1
|
Hasegawa H, Matsuzaki H, Makiyama K, Oshima T. Inferior Surface Leukoplakia of Vocal Folds: Risk of Recurrence: A Preliminary Study. EAR, NOSE & THROAT JOURNAL 2023; 102:170-174. [PMID: 33559492 DOI: 10.1177/0145561321989437] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES This study aimed to identify vocal fold leukoplakia (VFL) lesions on the inferior surface as a risk factor for recurrence. METHODS This was a retrospective study with data collected from 2001 to 2018. The study comprised 37 patients with VFL, divided into the nonrecurrent and recurrent groups. We examined the clinicopathological characteristics and the surgical procedures performed in each patient. RESULTS Among the 37 patients, 15 (40.5%) had residual (3) or recurrent (12) VFL. Of those patients with and without recurrence, 8 of 12 (66.7%) and 6 of 22 (27.3%), respectively, had inferior surface lesions of the vocal fold at the initial operation (P = .036). Recurrences were significantly higher in patients with inferior surface lesions. Other evaluated factors did not show significance for recurrence. CONCLUSION The presence of VFL lesions on the inferior surface is a significant risk factor for recurrence.
Collapse
Affiliation(s)
- Hisashi Hasegawa
- Department of Otolaryngology-Head and Neck Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Hiroumi Matsuzaki
- Department of Otolaryngology-Head and Neck Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Kiyoshi Makiyama
- Department of Otolaryngology-Head and Neck Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Takeshi Oshima
- Department of Otolaryngology-Head and Neck Surgery, Nihon University School of Medicine, Tokyo, Japan
| |
Collapse
|
2
|
Doğan E, Boran C, Cevizci MC, Sarıoğlu S. Comparison of the prognoses of laryngeal preneoplastic lesions based on Ljubljana and World Health Organization classifications. Turk J Med Sci 2023; 53:396-404. [PMID: 36945918 PMCID: PMC10387883 DOI: 10.55730/1300-0144.5596] [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: 07/07/2022] [Accepted: 11/04/2022] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND The aim of this study is to evaluate the prognosis of patients with laryngeal preneoplastic lesions based on Ljubljana classification (LC), Revised LC, World Health Organization Dysplasia System (WHO-DS) 2005 and WHO-DS 2017. METHODS Patients diagnosed with a laryngeal preneoplastic lesion in our clinic between 2005 and 2018 were included in the study. Biopsy preparations of patients were reexamined by the pathology unit and classified based on LC, Revised LC, WHODS 2005, and WHO-DS 2017. Patients with carcinoma were identified during follow-up. The prognosis of preneoplastic lesions was statistically analyzed based on carcinoma development and duration using these four different classifications. RESULTS Carcinoma developed in 16 of 142 patients after repeated biopsy. The risk for carcinoma development was found to be more statistically significant in atypical hyperplasia than in squamous cell hyperplasia and basal-parabasal cell hyperplasia according to LC (p: 0.027 and 0.035), no statistically significant difference was observed between squamous and basal-parabasal cell hyperplasia and CIS groups. The risk of carcinoma development was more statistically significant in high-grade squamous intraepithelial lesion (SIL) than in low-grade SIL according to revised LC (p: 0.04); in severe hyperplasia than in other groups according to WHO-DS 2005; and in highgrade dysplasia than in low-grade dysplasia according to WHO-DS 2017 (p: 0.013). The Cox regression analysis demonstrated that the risk of developing carcinoma statistically increased with age in all classifications, independent of the severity of dysplasia (p < 0.01). According to Cox regression analysis, there was no effect of sex on carcinoma development. DISCUSSION : In revised classifications, such as the revised LC and WHO-DS 2017, it is seen that facilitating clinical use is achieved by reducing the number of subgroups by combining the subgroups that do not statistically differ in terms of carcinoma development.
Collapse
Affiliation(s)
- Ersoy Doğan
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Cafer Boran
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | | | - Sülen Sarıoğlu
- Department of Pathology, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| |
Collapse
|
3
|
Alex RA, Mathews SS, Paul RR, Albert RRA. Laryngeal Dysplasia: To Biopsy or Not? Indian J Otolaryngol Head Neck Surg 2022; 74:2331-2333. [PMID: 36452722 PMCID: PMC9702373 DOI: 10.1007/s12070-020-02161-9] [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: 09/09/2020] [Accepted: 09/21/2020] [Indexed: 10/23/2022] Open
Abstract
A renal transplant recipient with chronic hepatitis B underwent multiple laser excisions over 4 years for laryngeal keratosis. From the initial histopathology reports of mild to moderate dysplasia, a progression to squamous carcinoma was noted over 4 years. This case report highlights the possible role of immunosuppressants and hepatitis virus in the aetiopathogenesis of laryngeal carcinoma.
