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Itamura K, Hsue VB, Barbu AM, Chen MM. Diagnostic Assessment (Imaging) and Staging of Laryngeal Cancer. Otolaryngol Clin North Am 2023; 56:215-231. [PMID: 37030936 DOI: 10.1016/j.otc.2022.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2023]
Abstract
Diagnosis of larynx cancer relies on a detailed history and physical and objective assessment with endoscopy and imaging. Endoscopy is needed to assess for vocal fold function that directly affects staging. Computed tomography and MRI can be used to assess for tumor extent in relation to intra- and extra-laryngeal structures, especially paraglottic and pre-epiglottic space involvement as well as cartilage invasion. Accurate staging is critical for subsequent treatment decision-making regarding larynx preservation.
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Affiliation(s)
- Kyohei Itamura
- Division of Otolaryngology-Head and Neck Surgery, Cedars-Sinai Medical Center, 8635 West Third Street #590W, Los Angeles, CA 90048, USA
| | - Victor B Hsue
- Division of Otolaryngology-Head and Neck Surgery, Cedars-Sinai Medical Center, 8635 West Third Street #590W, Los Angeles, CA 90048, USA
| | - Anca M Barbu
- Division of Otolaryngology-Head and Neck Surgery, Cedars-Sinai Medical Center, 8635 West Third Street #590W, Los Angeles, CA 90048, USA
| | - Michelle M Chen
- Division of Otolaryngology-Head and Neck Surgery, Cedars-Sinai Medical Center, 8635 West Third Street #590W, Los Angeles, CA 90048, USA; Department of Otolaryngology-Head and Neck Surgery, Stanford University, 900 Blake Wilbur Drive Rm W3045, Stanford, CA 94305, USA.
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2
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Young K, Ma E, Kejriwal S, Nielsen T, Aulakh SS, Birkeland AC. Intraoperative In Vivo Imaging Modalities in Head and Neck Cancer Surgical Margin Delineation: A Systematic Review. Cancers (Basel) 2022; 14:cancers14143416. [PMID: 35884477 PMCID: PMC9323577 DOI: 10.3390/cancers14143416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/06/2022] [Accepted: 07/12/2022] [Indexed: 11/16/2022] Open
Abstract
Surgical margin status is one of the strongest prognosticators in predicting patient outcomes in head and neck cancer, yet head and neck surgeons continue to face challenges in the accurate detection of these margins with the current standard of care. Novel intraoperative imaging modalities have demonstrated great promise for potentially increasing the accuracy and efficiency in surgical margin delineation. In this current study, we collated and analyzed various intraoperative imaging modalities utilized in head and neck cancer to evaluate their use in discriminating malignant from healthy tissues. The authors conducted a systematic database search through PubMed/Medline, Web of Science, and EBSCOhost (CINAHL). Study screening and data extraction were performed and verified by the authors, and more studies were added through handsearching. Here, intraoperative imaging modalities are described, including optical coherence tomography, narrow band imaging, autofluorescence, and fluorescent-tagged probe techniques. Available sensitivities and specificities in delineating cancerous from healthy tissues ranged from 83.0% to 100.0% and 79.2% to 100.0%, respectively, across the different imaging modalities. Many of these initial studies are in small sample sizes, with methodological differences that preclude more extensive quantitative comparison. Thus, there is impetus for future larger studies examining and comparing the efficacy of these intraoperative imaging technologies.
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Affiliation(s)
- Kurtis Young
- John A. Burns School of Medicine, Honolulu, HI 96813, USA; (K.Y.); (E.M.); (S.K.); (T.N.)
| | - Enze Ma
- John A. Burns School of Medicine, Honolulu, HI 96813, USA; (K.Y.); (E.M.); (S.K.); (T.N.)
| | - Sameer Kejriwal
- John A. Burns School of Medicine, Honolulu, HI 96813, USA; (K.Y.); (E.M.); (S.K.); (T.N.)
| | - Torbjoern Nielsen
- John A. Burns School of Medicine, Honolulu, HI 96813, USA; (K.Y.); (E.M.); (S.K.); (T.N.)
