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Filho FDSA, Santiago LH, Fernandes ACN, Korn GP, Pontes PADL, Camponês do Brasil ODO. Preliminary Correlation of the Immunoexpression of Cathepsin B and E-Cadherin Proteins in Vocal Fold Leukoplakia. J Voice 2024; 38:760-767. [PMID: 34663533 DOI: 10.1016/j.jvoice.2021.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/09/2021] [Accepted: 08/11/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Early identification of vocal fold leukoplakia (VFL), which has a risk of progressing to malignant transformation, remains a controversial topic. The identification of biological markers for diagnosing these lesions would lead to a more effective treatment. We aimed to analyze the immunoexpression of cathepsin B and E-cadherin in VFL and correlate it with clinical and epidemiological data and disease prognosis. METHODS Thirty-two patients with VFL treated with microsurgery were retrospectively evaluated. The patients were distributed according to the histological results into Group A (low grade) and Group B (high grade). The expression of markers was quantitatively determined as per their staining intensity and tissue distribution using ImageLab. The index of expression (IE) of each marker was correlated with tobacco and alcohol consumption, signs of laryngopharyngeal reflux, and local recurrence of the lesion. RESULTS The correlation between the IE of markers and variables within the two groups (A and B) demonstrated that patients in Group B with local recurrence had a higher IE of cathepsin B. When all patients (A + B) were included, the same analysis demonstrated that the IE of cathepsin B was higher among smokers and patients who did not show signs of reflux and that the IE of E-cadherin was higher only in patients with recurrence. CONCLUSION Patients with moderate to severe dysplasia and carcinoma in situ who smoked as well as had a high IE of cathepsin B were more prone to local recurrence. Regardless of the type of histological lesion, patients with signs of laryngopharyngeal reflux had a lower IE of cathepsin B. The IE of E-cadherin was higher among patients with VFL who relapsed after initial treatment.
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Affiliation(s)
- Francisco de Souza Amorim Filho
- Department of Otolaryngology, Head and Neck Surgery of the Federal University of São Paulo, Paulista School of Medicine, São Paulo, Brazil
| | | | - Ana Carolina Nascimento Fernandes
- Laboratório de Ensino e Pesquisa em Otorrinolaringologia, Faculdade de Medicina, Universidade de Brasília, Campus Universitário Darcy Ribeiro, Asa Norte, Brasília/DF, Brazil.
| | - Gustavo Polacow Korn
- Department of Otolaryngology and Head, Neck Surgery of the Federal University of São Paulo, Paulista School of Medicine, São Paulo, Brazil
| | - Paulo Augusto de Lima Pontes
- Department of Otolaryngology, Head and Neck Surgery of the Federal University of São Paulo, Paulista Medical School, São Paulo, Brazil
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You Z, Han B, Shi Z, Zhao M, Du S, Liu H, Hei X, Ren X, Yan Y. Vocal Cord Leukoplakia Classification Using Siamese Network Under Small Samples of White Light Endoscopy Images. Otolaryngol Head Neck Surg 2024; 170:1099-1108. [PMID: 38037413 DOI: 10.1002/ohn.591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/25/2023] [Accepted: 11/02/2023] [Indexed: 12/02/2023]
Abstract
OBJECTIVE Accurate vocal cord leukoplakia classification is instructive for clinical diagnosis and surgical treatment. This article introduces a reliable very deep Siamese network for accurate vocal cord leukoplakia classification. STUDY DESIGN A study of a classification network based on a retrospective database. SETTING Academic university and hospital. METHODS The white light image datasets of vocal cord leukoplakia used in this article were classified into 6 classes: normal tissues, inflammatory keratosis, mild dysplasia, moderate dysplasia, severe dysplasia, and squamous cell carcinoma. The classification performance was assessed by comparing it with 6 classical deep learning models, including AlexNet, VGG Net, Google Inception, ResNet, DenseNet, and Vision Transformer. RESULTS Experiments show the superior classification performance of our proposed network compared to state-of-the-art methods. The overall accuracy is 0.9756. The values of sensitivity and specificity are very high as well. The confusion matrix provides information for the 6-class classification task and demonstrates the superiority of our proposed network. CONCLUSION Our very deep Siamese network can provide accurate classification results of vocal cord leukoplakia, which facilitates early detection, clinical diagnosis, and surgical treatment. The excellent performance obtained in white light images can reduce the cost for patients, especially those living in developing countries.