Collapse
Affiliation(s)
- Reshmi Anna Alex
- Department of ENT, Christian Medical College, Vellore, Tamil Nadu 632004 India
| | - Suma Susan Mathews
- Department of ENT, Christian Medical College, Vellore, Tamil Nadu 632004 India
| | - Roshna Rose Paul
- Department of ENT, Christian Medical College, Vellore, Tamil Nadu 632004 India
| | - Rita Ruby A. Albert
- Department of ENT, Christian Medical College, Vellore, Tamil Nadu 632004 India
| |
Collapse
|
4
|
Laryngeal dysplasia: a 10-year review of rates of progression to invasive carcinoma and treatment-specific outcomes in a regional ENT department in Northern Ireland. The Journal of Laryngology & Otology 2022; 136:547-553. [DOI: 10.1017/s0022215122000366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractBackgroundLaryngeal dysplasia represents a complex pre-malignant condition characterised by a spectrum of mucosal changes, with a reported malignant transformation rate from dysplasia to invasive carcinoma of 14.0 per cent.ObjectiveTo identify whether increasing glottic dysplasia severity is associated with higher local malignant transformation rates or adverse clinical outcomes.MethodsThis retrospective cohort study identified 125 patients with any histopathological grade of glottic dysplasia over a 10-year period who were followed up for a standardised 10-year period.ResultsThe malignant transformation rate was 21.8 per cent over 10 years, demonstrating a statistically significant greater risk with increasing dysplasia severity. The mean time to transformation was 52 months, with time to transformation statistically associated with increasing dysplasia severity. Rapid progression to carcinoma within 12 months occurred in 40 per cent of cases, and 58 per cent of subsequently diagnosed laryngeal squamous cell carcinomas were tumour stage T1.ConclusionLaryngeal dysplasia carries a significant malignant potential, appearing greatest within 12 months of diagnosis and with increasing severity of dysplasia.
Collapse
|
5
|
Gilvetti C, Soneji C, Bisase B, Barrett AW. Recurrence and malignant transformation rates of high grade oral epithelial dysplasia over a 10 year follow up period and the influence of surgical intervention, size of excision biopsy and marginal clearance in a UK regional maxillofacial surgery unit. Oral Oncol 2021; 121:105462. [PMID: 34303087 DOI: 10.1016/j.oraloncology.2021.105462] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/14/2021] [Accepted: 07/09/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To determine the overall recurrence rate (RR) and malignant transformation rate (MTR) of high grade oral mucosal epithelial dysplasias (HGOED). MATERIALS & METHODS A clinicopathological review of records of patients diagnosed with a unifocal HGOED between 2004 and 2016 on incisional biopsy who then underwent excision. The mean duration of follow-up was 47.7 months (±29.9 SD). RESULTS Full demographic, historical and histopathological data were available for 120 patients. Six were lost to follow-up after excisional biopsy. Invasive squamous cell carcinoma (SCC) was present in 19 (18.3%) excisions. HGOED affected the lateral and ventral tongue in 58% of patients. Fourteen (11.7%) were not treated surgically but kept under surveillance. The overall RR was 34.7% (33 patients) and MTR 17.8% (17 patients). Four of the 14 (28.6%) patients who had not had the HGOED excised developed SCC, by contrast to the 13 of the 106 (12.3%) who had been treated. RR was significantly associated with positive excision margins (p = 0.007; OR = 3.6) and a clinical presentation of erythroplakia (p = 0.023; OR = 1.5). MTR was significantly associated with age (p = 0.034), clinical appearance (p = 0.030), site (p = 0.007), treatment received (p = 0.012) and positive excision margins (p = 0.007). The mean time for recurrence to develop was 62 months (±31.5 SD) (range 22-144 months), that for malignant transformation was 50 months (±32.5 SD) (range 8-97 months). CONCLUSION Patients with HGOED require follow-up for at least 10 years after treatment. Younger age, homogeneous clinical appearance, complete excision, a larger excision specimen and clear margins all improve prognosis.
Collapse
Affiliation(s)
- Ciro Gilvetti
- Maxillofacial Unit, Queen Victoria Hospital NHS Foundation Trust, Holtye Road, East Grinstead RH19 3DZ, UK.