| | | | - Andrew C. Birkeland
- Department of Otolaryngology—Head and Neck Surgery, University of California, Davis, CA 95817, USA
- Correspondence:
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Sun C, Hu L, Miao Z. Diagnostic performance of NBI in post-treatment follow up for laryngeal cancer: A systematic review and meta-analysis. Am J Otolaryngol 2022; 43:103530. [DOI: 10.1016/j.amjoto.2022.103530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/31/2022] [Accepted: 06/06/2022] [Indexed: 11/01/2022]
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van Schaik JE, Halmos GB, Witjes MJH, Plaat BEC. An overview of the current clinical status of optical imaging in head and neck cancer with a focus on Narrow Band imaging and fluorescence optical imaging. Oral Oncol 2021; 121:105504. [PMID: 34454339 DOI: 10.1016/j.oraloncology.2021.105504] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/25/2021] [Accepted: 08/18/2021] [Indexed: 11/28/2022]
Abstract
Early and accurate identification of head and neck squamous cell carcinoma (HNSCC) is important to improve treatment outcomes and prognosis. New optical imaging techniques may assist in both the diagnostic process as well as in the operative setting by real-time visualization and delineation of tumor. Narrow Band Imaging (NBI) is an endoscopic technique that uses blue and green light to enhance mucosal and submucosal blood vessels, leading to better detection of (pre)malignant lesions showing aberrant blood vessel patterns. Fluorescence optical imaging makes use of near-infrared fluorescent agents to visualize and delineate HNSCC, resulting in fewer positive surgical margins. Targeted fluorescent agents, such as fluorophores conjugated to antibodies, show the most promising results. The aim of this review is: (1) to provide the clinical head and neck surgeon an overview of the current clinical status of various optical imaging techniques in head and neck cancer; (2) to provide an in-depth review of NBI and fluorescence optical imaging, as these techniques have the highest potential for clinical implementation; and (3) to describe future improvements and developments within the field of these two techniques.
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Affiliation(s)
- Jeroen E van Schaik
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
| | - Gyorgy B Halmos
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Max J H Witjes
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, the Netherlands
| | - Boudewijn E C Plaat
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Sharma GK, Chen LY, Chou L, Badger C, Hong E, Rangarajan S, Chang TH, Armstrong WB, Verma SP, Chen Z, Ramalingam R, Wong BJF. Surface kinematic and depth-resolved analysis of human vocal folds in vivo during phonation using optical coherence tomography. JOURNAL OF BIOMEDICAL OPTICS 2021; 26:JBO-210125R. [PMID: 34414705 PMCID: PMC8374544 DOI: 10.1117/1.jbo.26.8.086005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 07/26/2021] [Indexed: 05/30/2023]
Abstract
SIGNIFICANCE The human vocal fold (VF) oscillates in multiple vectors and consists of distinct layers with varying viscoelastic properties that contribute to the mucosal wave. Office-based and operative laryngeal endoscopy are limited to diagnostic evaluation of the VF epithelial surface only and are restricted to axial-plane characterization of the horizontal mucosal wave. As such, understanding of the biomechanics of human VF motion remains limited. AIM Optical coherence tomography (OCT) is a micrometer-resolution, high-speed endoscopic imaging modality which acquires cross-sectional images of tissue. Our study aimed to leverage OCT technology and develop quantitative methods for analyzing the anatomy and kinematics of in vivo VF motion in the coronal plane. APPROACH A custom handheld laryngeal stage was used to capture OCT images with 800 A-lines at 250 Hz. Automated image postprocessing and analytical methods were developed. RESULTS Novel kinematic analysis of in vivo, long-range OCT imaging of the vibrating VF in awake human subjects is reported. Cross-sectional, coronal-plane panoramic videos of the larynx during phonation are presented with three-dimensional videokymographic and space-time velocity analysis of VF motion. CONCLUSIONS Long-range OCT with automated computational methods allows for cross-sectional dynamic laryngeal imaging and has the potential to broaden our understanding of human VF biomechanics and sound production.