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Affiliation(s)
- Zhenzhen You
- Scool of Computer Science and Engineering, Shaanxi Key Laboratory for Network Computing and Security Technology, School of Computer Science and Engineering, Xi'an University of Technology, Xi'an, China
| | - Botao Han
- Scool of Computer Science and Engineering, Shaanxi Key Laboratory for Network Computing and Security Technology, School of Computer Science and Engineering, Xi'an University of Technology, Xi'an, China
| | - Zhenghao Shi
- Scool of Computer Science and Engineering, Shaanxi Key Laboratory for Network Computing and Security Technology, School of Computer Science and Engineering, Xi'an University of Technology, Xi'an, China
| | - Minghua Zhao
- Scool of Computer Science and Engineering, Shaanxi Key Laboratory for Network Computing and Security Technology, School of Computer Science and Engineering, Xi'an University of Technology, Xi'an, China
| | - Shuangli Du
- Scool of Computer Science and Engineering, Shaanxi Key Laboratory for Network Computing and Security Technology, School of Computer Science and Engineering, Xi'an University of Technology, Xi'an, China
| | - Haiqin Liu
- Department of Otorhinolaryngology, Second Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, China
| | - Xinhong Hei
- Scool of Computer Science and Engineering, Shaanxi Key Laboratory for Network Computing and Security Technology, School of Computer Science and Engineering, Xi'an University of Technology, Xi'an, China
| | - Xiaoyong Ren
- Department of Otorhinolaryngology, Second Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, China
| | - Yan Yan
- Department of Otorhinolaryngology, Second Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, China
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Wang Q, Ling Y, Huang YYY, Li LR, Shen L, Zhang J, Fan GK. I-scan combined with laryngovideostroboscopy for predicting malignancy in vocal fold leukoplakia. Eur Arch Otorhinolaryngol 2024; 281:1409-1416. [PMID: 38147115 DOI: 10.1007/s00405-023-08390-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 11/30/2023] [Indexed: 12/27/2023]
Abstract
OBJECTIVE This study evaluated vocal fold leukoplakia using i-scan combined with laryngovideostroboscopy for risk assessment prediction. METHODS A total of 141 patients with 218 lesions were enrolled in this study. Morphological characteristics of leukoplakia, assessment of the vascular pattern using i-scan, and vocal fold vibratory function were analyzed. RESULTS The number of patients with no, mild, moderate, severe dysplasia, and invasive carcinoma were 68, 40, 17, 46 and 47, respectively. The sensitivity of morphological characteristic, vascular pattern, vibratory function and predictive model were 77.4%, 72%, 69.9%, and 82.8%, respectively. Receiver operating characteristic curve analysis of morphological characteristic, vascular pattern, vibratory function and predictive model were 0.771, 0.824, 0.769, and 0.923, respectively. The results of logistic regression analysis showed that rough morphological types, perpendicular vascular pattern, severe decrease and absence of mucosal waves increased the risk of malignancy (OR = 5.531, 4.973, and 16.992, respectively; P < 0.001). CONCLUSIONS I-scan combined with laryngovideostroboscopy can improve the differential diagnosis of low-risk and high-risk vocal fold leukoplakia.
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Affiliation(s)
- Qi Wang
- Department of Otolaryngology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Jie Fang Road 88, Hangzhou, 310000, Zhejiang, China
| | - Yi Ling
- Department of Otolaryngology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Jie Fang Road 88, Hangzhou, 310000, Zhejiang, China
| | - Yang-Yi-Yi Huang
- Department of Otolaryngology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Jie Fang Road 88, Hangzhou, 310000, Zhejiang, China
| | - Lin-Rong Li
- Department of Otolaryngology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Jie Fang Road 88, Hangzhou, 310000, Zhejiang, China
| | - Lei Shen
- Department of Otolaryngology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Jie Fang Road 88, Hangzhou, 310000, Zhejiang, China
| | - Jian Zhang
- Department of Otolaryngology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Jie Fang Road 88, Hangzhou, 310000, Zhejiang, China
| | - Guo-Kang Fan
- Department of Otolaryngology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Jie Fang Road 88, Hangzhou, 310000, Zhejiang, China.