| | - Chandni Soneji
- Maxillofacial Unit, Queen Victoria Hospital NHS Foundation Trust, Holtye Road, East Grinstead RH19 3DZ, UK
| | - Brian Bisase
- Maxillofacial Unit, Queen Victoria Hospital NHS Foundation Trust, Holtye Road, East Grinstead RH19 3DZ, UK
| | - Andrew William Barrett
- Department of Histopathology, Queen Victoria Hospital NHS Foundation Trust, Holtye Road, East Grinstead RH19 3DZ, UK
| |
Collapse
|
6
|
Shimodate Y, Itakura J, Sunami T, Ueno M, Ishikawa S, Hira D, Takayama H, Sumiya T, Sue M, Takezawa R, Doi A, Nishimura N, Mouri H, Matsueda K, Yamamoto H, Mizuno M. Efficacy and safety of cold forceps biopsy for diminutive pharyngeal neoplasms: Single-center, prospective pilot study. Dig Endosc 2021; 33:761-769. [PMID: 32920920 DOI: 10.1111/den.13838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/28/2020] [Accepted: 09/04/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Management of diminutive pharyngeal neoplasms is controversial. Thus, we conducted a single-center, prospective pilot study to investigate the efficacy and safety of endoscopic excision with cold forceps biopsy (CFB) of these lesions. PATIENTS AND METHODS Thirty-nine lesions endoscopically diagnosed with narrow-band imaging as pharyngeal neoplasms of 3 mm or smaller were excised with CFB using jumbo biopsy forceps (cap diameter 2.8 mm, jaw volume 12.4 mm3 ). The primary outcome was endoscopically determined local remnant/recurrence rate 3 months after CFB. The secondary outcomes were histopathologically determined local remnant/recurrence rate; risk factors associated with the endoscopic remnant/recurrence; and incidence of intraoperative or delayed bleeding and other adverse events. RESULTS Histological diagnosis of the 39 CFB-excised lesions were: 11 high-grade dysplasia (28.2%), 22 low-grade dysplasia (56.4%), two basal cell hyperplasia (5.1%) and four atypical squamous epithelium (10.3%).Twenty-seven patients (30 lesions) underwent follow-up endoscopy 3 months after CFB; the endoscopic and pathological local remnant/recurrence rate was 20% (6/30; 95% confidence interval (CI), 7.7-36.6%) and 16.7% (5/30; 95% CI, 5.6-34.7%), respectively. Location of the lesion in the hypopharynx was a significant risk factor associated with the endoscopic local remnant/recurrence (P = 0.049). No significant adverse events occurred. CONCLUSIONS Cold forceps biopsy with jumbo biopsy forceps appears to be a safe and effective technique for excising diminutive pharyngeal neoplasms. Although small, the excised lesions may have a remarkably high frequency of high-grade dysplasia. (Clinical trial registration number: UMIN000037980).
Collapse
Affiliation(s)
- Yuichi Shimodate
- Departments of, Department of, Gastroenterology and Hepatology, Kurashiki Central Hospital, Okayama, Japan
| | - Junya Itakura
- Department of, Pathology, Kurashiki Central Hospital, Okayama, Japan
| | - Tomohiko Sunami
- Departments of, Department of, Gastroenterology and Hepatology, Kurashiki Central Hospital, Okayama, Japan
| | - Masayuki Ueno
- Departments of, Department of, Gastroenterology and Hepatology, Kurashiki Central Hospital, Okayama, Japan
| | - Sho Ishikawa
- Departments of, Department of, Gastroenterology and Hepatology, Kurashiki Central Hospital, Okayama, Japan
| | - Daichi Hira
- Departments of, Department of, Gastroenterology and Hepatology, Kurashiki Central Hospital, Okayama, Japan
| | - Hiroshi Takayama
- Departments of, Department of, Gastroenterology and Hepatology, Kurashiki Central Hospital, Okayama, Japan
| | - Tomoki Sumiya
- Departments of, Department of, Gastroenterology and Hepatology, Kurashiki Central Hospital, Okayama, Japan
| | - Masahiko Sue
- Departments of, Department of, Gastroenterology and Hepatology, Kurashiki Central Hospital, Okayama, Japan
| | - Rio Takezawa
- Departments of, Department of, Gastroenterology and Hepatology, Kurashiki Central Hospital, Okayama, Japan
| | - Akira Doi
- Departments of, Department of, Gastroenterology and Hepatology, Kurashiki Central Hospital, Okayama, Japan
| | - Naoyuki Nishimura
- Departments of, Department of, Gastroenterology and Hepatology, Kurashiki Central Hospital, Okayama, Japan
| | - Hirokazu Mouri
- Departments of, Department of, Gastroenterology and Hepatology, Kurashiki Central Hospital, Okayama, Japan
| | - Kazuhiro Matsueda
- Departments of, Department of, Gastroenterology and Hepatology, Kurashiki Central Hospital, Okayama, Japan
| | - Hiroshi Yamamoto
- Departments of, Department of, Gastroenterology and Hepatology, Kurashiki Central Hospital, Okayama, Japan
| | - Motowo Mizuno
- Departments of, Department of, Gastroenterology and Hepatology, Kurashiki Central Hospital, Okayama, Japan
| |
Collapse
|
7