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Affiliation(s)
- Giriraj K. Sharma
- University of California, Irvine Medical Center, Department of Otolaryngology–Head and Neck Surgery, Irvine, California, United States
- University of California, Irvine, Beckman Laser Institute and Medical Clinic, Irvine, California, United States
| | - Lily Y. Chen
- University of California, Irvine, Beckman Laser Institute and Medical Clinic, Irvine, California, United States
| | - Lidek Chou
- OCT Medical Imaging, Inc., Irvine, California, United States
| | - Christopher Badger
- University of California, Irvine, School of Medicine, Irvine, California, United States
| | - Ellen Hong
- University of California, Irvine, Beckman Laser Institute and Medical Clinic, Irvine, California, United States
| | | | | | - William B. Armstrong
- University of California, Irvine Medical Center, Department of Otolaryngology–Head and Neck Surgery, Irvine, California, United States
| | - Sunil P. Verma
- University of California, Irvine Medical Center, Department of Otolaryngology–Head and Neck Surgery, Irvine, California, United States
| | - Zhongping Chen
- University of California, Irvine, Beckman Laser Institute and Medical Clinic, Irvine, California, United States
- University of California, Irvine, Department of Biomedical Engineering, Irvine, California, United States
| | - Ram Ramalingam
- OCT Medical Imaging, Inc., Irvine, California, United States
| | - Brian J.-F. Wong
- University of California, Irvine Medical Center, Department of Otolaryngology–Head and Neck Surgery, Irvine, California, United States
- University of California, Irvine, Beckman Laser Institute and Medical Clinic, Irvine, California, United States
- University of California, Irvine, Department of Biomedical Engineering, Irvine, California, United States
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Current Intraoperative Imaging Techniques to Improve Surgical Resection of Laryngeal Cancer: A Systematic Review. Cancers (Basel) 2021; 13:cancers13081895. [PMID: 33920824 PMCID: PMC8071167 DOI: 10.3390/cancers13081895] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/09/2021] [Accepted: 04/13/2021] [Indexed: 12/22/2022] Open
Abstract
Simple Summary Laryngeal cancer is a prevalent head and neck malignancy, with poor prognosis and low survival rates for patients with advanced disease. The recurrence rate for advanced laryngeal cancer is between 25 and 50%. In order to improve surgical resection of laryngeal cancer and reduce local recurrence rates, various intraoperative optical imaging techniques have been investigated. In this systematic review we identify these technologies, evaluating the current state and future directions of optical imaging for this indication. Evidently, the investigated imaging modalities are generally unsuitable for deep margin assessment, and, therefore, inadequate to guide resection in advanced laryngeal disease. We discuss two optical imaging techniques that can overcome these limitations and suggest how they can be used to achieve adequate margins in laryngeal cancer at all stages. Abstract Laryngeal cancer is a prevalent head and neck malignancy, with poor prognosis and low survival rates for patients with advanced disease. Treatment consists of unimodal therapy through surgery or radiotherapy in early staged tumors, while advanced stage tumors are generally treated with multimodal chemoradiotherapy or (total) laryngectomy followed by radiotherapy. Still, the recurrence rate for advanced laryngeal cancer is between 25 and 50%. In order to improve surgical resection of laryngeal cancer and reduce local recurrence rates, various intraoperative optical imaging techniques have been investigated. In this systematic review, we identify these technologies, evaluating the current state and future directions of optical imaging for this indication. Narrow-band imaging (NBI) and autofluorescence (AF) are established tools for early detection of laryngeal cancer. Nonetheless, their intraoperative utility is limited by an intrinsic inability to image beyond the (sub-)mucosa. Likewise, contact endoscopy (CE) and optical coherence tomography (OCT) are technically cumbersome and only useful for mucosal margin assessment. Research on fluorescence imaging (FLI) for this application is sparse, dealing solely with nonspecific fluorescent agents. Evidently, the imaging modalities that have been investigated thus far are generally unsuitable for deep margin assessment. We discuss two optical imaging techniques that can overcome these limitations and suggest how they can be used to achieve adequate margins in laryngeal cancer at all stages.