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Ni XG, Zhu JQ, Tie CW, Wang ML, Zhang W, Wang GQ. Laryngoscopy-based scoring system for the diagnosis of vocal fold leukoplakia. J Laryngol Otol 2024; 138:331-337. [PMID: 37994484 DOI: 10.1017/s0022215123000683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
OBJECTIVE To propose a scoring system based on laryngoscopic characteristics for the differential diagnosis of benign and malignant vocal fold leukoplakia. METHODS Laryngoscopic images from 200 vocal fold leukoplakia cases were retrospectively analysed. The laryngoscopic signs of benign and malignant vocal fold leukoplakia were compared, and statistically significant features were assigned and accumulated to establish the leukoplakia finding score. RESULTS A total of five indicators associated with malignant vocal fold leukoplakia were included to construct the leukoplakia finding score, with a possible range of 0-10 points. A score of 6 points or more was indicative of a diagnosis of malignant vocal fold leukoplakia. The sensitivity, specificity and accuracy values of the leukoplakia finding score were 93.8 per cent, 83.6 per cent and 86.0 per cent, respectively. The consistency in the leukoplakia finding score obtained by different laryngologists was strong (kappa = 0.809). CONCLUSION This scoring system based on laryngoscopic characteristics has high diagnostic value for distinguishing benign and malignant vocal fold leukoplakia.
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Affiliation(s)
- Xiao-Guang Ni
- Department of Endoscopy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ji-Qing Zhu
- Department of Endoscopy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Cheng-Wei Tie
- Department of Endoscopy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Mei-Ling Wang
- Department of Endoscopy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital and Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Wei Zhang
- Department of Endoscopy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital and Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Gui-Qi Wang
- Department of Endoscopy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Aljohani K, Alqarni A, Harte M, Alghamdi R, Alzahrani S, Albuquerque R. Oral Potentially Malignant Disorders and Oral Cancer in Saudi Arabia: An Epidemiological Review of the Literature. J Clin Med 2024; 13:1376. [PMID: 38592216 PMCID: PMC10932327 DOI: 10.3390/jcm13051376] [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: 01/03/2024] [Revised: 02/13/2024] [Accepted: 02/21/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Oral potentially malignant disorders (OPMDs) are a group of chronic oral mucosal diseases associated with an increased risk of malignant transformation. Multiple studies have investigated the prevalence of these conditions in multiple regions; however, there are limited data about the prevalence of OPMDs in the Kingdom of Saudi Arabia (KSA). This paper aims to review the prevalence of OPMDs in the KSA, to ensure better understanding of the population risk and propose a more standardised approach to the diagnosis and management of this group across the KSA. In addition, this review will discuss the prevalence of oral cancer in the KSA, considering independent risk factors for oral cancer development. Methods: Electronic databases including PubMed, Medline, Medscape, ScienceDirect, StatPearls, BMC Oral Health and the Cochrane Library were searched with the keywords "Oral Potentially Malignant Disorders"; "Saudi Arabia"; and "Oral Cancer". Identified articles were reviewed independently by 2 reviewers against defined inclusion and exclusion criteria. Results: 16 studies were included in this review. The prevalence of OPMDs in KSA varies significantly depending on age, gender, social habits, background disease and dental status. Conclusions: This review highlights the need for up-to-date data on the prevalence, distribution, and characteristics of OPMDs in KSA. The diverse prevalence rates and distinct characteristics of various OPMDs emphasise the necessity for targeted preventive measures. As the data on OPMDs in KSA remains limited, future research efforts should prioritise the establishment of comprehensive epidemiological studies to inform effective public health interventions in this region.
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Affiliation(s)
- Khalid Aljohani
- Department of Oral Diagnostic Sciences, Faculty of Dentistry, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Ali Alqarni
- Department of Oral & Maxillofacial Surgery and Diagnostic Sciences, Faculty of Dentistry, Taif University, Taif 21944, Saudi Arabia;
| | - Molly Harte
- Department of Oral Medicine, Guy’s and St Thomas NHS Foundation Trust, Faculty of Dentistry, Oral Craniofacial Sciences, King’s College London, London SE1 8WA, UK; (M.H.); (R.A.)
| | - Rawia Alghamdi
- Independent Researcher, Jeddah 22335, Saudi Arabia; (R.A.); (S.A.)
| | - Saja Alzahrani
- Independent Researcher, Jeddah 22335, Saudi Arabia; (R.A.); (S.A.)
| | - Rui Albuquerque
- Department of Oral Medicine, Guy’s and St Thomas NHS Foundation Trust, Faculty of Dentistry, Oral Craniofacial Sciences, King’s College London, London SE1 8WA, UK; (M.H.); (R.A.)