|
Yang Y, Zhou J, He P, Wu H. The Role of Keratin-8 and Keratin-18 Polymorphisms and Protein Levels in the Occurrence and Progression of Vocal Leukoplakia. ORL J Otorhinolaryngol Relat Spec 2021; 83:65-74. [PMID: 33472210 DOI: 10.1159/000511447] [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: 02/05/2020] [Accepted: 09/08/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This study aimed to evaluate the association between the single-nucleotide polymorphism (SNP) and tissue protein level of keratin-8/18 and the occurrence and progression of vocal leukoplakia. METHODS The case-control study enrolled 158 patients with vocal leukoplakia, 326 patients with laryngeal squamous cell carcinoma (LSCC), and 268 healthy controls, which were tested for genotype analysis with keratin-8 and keratin-18 gene polymorphisms using pyrosequencing. The tissue protein expression levels of keratin-8 and keratin-18 were evaluated using immunohistochemistry. RESULTS The keratin-8 SNP RS1907671 showed an obvious increased risk for vocal leukoplakia (OR 1.56, p = 0.002), while the other SNPs (RS2035875, RS2035878, RS4300473) were tested as protective factors for vocal leukoplakia and LSCC (OR <1, p < 0.05). In keratin-18 SNP test, both RS2070876 and RS2638526 polymorphisms demonstrated decreased risks for vocal leukoplakia and LSCC (OR <1, p < 0.05). The protein levels of keratin-8 and keratin-18 in vocal leukoplakia group were significantly higher than those of the LSCC group (p < 0.05). CONCLUSIONS Keratin-8 and keratin-18 polymorphisms and protein levels are associated with the occurrence and progression of vocal leukoplakia.
Collapse
Affiliation(s)
- Yue Yang
- Department of Otolaryngology-Head and Neck Surgery, Eye and ENT Hospital, Fudan University, Shanghai, China.,Shanghai Key Clinical Disciplines of Otorhinolaryngology, Eye and ENT Hospital, Fudan University, Shanghai, China
| | - Jian Zhou
- Department of Otolaryngology-Head and Neck Surgery, Eye and ENT Hospital, Fudan University, Shanghai, China.,Shanghai Key Clinical Disciplines of Otorhinolaryngology, Eye and ENT Hospital, Fudan University, Shanghai, China
| | - Peijie He
- Department of Otolaryngology-Head and Neck Surgery, Eye and ENT Hospital, Fudan University, Shanghai, China.,Shanghai Key Clinical Disciplines of Otorhinolaryngology, Eye and ENT Hospital, Fudan University, Shanghai, China
| | - Haitao Wu
- Department of Otolaryngology-Head and Neck Surgery, Eye and ENT Hospital, Fudan University, Shanghai, China, .,Shanghai Key Clinical Disciplines of Otorhinolaryngology, Eye and ENT Hospital, Fudan University, Shanghai, China,
| |
Collapse
|
8
|
Yan F, Reddy PD, Nguyen SA, Chi AC, Neville BW, Day TA. Grading systems of oral cavity pre-malignancy: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2020; 277:2967-2976. [PMID: 32447493 DOI: 10.1007/s00405-020-06036-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 05/05/2020] [Indexed: 01/14/2023]
Abstract
PURPOSE Oral potentially malignant disorders (OPMDs) may have varying degrees of oral epithelial dysplasia (OED). Traditional grading schemes separate OED into three-tiers (mild, moderate, and severe). Alternatively, a binary grading system has been previously proposed that stratifies OED into low-risk and high-risk categories based on a quantitative threshold of dysplastic pathologic characteristics. This systematic review evaluates the predictive value of a binary OED grading system and examines agreement between pathologists. METHODS This meta-analysis queried 4 databases (PubMed, Ovid-MEDLINE, Cochrane, and SCOPUS) and includes 4 studies evaluating binary OED grading systems. Meta-analysis of proportions and correlations was performed to pool malignant transformation rates (MTR), risk of malignant transformation between OED categories, and measures of interobserver agreement. RESULTS Pooled analysis of 629 lesions from 4 different studies found a six-time increased odds of malignant transformation in high-risk lesions over low-risk lesions [odds ratio (OR) 6.14, 95% 1.18-15.38]. Reported ORs ranged from 2.8 to 22.4. The overall MTR was 26.8%, with the high-risk and low-risk lesions having MTRs of 57.9% (95% CI 0.386-0.723) and 12.7% (95% CI - 0.210 to 0.438), respectively. Pooled unweighted interobserver kappa values for the binary grading system and three-tiered system were 0.693 (95% CI 0.640-0.740) and 0.388 (95% CI 0.195-0.552), respectively. CONCLUSION Binary grading of OED into low-risk and high-risk categories may effectively determine malignant potential, with improved interobserver agreement over three-tiered grading. Improved grading schemes of OED may help guide management (watchful waiting vs. excision) of these OPMDs.