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Wittig L, Betz C, Eggert D. Optical coherence tomography for tissue classification of the larynx in an outpatient setting‐a translational challenge on the verge of a resolution? TRANSLATIONAL BIOPHOTONICS 2020. [DOI: 10.1002/tbio.202000013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Lukas Wittig
- Universitätsklinikum Hamburg‐Eppendorf, Otorhinolaryngology, Head and Neck Surgery Hamburg Germany
| | - Christian Betz
- Universitätsklinikum Hamburg‐Eppendorf, Otorhinolaryngology, Head and Neck Surgery Hamburg Germany
| | - Dennis Eggert
- Universitätsklinikum Hamburg‐Eppendorf, Otorhinolaryngology, Head and Neck Surgery Hamburg Germany
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Imaging the Vocal Folds: A Feasibility Study on Strain Imaging and Elastography of Porcine Vocal Folds. APPLIED SCIENCES-BASEL 2019. [DOI: 10.3390/app9132729] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Vocal folds are an essential part of human voice production. The biomechanical properties are a good indicator for pathological changes. In particular, as an oscillation system, changes in the biomechanical properties have an impact on the vibration behavior. Subsequently, those changes could lead to voice-related disturbances. However, no existing examination combines biomechanical properties and spatial imaging. Therefore, we propose an image registration-based approach, using ultrasound in order to gain this information synchronously. We used a quasi-static load to compress the tissue and measured the displacement by image registration. The strain distribution was directly calculated from the displacement field, whereas the elastic properties were estimated by a finite element model. In order to show the feasibility and reliability of the algorithm, we tested it on gelatin phantoms. Further, by examining ex vivo porcine vocal folds, we were able to show the practicability of the approach. We displayed the strain distribution in the tissue and the elastic properties of the vocal folds. The results were superimposed on the corresponding ultrasound images. The findings are promising and show the feasibility of the suggested approach. Possible applications are in improved diagnosis of voice disorders, by measuring the biomechanical properties of the vocal folds with ultrasound. The transducer will be placed on the vocal folds of the anesthetized patient, and the elastic properties will be measured. Further, the understanding of the vocal folds’ biomechanics and the voice forming process could benefit from it.
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Pham TT, Chen L, Heidari AE, Chen JJ, Zhukhovitskaya A, Li Y, Patel U, Chen Z, Wong BJ. Computational analysis of six optical coherence tomography systems for vocal fold imaging: A comparison study. Lasers Surg Med 2019; 51:412-422. [PMID: 30681167 PMCID: PMC6658351 DOI: 10.1002/lsm.23060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVES There have been many advancements in laryngeal imaging using optical coherence tomography (OCT), with varying system design and probes for use in research, office, and operating room settings. We evaluated the performance of six distinct OCT systems in imaging porcine vocal folds (cords) using computational image processing and segmentation. METHODS Porcine vocal folds were scanned using six OCT systems. Imaging system and probe performance were quantitatively assessed for signal penetration, layer differentiation, and epithelium (EP) measurement. Fitted exponential decay curves with corresponding α constant and intensity thresholding segmentation were utilized to quantify the aforementioned parameters. RESULTS The smallest average α constant and deepest signal penetration was of the SS-OCT 1700 nm 90 kHz microscope system (α = -1.74), followed by the SS-OCT 1310 nm 200 kHz VCSEL microscope system (α = -1.99), and SS-OCT 1310 nm 50 kHz rigid forward viewing endoscope system (α = -2.23). The EP was not readily visualized for three out of six systems, but was detected using automated segmentation. Average EP thickness (mean ± SD) was calculated as 55.79 ± 31.86 μm which agrees favorably with previous literature. CONCLUSION Comparisons of OCT systems are challenging, as they encompass different probe design, optical path, and lasers, depending on application. Practical evaluation of different systems using computer based quantitative image processing and segmentation revealed basic, constructive information, such as EP measurements. To further validate the comparisons of system performance with clinical usability, in vivo human laryngeal imaging will be conducted. Further development of automated image processing and segmentation can be useful in rapid analysis of information. Lasers Surg. Med. 51:412-422, 2019. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- Tiffany T. Pham
- Beckman Laser Institute & Medical Clinic, University of California—Irvine, Irvine, California 92612
- School of Medicine, University of California—Irvine, Irvine, California 92617
| | - Lily Chen
- Beckman Laser Institute & Medical Clinic, University of California—Irvine, Irvine, California 92612
| | - Andrew E. Heidari
- Beckman Laser Institute & Medical Clinic, University of California—Irvine, Irvine, California 92612
- Department of Biomedical Engineering, University of California—Irvine, Irvine, California 92697