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Hosri J, Aoun J, Yammine Y, Ghadieh J, Hamdan A. The sensitivity of laryngeal findings in predicting high-grade dysplasia in patients with vocal fold leukoplakia undergoing office-based biopsies: A retrospective analysis of 100 cases. Laryngoscope Investig Otolaryngol 2024; 9:e1209. [PMID: 38362176 PMCID: PMC10866589 DOI: 10.1002/lio2.1209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/12/2023] [Accepted: 12/21/2023] [Indexed: 02/17/2024] Open
Abstract
Objective To investigate the sensitivity of laryngeal findings in predicting high-grade dysplasia/carcinoma in situ (CIS) and squamous cell carcinoma (SCC) in patients with vocal fold leukoplakia. Methods A retrospective review of the medical records and video recordings of the laryngeal examination of patients with vocal fold leukoplakia who underwent un-sedated office-based laryngeal biopsy in a tertiary referral center between January 2022 and August 2023 was conducted. Laryngeal findings included the size, surface, projection, and edges of the lesion. Vocal fold leukoplakia was classified according to the WHO as benign, low-grade dysplasia, high-grade dysplasia/CIS, and squamous cell carcinoma. Results Seventy patients with 100 vocal fold leukoplakia were included. Size was found to have the highest sensitivity with an AUC of 0.730 (95% CI [0.618-0.842], p = 0.002) followed by surface and projection with AUCs of 0.672 (95% CI [0.548-0.795], p = 0.019) and 0.675 (95% CI [0.546-0.804], p = 0.017), respectively. Furthermore, the odds of diagnosing high-risk lesions (high-grade dysplasia/CIS and SCC) were the greatest when the lesion was large and rough (OR = 10.28; 95% CI [3.08-34.36]). Conclusion The morphological features of vocal fold leukoplakia may assist the physician in predicting the risk of malignancy. Large and rough lesions were more likely to harbor high-grade dysplasia/CIS and SCC compared to small and smooth lesions.
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Affiliation(s)
- Jad Hosri
- Department of Otolaryngology‐Head and Neck SurgeryAmerican University of Beirut Medical CenterBeirutLebanon
| | - Jessica Aoun
- Department of Pathology and Laboratory MedicineAmerican University of Beirut Medical CenterBeirutLebanon
| | - Yara Yammine
- Department of Otolaryngology‐Head and Neck SurgeryAmerican University of Beirut Medical CenterBeirutLebanon
| | - Justin Ghadieh
- Faculty of MedicineAmerican University of BeirutBeirutLebanon
| | - Abdul‐Latif Hamdan
- Department of Otolaryngology‐Head and Neck SurgeryAmerican University of Beirut Medical CenterBeirutLebanon
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Pavlidis P, Tseriotis VS, Matthias C, Katsikari I, Chatzinikolaou A, Gouveris H. Contact Endoscopic Surface Vascular and Epithelial Morphology in Leukoplakia and Carcinoma of the Vocal Cords: Vascular and morphological changes of vocal folds in leukoplakia and cancer. Indian J Otolaryngol Head Neck Surg 2024; 76:462-468. [PMID: 38440476 PMCID: PMC10908749 DOI: 10.1007/s12070-023-04183-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 08/23/2023] [Indexed: 03/06/2024] Open
Abstract
Purpose Leukoplakia is a macroscopic morphological term for thick white or grey mucosal patches that can represent various histologic diagnostic entities ranging from hyperplasia to malignancy. Aim was the study morphology of the superficial mucosa and microvascular network of the vocal cords in patients with suspected glottic squamous cell carcinoma (SCC) using contact endoscopy (CE). Material and Methods Seventy-nine patients (21 female, 58 male), with a mean age of 57.5 years ± 7.12 (range, 32-73 years), were prospectively enrolled and evaluated. Of these patients, 58 had leukoplakia (Group A/41 males and 17 females, with a mean age of 53.7 years ± 6.65), and 21 (Group B/ 17males and 4 females/ with a mean age of 60.5 years ± 6.04) had malignant lesions (pT1, n = 6; p T2, n = 8; pT3, n = 8; Group B), as proven by the results of the histological examination. Further, 79 non-smokers (control group-group C) were studied. CE imaging findings were classified into five types (I to V) based on the features of the mucosal intra-epithelial capillary loops. CE findings were correlated to the histologic findings. A separate analysis involving smoking status was done. Results The CE-based intraepithelial papillary capillary loop classification score was strongly correlated with the histological findings. Age was strongly associated with both malignancy and bilateral involvement. Smoking habits didn't significantly differ between patients with unilateral and bilateral SCC. Conclusions CE imaging of the vocal cord mucosal capillaries may be useful for the early detection of glottic SCC and pre-cancerous lesions.