Collapse
Affiliation(s)
- Flora Yan
- Head and Neck Tumor Center, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, MSC 550, Charleston, SC, 29425, USA.
| | - Priyanka D Reddy
- Head and Neck Tumor Center, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, MSC 550, Charleston, SC, 29425, USA
| | - Shaun A Nguyen
- Head and Neck Tumor Center, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, MSC 550, Charleston, SC, 29425, USA
| | - Angela C Chi
- Division of Oral Pathology, Medical University of South Carolina, Charleston, SC, USA
| | - Brad W Neville
- Division of Oral Pathology, Medical University of South Carolina, Charleston, SC, USA
| | - Terry A Day
- Head and Neck Tumor Center, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, MSC 550, Charleston, SC, 29425, USA
| |
Collapse
|
9
|
Tilakaratne WM, Jayasooriya PR, Jayasuriya NS, De Silva RK. Oral epithelial dysplasia: Causes, quantification, prognosis, and management challenges. Periodontol 2000 2019; 80:126-147. [PMID: 31090138 DOI: 10.1111/prd.12259] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Oral epithelial dysplasia is a spectrum of architectural and cytological epithelial changes caused by accumulation of genetic changes, and is associated with an increased risk of progression to squamous cell carcinoma. It is a microscopic diagnosis of immense clinical importance. The initial reports of oral potentially malignant disorders with oral epithelial dysplasia transforming to oral cancer helped in understanding the nature of oral malignancies. Since then, clinical studies on oral potentially malignant disorders have combined microscopic findings of oral epithelial dysplasia to assess the malignant transformation potential of different grades of epithelial dysplasia. A significant amount of scientific literature has amassed on oral epithelial dysplasia relating to aspects of its diagnosis and management. However, the evidence base is weak as a result of the significant variability of published research. Poorly described study methods, variability in different oral epithelial dysplasia grading systems, inter- and intra-examiner variability causing issues of reliability, inadequate sample size, and inconsistent durations of follow-up are some of the methodological issues contributing to the failure to provide dependable information. Randomized clinical trials on the malignant transformation potential of oral epithelial dysplasia and its treatment outcomes are limited. This comprehensive literature review on oral epithelial dysplasia summarizes the scientific knowledge published in the scientific literature in English since its first description. The historical development, etiological factors, grading systems, diagnostic criteria, assessment of risk factors and prevention of malignant transformation, management principles of different grades of oral epithelial dysplasia (surgical and nonsurgical), recommendations on follow-up, and prognostic indicators are discussed in detail.
Collapse
Affiliation(s)
- Wanninayake M Tilakaratne
- Department of Oral Pathology, Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri Lanka
| | - Primali R Jayasooriya
- Department of Oral Pathology, Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri Lanka
| | - Nadeena S Jayasuriya
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri Lanka
| | - Rohana Kumara De Silva
- Department of Oral Diagnostic and Surgical Sciences, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| |
Collapse
|
10
|
Li C, Zhang N, Wang S, Cheng L, Wu H, Chen J, Chen M, Shi F. A new classification of vocal fold leukoplakia by morphological appearance guiding the treatment. Acta Otolaryngol 2018; 138:584-589. [PMID: 29504444 DOI: 10.1080/00016489.2018.1425000] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To provide a reference for classification and treatment of vocal cords leukoplakia. METHODS 640 cases of patients with vocal cords leukoplakia were divided into three groups based on the appearances. There were respectively 81 smooth flat lesions, 155 smooth hypertrophy lesions and 13 rough lesions were treated with conservative methods and 26, 153 and 212 cases were resected surgically for biopsy. RESULTS A majority of smooth flat leukoplakia lesions were cured by non-operational methods and no atypical hyperplasia. Most of rough lesions were invalid and even progressed treated with conservative therapy and were severe dysplasia or canceration. Although 67.6% smooth hypertrophy lesions were cured or improved by conservative methods and 47% lesions had no or mild dysplasia, over 30% of lesions were still invalid or progressed and over 50% had moderate, severe dysplasia and canceration. By statistical analysis, the appearance of leukoplakia was concordant with pathological changes. CONCLUSIONS It is suggested that smooth flat vocal cords leukoplakia could be treated with conservative methods and rough lesions should be resected operationally, while for smooth hypertrophy vocal cords leukoplakia could be first followed-up and then adopt measures based on the appearance changes.