| | - Jason J. Chen
- Beckman Laser Institute & Medical Clinic, University of California—Irvine, Irvine, California 92612
- Department of Biomedical Engineering, University of California—Irvine, Irvine, California 92697
| | - Alisa Zhukhovitskaya
- Beckman Laser Institute & Medical Clinic, University of California—Irvine, Irvine, California 92612
- Department of Otolaryngology—Head and Neck Surgery, University of California—Irvine, Orange, California 92868
| | - Yan Li
- Beckman Laser Institute & Medical Clinic, University of California—Irvine, Irvine, California 92612
- Department of Biomedical Engineering, University of California—Irvine, Irvine, California 92697
| | - Urja Patel
- Beckman Laser Institute & Medical Clinic, University of California—Irvine, Irvine, California 92612
| | - Zhongping Chen
- Beckman Laser Institute & Medical Clinic, University of California—Irvine, Irvine, California 92612
- Department of Biomedical Engineering, University of California—Irvine, Irvine, California 92697
| | - Brian J.F. Wong
- Beckman Laser Institute & Medical Clinic, University of California—Irvine, Irvine, California 92612
- School of Medicine, University of California—Irvine, Irvine, California 92617
- Department of Biomedical Engineering, University of California—Irvine, Irvine, California 92697
- Department of Otolaryngology—Head and Neck Surgery, University of California—Irvine, Orange, California 92868
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Kocak I, Alkan Z, Ovunc O. Air Injection and Transillumination in Phonosurgery: A Novel Technique. J Voice 2019; 34:783-790. [PMID: 30987858 DOI: 10.1016/j.jvoice.2019.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 03/19/2019] [Accepted: 03/20/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES/HYPOTHESIS The goal of this study was to introduce two novel techniques in phonomicrosurgery, air injection (AIR), and transillumination (TI), to improve the diagnosis and surgical excision of pathological tissue in vocal folds during suspension laryngoscopy while preserving the healthy tissue as much as possible. STUDY DESIGN Prospective clinical case series. METHODS Thirty-four patients with benign vocal cord lesions who underwent phonomicrosurgery between January 2016 and May 2017 were evaluated. Pre- and intraoperative recordings were evaluated by three experienced laryngologists. Stroboscopic video images taken during the preoperative diagnosis and interoperative video recordings made before and after AIR and TI were performed were reviewed and compared. During the preoperative evaluation, the surgeons declared their surgical plans and noted changes while observing the intraoperative evaluation during AIR and TI. RESULTS Sixty-eight vocal folds were evaluated. The initial diagnosis was found to be consistent with the final diagnosis in only 10 patients (29.4%). The diagnoses of 29 vocal folds (42.6%) and the surgical plans changed after AIR and TI. In six cases, submucosal bands, additional morphological structures in the vicinity of the primary pathology, were observed; these could only be visualized with AIR and TI. AIR and TI revealed new pathologies in four vocal folds that were noted to be normal in the preoperative evaluation. CONCLUSION AIR and TI are useful and promising techniques to identify undiagnosed lesions in vocal folds and to increase the success of minimally invasive phonosurgery.
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Affiliation(s)
- Ismail Kocak
- Okan University School of Medicine. Department of Otorhinolaryngology. Istanbul, Turkey
| | - Zeynep Alkan
- Yeditepe University School of Medicine. Department of Otorhinolaryngology. Istanbul, Turkey.
| | - Okan Ovunc
- Istanbul Training and Research Hospital, Otolaryngology Head and Neck Surgery Department Istanbul, Turkey
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Lee J, Wijesinghe RE, Jeon D, Kim P, Choung YH, Jang JH, Jeon M, Kim J. Clinical Utility of Intraoperative Tympanomastoidectomy Assessment Using a Surgical Microscope Integrated with an Optical Coherence Tomography. Sci Rep 2018; 8:17432. [PMID: 30479360 PMCID: PMC6258704 DOI: 10.1038/s41598-018-35563-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 10/29/2018] [Indexed: 12/15/2022] Open
Abstract
Significant technical and optical advances are required for intraoperative optical coherence tomography (OCT) to be utilized during otological surgeries. Integrating OCT with surgical microscopy makes it possible to evaluate soft tissue in real-time and at a high resolution. Herein, we describe an augmented-reality, intraoperative OCT/microscope system with an extended working distance of 280 mm, providing more space for surgical manipulation than conventional techniques. We initially performed ex vivo experiments to evaluate system performance. In addition, we validated the system by performing preliminary clinical assessments of tympanomastoidectomy outcomes in six patients with chronic otitis media. The system evaluated residual inflammation in the region-of-interest of the mastoid bone. Most importantly, the system intraoperatively revealed the connection between the graft and the remnant tympanic membrane. The extended working distance allows otological surgeons to evaluate the status of both the mastoid bone and tympanic membrane during manipulation, affording full intraoperative imaging.