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Affiliation(s)
- Pavlos Pavlidis
- Department of Otorhinolaryngology / Head and Neck Surgery, University Medical Center Mainz, Badralexi 3, Veria, 59132 Mainz, Germany
- Laboratory of Clinical Pharmacology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Christopher Matthias
- Department of Otorhinolaryngology / Head and Neck Surgery, University Medical Center Mainz, Badralexi 3, Veria, 59132 Mainz, Germany
| | | | | | - Haralampos Gouveris
- Department of Otorhinolaryngology / Head and Neck Surgery, University Medical Center Mainz, Badralexi 3, Veria, 59132 Mainz, Germany
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Klimza H, Jackowska J, Pietruszewska W, Porębski A, Nogal P, Leduchowska A, Wierzbicka M. Vocal fold leukoplakia recurrence risk model. Sci Rep 2024; 14:266. [PMID: 38168150 PMCID: PMC10761819 DOI: 10.1038/s41598-023-50691-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 12/22/2023] [Indexed: 01/05/2024] Open
Abstract
The paper aims to define the variables that elevate the risk of VFL recurrence after adequate primary treatment, and to present the Recurrence Risk Model with practical conclusions to handle pVFL and rVFL. Out of 207 patients with primary vocal fold leukoplakia (pVFL), in 41 (19.8%) recurrent VFL (rVFL) was diagnosed. All patients were assessed by using a trans-nasal flexible video-endoscope using white light, and NBI. The primary measure of our study was to investigate whether morphological features of pVFL in WL, vascular pattern in NBI, and primary histological findings could predict VFL recurrence. To create a model of risk factors, two methods were used: logistic regression and a conditional inference decision tree. The study showed smoking was the factor that significantly and most strongly increased the likelihood of rVFL, as well as the older age groups have a greater odds of rVFL. Types IV, V and VI, according to Ni 2019 classification, were associated with a significantly higher risk of rVFL. The algorithm combining patients' dependent variables and the combination of two classifications improves the predictive value of the presented VFL Recurrence Risk Model.
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Affiliation(s)
- Hanna Klimza
- Regional Specialist Hospital Wroclaw, Research & Development Centre, Kamieńskiego 73a, 51-124, Wrocław, Poland.
| | - Joanna Jackowska
- Department of Otolaryngology, Head and Neck Surgery, Poznań University of Medical Sciences, Przybyszewskiego Street 49, 60-355, Poznań, Poland
| | - Wioletta Pietruszewska
- Department of Otiatrics, Laryngology and Laryngological Oncology, Medical University of Łódź, Kościuszki Alley 4, 90-419, Łódź, Poland
| | - Andrzej Porębski
- Faculty of Law and Administration, Jagiellonian University, 24 Gołębia St., 31-007, Kraków, Poland
| | - Piotr Nogal
- Department of Otolaryngology, Head and Neck Surgery, Poznań University of Medical Sciences, Przybyszewskiego Street 49, 60-355, Poznań, Poland
| | - Agata Leduchowska
- Department of Otiatrics, Laryngology and Laryngological Oncology, Medical University of Łódź, Kościuszki Alley 4, 90-419, Łódź, Poland
| | - Małgorzata Wierzbicka
- Regional Specialist Hospital Wroclaw, Research & Development Centre, Kamieńskiego 73a, 51-124, Wrocław, Poland
- Wroclaw University of Science and Technology, 27 Wybrzeże Stanisława Wyspiańskiego St, 50-370, Wroclaw, Poland
- Institute of Human Genetics Polish Academy of Sciences, Strzeszynska 32, 60-479, Poznań, Poland
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Yin S, Huang H, Sun P, Zhang D. Analysis of prognostic factors for vocal fold leukoplakia based on 344 cases at a two-year follow up. J Laryngol Otol 2023; 137:1170-1175. [PMID: 37194075 DOI: 10.1017/s0022215123000762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
OBJECTIVE To evaluate risk factors for poor prognosis in vocal fold leukoplakia. METHODS Clinical data were collected for 344 patients with vocal fold leukoplakia who received surgical treatment in our otolaryngology department from October 2010 to June 2019. Univariate and multivariate logistic regression analyses of the relevant factors were conducted. RESULTS Among the 344 patients, 98 exhibited recurrence and 30 underwent a malignant change. Multivariate logistic regression analysis showed that size of the lesion (p = 0.03, odds ratio = 2.14), form of the lesion under white light (p < 0.001), surgical method (p < 0.001, odds ratio = 0.28) and pathological type (p < 0.001) were independent factors that affected the recurrence of vocal fold leukoplakia. In both univariate and multivariate analyses, the sole independent risk factor for malignant transformation of vocal fold leukoplakia was pathological type (p < 0.001). CONCLUSION The outlook for vocal fold leukoplakia depends on several clinical factors, especially pathological type. The more severe the pathological type, the more likely it is to recur or become cancerous.