Collapse
Affiliation(s)
- Changjiang Li
- Department of Otorhinolaryngology-Head and Neck Surgery (Shanghai Key Clinical Disciplines of Otorhinolaryngology), Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai, People’s Republic of China
| | - Na Zhang
- Department of Otorhinolaryngology-Head and Neck Surgery, First Central Hospital, Otorhinolaryngology Institute of Tianjin, Tianjin, People’s Republic of China
| | - Shuyi Wang
- Department of Otorhinolaryngology-Head and Neck Surgery (Shanghai Key Clinical Disciplines of Otorhinolaryngology), Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai, People’s Republic of China
| | - Lei Cheng
- Department of Otorhinolaryngology-Head and Neck Surgery (Shanghai Key Clinical Disciplines of Otorhinolaryngology), Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai, People’s Republic of China
| | - Haitao Wu
- Department of Otorhinolaryngology-Head and Neck Surgery (Shanghai Key Clinical Disciplines of Otorhinolaryngology), Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai, People’s Republic of China
| | - Jian Chen
- Department of Otorhinolaryngology-Head and Neck Surgery (Shanghai Key Clinical Disciplines of Otorhinolaryngology), Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai, People’s Republic of China
| | - Min Chen
- Department of Otorhinolaryngology-Head and Neck Surgery (Shanghai Key Clinical Disciplines of Otorhinolaryngology), Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai, People’s Republic of China
| | - Fang Shi
- Department of Otorhinolaryngology-Head and Neck Surgery (Shanghai Key Clinical Disciplines of Otorhinolaryngology), Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai, People’s Republic of China
| |
Collapse
|
11
|
Cho KJ, Song JS. Recent Changes of Classification for Squamous Intraepithelial Lesions of the Head and Neck. Arch Pathol Lab Med 2018; 142:829-832. [PMID: 29775074 DOI: 10.5858/arpa.2017-0438-ra] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT - Interpretation of atypical squamous lesions of the head and neck has always been a nettlesome task for pathologists. Moreover, many different grading systems for squamous intraepithelial lesions have been proposed in past decades. The recent World Health Organization 2017 classification presents 2 types of 2-tier systems for laryngeal and oral precursor lesions. OBJECTIVE - To review the recent changes in classification and the clinical significance for squamous intraepithelial lesions of the head and neck. DATA SOURCES - Personal experience and data from the literature. CONCLUSIONS - The 2-tier grading system for laryngeal dysplasia, presented by World Health Organization in 2017, is expected to improve diagnostic reproducibility and clinical implication. However, the diagnostic criteria for low-grade dysplasia do not distinguish it clearly from basal cell hyperplasia. The World Health Organization 2017 classification of oral epithelial dysplasia remains unclear, and complicated and variable grading systems still make head and neck intraepithelial lesions difficult to interpret.
Collapse
Affiliation(s)
| | - Joon Seon Song
- From the Department of Pathology, University of Ulsan College Medicine, Asan Medical Center, Seoul, Korea
| |
Collapse
|
12
|
Abstract
Head and neck squamous cell carcinoma (HNSCC) is by far the most frequent malignant tumor in this anatomic region. Today, HNSCC is divided into two morphologically, molecularly and clinically fundamentally different entities: conventional and virus-associated (HPV/EBV) neoplasms. Premalignant lesions of nonvirus-associated HNSCC include conventional leukoplakia, dysplasia and proliferative verrucous hyperplasia with an increasing risk for malignant transformation. The morphology of HNSCC comprises a spectrum of growth patterns. In addition, special types of HNSCC must be delineated. Recently, for virus-associated HNSCC, some important clinicopathological specifics have become relevant including a separate staging system for these neoplasms. For non-virus associated HNSCC, new grading procedures have been proposed, which significantly impact on prognosis. These issues will be discussed in this review.
Collapse
|
13
|
Chen M, Chen J, Cheng L, Wu H. Recurrence of vocal fold leukoplakia after carbon dioxide laser therapy. Eur Arch Otorhinolaryngol 2017; 274:3429-3435. [PMID: 28600598 DOI: 10.1007/s00405-017-4632-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 06/01/2017] [Indexed: 10/19/2022]
Abstract
This work aims to analyze the recurrence of vocal fold leukoplakia after carbon dioxide (CO2) laser resection. In this retrospective study, all patients undergoing CO2 laser resection of vocal fold leukoplakia were followed up for at least 2 years. Recurrence was diagnosed as any presence of leukoplakia in the vocal cord subsequent to previous successful complete resection. A total of 326 patients with complete resection of vocal fold leukoplakia and follow-up subsequent surveillance laryngoscopy were studied. The recurrence rate, the recurrence time, and risk factors were evaluated. Of these, 52 (16.0%) patients experienced recurrence with a mean follow-up time of 50.5 ± 15.4 months. The mean time to recurrence was 16.2 ± 14.1 months. Univariate analysis showed that the size of lesion (P < 0.001, Pearson χ 2 test; P < 0.001, log-rank test) and the pathological grade (P = 0.025, Pearson χ 2 test; P = 0.028, log-rank test) were significantly related to recurrence. The size of lesion was an independent prognostic factor for recurrence using multivariate analysis (P = 0.001, logistic regression; P = 0.001, Cox proportional hazards model). Considering the possible recurrence of vocal fold leukoplakia, long-term follow-up is required after CO2 laser resection. In conclusion, the size of lesion combined with the pathological grade are important risk factors that predict vocal fold leukoplakia recurrence.
