re-treatments. Two patients had biopsy-proven recurrence (2.3%), but only 21 of 24 re-treated patients received a formal biopsy. No patients died from laryngeal cancer. DSS and OS were 100% and 92.3%, respectively. The mean VHI-10 scores were 19.3 preoperatively, 3.8 at 6-months postop, and 3.8 at 2-years postop. Smokers had a longer interval to re-treatment ( P = .03), patients with T2 lesions had a shorter interval to re-treatment (0.02), and patients with T2 lesions presented with worse initial VHI-10 scores (0.002). Conclusions: A multi-institutional, retrospective case series of TLM-KTP ablation of EGC demonstrated excellent oncologic outcomes when close surveillance and proactive re-treatments were utilized. Disease-specific survival, overall survival, and vocal function were excellent. Additional studies are necessary to further analyze the merits and risks of this treatment approach.

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“…Vocal fold leukoplakia is a common cause of hoarseness and a common pre-cancerous lesion in laryngeal cancer. Although the morphological and pathological features of vocal fold leukoplakia under routine laryngoscopy are closely associated, 11 subjective factors that influence this association, such as laryngologists’ clinical experience, are relatively strong, thereby reducing objectivity in the diagnostic process.…”

Section: Discussionmentioning

confidence: 99%

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

Zhu

Zhang

et al. 2020

J. Laryngol. Otol.

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Objective To investigate the value of narrow-band imaging training for differentiating between benign and malignant vocal fold leukoplakia. Method Thirty cases of vocal fold leukoplakia were selected. Results Narrow-band imaging endoscopy training had a significant positive effect on the specificity of the differential diagnosis of vocal fold leukoplakia. In addition, the consistency of diagnostic typing of vocal fold leukoplakia by narrow-band imaging improved to ‘moderate agreement’ following the combination of types I and II and the combination of types IV, V and VI in the typing of vocal fold leukoplakia. Conclusion The narrow-band imaging training course may improve the ability of laryngologists to diagnose vocal fold leukoplakia. The new endoscopic diagnostic classification by narrow-band imaging needs to be further simplified to facilitate clinical application.

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Relationship between laryngoscopic and pathological characteristics of vocal cords leukoplakia

Abstract: The pathological results of vocal cord leukoplakia can be evaluated by morphology in most cases.

Cited by 15 publications

References 16 publications

Glottic Keratosis: Significance and Identification of Laryngoscopic Findings

Glottic Keratosis: Significance and Identification of Laryngoscopic Findings

KTP Laser Treatment of Early Glottic Cancer: A Multi-Institutional Retrospective Study

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

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