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Affiliation(s)
- S Yin
- Department of Otolaryngology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - H Huang
- Department of Otolaryngology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - P Sun
- Department of Otolaryngology, First Affiliated Hospital of Soochow University, Suzhou, China
- Department of Head and Neck, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - D Zhang
- Department of Otolaryngology, First Affiliated Hospital of Soochow University, Suzhou, China
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Pietruszewska W, Morawska J, Manning JT, Sitek A, Antoszewski B, Kasielska-Trojan A. Digit ratio (2D:4D), laryngeal cancer and vocal fold leukoplakia. J Cancer Res Clin Oncol 2023:10.1007/s00432-023-04850-8. [PMID: 37211562 PMCID: PMC10374665 DOI: 10.1007/s00432-023-04850-8] [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: 04/14/2023] [Accepted: 05/08/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND To date, there are no studies that have analyzed the possible influence of exposure to prenatal sex hormones on the risk of laryngeal cancer (LC) and premalignant laryngeal lesion-vocal fold leukoplakia (VFL). Digit ratio (2D:4D) is suggested to be a proxy of prenatal sex hormone exposure. OBJECTIVE To examine 2D:4D in patients with LC and clarify if it could add to the verified risk factors in estimating the overall risk of LC. METHODS 511 subjects participated in the study. The study group included 269 patients: with LC (N = 114, 64 men) and VFL (N = 155, 116 men). Controls included 242 healthy individuals (66.40 ± 4.50 years (106 men)). RESULTS Predictive models estimating the risk of VFL and LC in women, based solely on predictors like smoking and alcohol consumption had a lower area under the ROC curve (AUC) than the model with left 2D:4D. AUC for the model estimating the likelihood of VFL increased from 0.83 to 0.85, and for LC from 0.76 to 0.79. CONCLUSIONS Low left 2D:4D may be associated with an increased risk of developing leukoplakia and laryngeal cancer in women. In the case of laryngeal cancer, left 2D:4D may serve as additional variable (to other known risk factors, such as smoking and/or alcohol consumption), which can improve cancer risk prediction.
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Affiliation(s)
- Wioletta Pietruszewska
- Department of Otolaryngology, Head and Neck Oncology, Medical University of Lodz, Lodz, Poland
| | - Joanna Morawska
- Department of Otolaryngology, Head and Neck Oncology, Medical University of Lodz, Lodz, Poland
| | - John T Manning
- Applied Sports, Technology, Exercise, and Medicine (A-STEM), Swansea University, Swansea, UK
| | - Aneta Sitek
- Department of Anthropology, University of Lodz, Lodz, Poland
| | - Bogusław Antoszewski
- Plastic, Reconstructive and Aesthetic Surgery Clinic, Institute of Surgery, Medical University of Lodz, Kopcinskiego 22, 90-153, Lodz, Poland
| | - Anna Kasielska-Trojan
- Plastic, Reconstructive and Aesthetic Surgery Clinic, Institute of Surgery, Medical University of Lodz, Kopcinskiego 22, 90-153, Lodz, Poland.