Collapse
Affiliation(s)
- Min Chen
- Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai Key Clinical Disciplines of Otorhinolaryngology, 83 Fenyang Road, Shanghai, 200031, China
| | - Jian Chen
- Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai Key Clinical Disciplines of Otorhinolaryngology, 83 Fenyang Road, Shanghai, 200031, China
| | - Lei Cheng
- Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai Key Clinical Disciplines of Otorhinolaryngology, 83 Fenyang Road, Shanghai, 200031, China
| | - Haitao Wu
- Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai Key Clinical Disciplines of Otorhinolaryngology, 83 Fenyang Road, Shanghai, 200031, China.
| |
Collapse
|
14
|
Laryngeal Squamous Intraepithelial Lesions: An Updated Review on Etiology, Classification, Molecular Changes, and Treatment. Adv Anat Pathol 2016; 23:84-91. [PMID: 26849814 DOI: 10.1097/pap.0000000000000106] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Laryngeal carcinogenesis is a multistep process, characterized by an accumulation of genetic changes associated with architectural and cytologic alterations, ranging from squamous hyperplasia to carcinoma in situ and encompassed by the terminology of squamous intraepithelial lesions (SILs). The etiology, classification, genetic changes, and malignant progression of these lesions are reviewed. Tobacco remains the principal etiological factor with gastroesophageal reflux disease recently considered as a possible factor. In contrast, there is little evidence that microbiological agents, especially human papillomavirus infection, are frequently involved in laryngeal carcinogenesis and probably <10% of SILs are driven by biologically active human papillomavirus infection. Light microscopy, despite a degree of subjectivity, remains the mainstay of accurate diagnosis, prognosis, and guidance for a patient's treatment. The currently used classifications, the dysplasia system, squamous intraepithelial neoplasia, and the Ljubljana classification, reflect different standpoints on this important topic. The modified Ljubljana classification, with good interobserver agreement, could be considered as a proposal for a unified classification of laryngeal SILs. This review also briefly discusses recently discovered genetic changes, such as CDKN2A and CTNNB1 genes, and chromosome instability of chromosomes 1 and 7; however, none of these can at present improve histologic diagnosis. Malignant progression of precursor lesions varies from 2% to 74%, according to different studies. Cold-steel microinstruments, CO2 laser, and radiotherapy are used to treat the different grades of precursor lesions. There is as yet no worldwide agreement on the treatment of high-grade lesions and carcinoma in situ.
Collapse
|
15
|
Stroboscopy in Detection of Laryngeal Dysplasia Effectiveness and Limitations. J Voice 2014; 28:262.e13-262.e21. [DOI: 10.1016/j.jvoice.2013.07.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2013] [Accepted: 07/16/2013] [Indexed: 11/21/2022]
|
16
|
Makki FM, Rigby MH, Bullock M, Brown T, Hart RD, Trites J, Hinni ML, Taylor SM. CO(2) laser versus cold steel margin analysis following endoscopic excision of glottic cancer. J Otolaryngol Head Neck Surg 2014; 43:6. [PMID: 24502856 PMCID: PMC3927765 DOI: 10.1186/1916-0216-43-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 01/27/2014] [Indexed: 11/25/2022] Open
Abstract
Objective To compare the suitability of CO2 laser with steel instruments for margin excision in transoral laser microsurgery. Methods Prospective randomized blinded study. Patients with glottic cancer undergoing laser resection were randomized to margin excision by either steel instruments or CO2 laser. Margins were analyzed for size, interpretability and degree of artifact by a pathologist who was blinded to technique. Results 45 patients were enrolled in the study with 226 total margins taken. 39 margins taken by laser had marked artifact and 0 were uninterpretable. 20 margins taken by steel instruments had marked artifact, and 2 were uninterpretable. Controlling for margin size, the laser technique was associated with increasing degrees of margin artifact (p = 0.210), but there was no difference in crude rates of uninterpretability (p = 0.24). Conclusion Laser margin excision is associated with a greater degree of artifact than steel instrument excision, but was not associated with higher rate of uninterpretability.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - S Mark Taylor
- Department of Surgery, Division of Otolaryngology Head & Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.