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Affiliation(s)
- Jaeyul Lee
- School of Electronics Engineering, College of IT Engineering, Kyungpook National University, 80 Daehak-ro, Buk-gu, Daegu, 41566, Republic of Korea
| | - Ruchire Eranga Wijesinghe
- Department of Biomedical Engineering, College of Engineering, Kyungil University, 50, Gamasil-gil, Hayang-eup, Gyeongsan-si, Gyeongsangbuk-do, 38428, Republic of Korea
| | - Deokmin Jeon
- School of Electronics Engineering, College of IT Engineering, Kyungpook National University, 80 Daehak-ro, Buk-gu, Daegu, 41566, Republic of Korea
| | - Pilun Kim
- School of Electronics Engineering, College of IT Engineering, Kyungpook National University, 80 Daehak-ro, Buk-gu, Daegu, 41566, Republic of Korea
| | - Yun-Hoon Choung
- Department of Otolaryngology, School of Medicine, Ajou University, 164 World cup-ro, Yeongtong-gu, Suwon, Gyeunggi-do, 16499, Republic of Korea
| | - Jeong Hun Jang
- Department of Otolaryngology, School of Medicine, Ajou University, 164 World cup-ro, Yeongtong-gu, Suwon, Gyeunggi-do, 16499, Republic of Korea.
| | - Mansik Jeon
- School of Electronics Engineering, College of IT Engineering, Kyungpook National University, 80 Daehak-ro, Buk-gu, Daegu, 41566, Republic of Korea
| | - Jeehyun Kim
- School of Electronics Engineering, College of IT Engineering, Kyungpook National University, 80 Daehak-ro, Buk-gu, Daegu, 41566, Republic of Korea.
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12
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Chen M, Li C, Yang Y, Cheng L, Wu H. A morphological classification for vocal fold leukoplakia. Braz J Otorhinolaryngol 2018; 85:588-596. [PMID: 30166121 PMCID: PMC9443019 DOI: 10.1016/j.bjorl.2018.04.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 04/21/2018] [Accepted: 04/25/2018] [Indexed: 12/29/2022] Open
Abstract
Introduction There is still no general method for discriminating between benign and malignant leukoplakia and identifying vocal fold leukoplakia. Objective To evaluate the reliability of a morphological classification and the correlation between morphological types and pathological grades of vocal fold leukoplakia. Methods A total of 375 patients with vocal fold leukoplakia between 2009 and 2015 were retrospectively reviewed. Two observers divided the vocal fold leukoplakia into flat and smooth, elevated and smooth, and rough type on the basis of morphological appearance. The inter-observer reliability was evaluated and the results of classification from both observers were compared with final pathological grades. Clinical characteristics between low risk and high risk group were also analyzed. Results The percentage inter-observer agreement of the morphological classification was 78.7% (κ = 0.615, p < 0.001). In the results from both observers, the morphological types were significantly correlated with the pathological grades (p1 < 0.001, p2 < 0.001, Kruskal–Wallis test; r1 = 0.646, p1 < 0.001, r2 = 0.539, p2 < 0.001, Spearman Correlation Analysis). Multivariate analysis showed patient's age (p = 0.018), the size of lesion (p < 0.001), and morphological type (p < 0.001) were significantly different between low risk group and high risk group. Combined receiver operating characteristic curve analysis of significant parameters revealed an area under the receiver operating characteristic curve of 0.863 (95% CI 0.823–0.903, p < 0.001). Conclusions The proposed morphological classification of vocal fold leukoplakia was consistent between observers and morphological types correlated with pathological grades. Patient's age, the size of lesion, and morphological type might enable risk stratification and provide treatment guidelines for vocal fold leukoplakia.