| |
Collapse
|
17
|
Panwar A, Lindau R, Wieland A. Management of premalignant lesions of the larynx. Expert Rev Anticancer Ther 2014; 13:1045-51. [DOI: 10.1586/14737140.2013.829643] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
18
|
Ten-year retrospective study of head and neck carcinoma in situ: incidence, treatment, and clinical outcome. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 116:174-8. [PMID: 23643320 DOI: 10.1016/j.oooo.2013.03.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Revised: 02/14/2013] [Accepted: 03/03/2013] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To examine the management and clinical outcome for patients with primary head and neck carcinoma in situ (CIS) and to estimate the incidence in the referral population. STUDY DESIGN A retrospective study from 2000-2009 of patients with head and neck CIS referred for treatment at Rigshospitalet. The referral area was East Denmark and Greenland with a population of 2.4 million. RESULTS Fifty-five patients with primary CIS were identified: 21 oral cavity, 7 pharynx, 25 larynx, 2 nasal cavity/paranasal sinuses. The median annual incidence was 0.24/100,000. Eleven patients (20%) had T-site recurrence. The 5-year disease-specific survival rate and 5-year recurrence-free survival rate were 98% and 74% respectively. CONCLUSIONS The annual incidence of primary head and neck CIS was low and in accordance with previous findings reported in the literature. We recommend that CIS lesions should be treated on T-site and surveilled as T1/T2 head and neck carcinomas.
Collapse
|
19
|
Calabrese L, Ostuni A, Ansarin M, Giugliano G, Maffini F, Alterio D, Rocca MC, Petralia G, Bruschini R, Chiesa F. Future challenges in head and neck cancer: From the bench to the bedside? Crit Rev Oncol Hematol 2012; 84 Suppl 1:e90-6. [DOI: 10.1016/j.critrevonc.2010.11.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2010] [Revised: 10/29/2010] [Accepted: 11/03/2010] [Indexed: 01/23/2023] Open
|
20
|
Zhang HK, Liu HG. Is severe dysplasia the same lesion as carcinoma in situ? 10-Year follow-up of laryngeal precancerous lesions. Acta Otolaryngol 2012; 132:325-8. [PMID: 22229875 DOI: 10.3109/00016489.2011.642812] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Our results showed that the behavior of moderate dysplasia lesions was more like that of severe dysplasia lesions, while severe dysplasia was very different from carcinoma in situ (CIS). CIS should be managed more aggressively than the other lesions. Mild dysplasia could not be viewed as a precancerous lesion of the larynx. OBJECTIVE This study aimed to identify the possibilities of the precancerous lesions of larynx (including mild dysplasia, moderate dysplasia, severe dysplasia, and CIS) progressing to invasive carcinomas and to highlight the importance of adequate management and follow-up strategies for these patients. METHODS A retrospective study of patients who had these preinvasive lesions in the larynx over a 10-year period was performed. RESULTS These patients were followed for a minimum period of 2 years from the initial diagnosis. In all, 86 patients were identified the cohort. Of these, 17 (19.8%) patients developed carcinoma: 0 of 22 with mild dysplasia, 5 of 25 (20%) with moderate dysplasia, 2 of 14 (15%) with severe dysplasia, and 10 of 25 (40%) patients with CIS progressed to invasive cancers (p = 0.001). Over 50% of cases progressed 3 years after the original biopsy. Only 1 of 86 (1%) died of the disease.
Collapse
Affiliation(s)
- Hong Kai Zhang
- Department of Pathology, Beijing Tongren Hospital, affiliated to the Capital Medical University, PR China
| | | |
Collapse
|
21
|
Abstract
Although the glottis is amenable to chemotherapy, currently most lesions from stage I laryngeal dysplasia up to carcinoma in situ are excised. This literature review presents selected molecular biological aspects especially in relation to dysplasia of the larynx and its therapy, as well as currently preferred biomarkers for chemotherapeutic prevention of laryngeal dysplasia.
Collapse
|
22
|
Abstract
Benign and malignant lesions of the larynx and hypopharynx present an interesting and diverse spectrum of diagnostic entities, which may be infrequently encountered in routine surgical pathology practice. This article places emphasis on illustrating the classical pathologic characteristics, differential diagnosis, clinical significance, and presentation of common lesions unique to these sites. The initial diagnosis of these lesions is via small endoscopic biopsy. Many of the entities have overlapping histologic features which necessitate optimizing the information available in a small sample. The focus of this article is to provide useful criteria to enable separating the more common types of lesions encountered in these sites.
Collapse
Affiliation(s)
- Joaquín J García
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Mary S Richardson
- Medical University of South Carolina, 171 Ashley Avenue, MSC 908, Charleston, SC 29425, USA
| |
Collapse
|
23
|
Montgomery J, White A. A decade of laryngeal dysplasia in Paisley, Scotland. Eur Arch Otorhinolaryngol 2011; 269:947-51. [DOI: 10.1007/s00405-011-1684-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Accepted: 06/21/2011] [Indexed: 10/18/2022]
|
24
|
|