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Affiliation(s)
- Min Chen
- Fudan University, Eye, Ear, Nose, and Throat Hospital, Department of Otolaryngology-Head and Neck Surgery, Shanghai, China; Shanghai Key Clinical, Disciplines of Otorhinolaryngology, Shanghai, China
| | - Changjiang Li
- Fudan University, Eye, Ear, Nose, and Throat Hospital, Department of Otolaryngology-Head and Neck Surgery, Shanghai, China; Shanghai Key Clinical, Disciplines of Otorhinolaryngology, Shanghai, China
| | - Yue Yang
- Fudan University, Eye, Ear, Nose, and Throat Hospital, Department of Otolaryngology-Head and Neck Surgery, Shanghai, China; Shanghai Key Clinical, Disciplines of Otorhinolaryngology, Shanghai, China
| | - Lei Cheng
- Fudan University, Eye, Ear, Nose, and Throat Hospital, Department of Otolaryngology-Head and Neck Surgery, Shanghai, China; Shanghai Key Clinical, Disciplines of Otorhinolaryngology, Shanghai, China.
| | - Haitao Wu
- Fudan University, Eye, Ear, Nose, and Throat Hospital, Department of Otolaryngology-Head and Neck Surgery, Shanghai, China; Shanghai Key Clinical, Disciplines of Otorhinolaryngology, Shanghai, China.
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Winiarski P, Lewandowski A, Greczka G, Banaszewski J, Klimza H, Wierzbicka M. Primary and salvage laser surgery of 341 glottic cancers-Comparison of treatment outcomes between University Head Neck Tertiary Referral Center and Local Head Neck Department. Lasers Surg Med 2017; 50:311-318. [PMID: 29135033 DOI: 10.1002/lsm.22759] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The main goal was to compare the clinical data of patients with T1 and T2 glottic cancer treated with CO2 transoral laser microlaryngoscopy (TLM) in the Tertiary Referral University Department of Otolaryngology, Head Neck Surgery, Poznan and the local Department of Otolaryngology, Oncology and Maxillofacial Surgery, Bydgoszcz. MATERIAL AND METHODS Unified databases for the 7-year period January 2005-December 2011 were created to compare these two cohorts. The database contained 341 patients: 231 from the tertiary center and 110 from the local department, of which 298 (87%) were men, and 43 (13%) were women. RESULTS Cordectomy type I-IV was performed in 250 (73%) patients, cordectomy type V-VI in 84 (25%) patients, and cordectomy enlarged to epiglottic petiole in 7 (2%) patients. Local recurrence was observed in 96 (28%) cases. Among these cases, 81 (87.5%) patients had salvage surgery: 43 re-cordectomy, 10 open partial laryngectomy, and 28 total laryngectomy. The outcomes for the whole cohort, Tertiary Referral Center and Local Department respectively were as follows: larynx preservation rate was 91.8%, 93.6%, and 88%; 3-year disease specific survival was 97.4%, 97.9%, and 93.3%; 3-year overall survival was 93.5%, 96.6%, and 85.5%; 5-year disease specific survival was 95.2%, 95.2%, and 96.3%; and 5-year overall survival was 84.5%, 88.7%, and 76%, respectively. CONCLUSION Comparison of the cohorts showed that outcomes of primary treatment were similar but there were noticeable differences in salvage treatment efficacy, favoring patients from the Tertiary Referral Center. Lasers Surg. Med. 50:311-318, 2018. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Piotr Winiarski
- Department of Otolaryngology, Otolaryngological Oncology and Maxillofacial Surgery, Jan Biziel Second University Hospital, Bydgoszcz, Poland
| | - Artur Lewandowski
- Department of Otolaryngology, Otolaryngological Oncology and Maxillofacial Surgery, Jan Biziel Second University Hospital, Bydgoszcz, Poland
| | - Grażyna Greczka
- Department of Otolaryngology and Oncological Laryngology, Poznan University of Medical Sciences, Poznan, Poland
| | - Jacek Banaszewski
- Department of Otolaryngology and Oncological Laryngology, Poznan University of Medical Sciences, Poznan, Poland
| | - Hanna Klimza
- Department of Otolaryngology and Oncological Laryngology, Poznan University of Medical Sciences, Poznan, Poland
| | - Małgorzata Wierzbicka
- Department of Otolaryngology and Oncological Laryngology, Poznan University of Medical Sciences, Poznan, Poland
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