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Wandell GM, Law AB, Maxin A, Ha VT, Wilson EC, Nash MG, Merati AL, Whipple ME, Meyer TK. Defining the Performance of Clinician's Ability to Screen for Laryngeal Mass From Voice. Otolaryngol Head Neck Surg 2023; 168:1371-1380. [PMID: 36939403 DOI: 10.1002/ohn.206] [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: 03/17/2022] [Revised: 10/12/2022] [Accepted: 11/03/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Defining a clinician's ability to perceptually identify mass from voice will inform the feasibility, design priorities, and performance standards for tools developed to screen for laryngeal mass from voice. This study defined clinician ability of and examined the impact of expertise on screening for laryngeal mass from voice. STUDY DESIGN Task comparison study between experts and nonexperts rating voices for the probability of a laryngeal mass. SETTING Online, remote. METHODS Experts (voice-focused speech-language pathologists and otolaryngologists) and nonexperts (general medicine providers) rated 5-s/i/voice samples (with pathology defined by laryngoscopy) for the probability of laryngeal mass via an online survey. The intraclass correlation coefficient (ICC) estimated interrater and intrarater reliability. Diagnostic performance metrics were calculated. A linear mixed effects model examined the impact of expertise and pathology on ratings. RESULTS Forty clinicians (21 experts and 19 nonexperts) evaluated 344 voice samples. Experts outperformed nonexperts, with a higher area under the curve (70% vs 61%), sensitivity (49% vs 36%), and specificity (83% vs 77%) (all comparisons p < .05). Interrater reliability was fair for experts and poor for nonexperts (ICC: 0.48 vs 0.34), while intrarater reliability was excellent and good, respectively (ICC: 0.9 and 0.6). The main effects of expertise and underlying pathology were significant in the linear model (p < .001). CONCLUSION Clinicians demonstrate inadequate performance screening for laryngeal mass from voice to use auditory perception for dysphonia triage. Experts' superior performance indicates that there is acoustic information in a voice that may be utilized to detect laryngeal mass based on voice.
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Affiliation(s)
- Grace M Wandell
- Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Anthony B Law
- Department of Otolaryngology-Head and Neck Surgery, Emory School of Medicine, Atlanta, Georgia, USA
| | - Anthony Maxin
- School of Medicine, Creighton University, Nebraska, Omaha, USA
| | - Vivian T Ha
- Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Emily C Wilson
- Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, USA.,Department of Speech and Hearing Sciences, University of Washington, Seattle, Washington, USA
| | - Michael G Nash
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Albert L Merati
- Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Mark E Whipple
- Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Tanya K Meyer
- Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, USA
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12
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Kántor P, Staníková L, Švejdová A, Zeleník K, Komínek P. Narrative Review of Classification Systems Describing Laryngeal Vascularity Using Advanced Endoscopic Imaging. J Clin Med 2022; 12:jcm12010010. [PMID: 36614807 PMCID: PMC9821525 DOI: 10.3390/jcm12010010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/12/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022] Open
Abstract
Endoscopic methods are critical in the early diagnosis of mucosal lesions of the head and neck. In recent years, new examination methods and classification systems have been developed and introduced into clinical practice. All of these new techniques target the notion of optical biopsy, which tries to assess the nature of the lesion before histology examination. Many methods suffer from interpretation issues due to subjective interpretation of the findings. Therefore, multiple classification systems have been developed to assist the proper interpretation of mucosal findings and reduce the error rate. They provide various perspectives on the assessment and interpretation of mucosa changes. This article provides a comprehensive and critical view of the available classification systems as well as their advantages and disadvantages.
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Affiliation(s)
- Peter Kántor
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, 708 52 Ostrava, Czech Republic
- Department of Craniofacial Surgery, Faculty of Medicine, University of Ostrava, 701 03 Ostrava, Czech Republic
- Correspondence: ; Tel.: +420-722-437-109
| | - Lucia Staníková
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, 708 52 Ostrava, Czech Republic
- Department of Craniofacial Surgery, Faculty of Medicine, University of Ostrava, 701 03 Ostrava, Czech Republic
| | - Anna Švejdová
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Hradec Králove, Faculty of Medicine in Hradec Králove, Charles University, 500 03 Hradec Králové, Czech Republic
| | - Karol Zeleník
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, 708 52 Ostrava, Czech Republic
- Department of Craniofacial Surgery, Faculty of Medicine, University of Ostrava, 701 03 Ostrava, Czech Republic
| | - Pavel Komínek
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, 708 52 Ostrava, Czech Republic
- Department of Craniofacial Surgery, Faculty of Medicine, University of Ostrava, 701 03 Ostrava, Czech Republic
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13
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Videolaryngoendoscopic and Stroboscopic Evaluation in Predicting the Malignancy Risk of Vocal Fold Leukoplakia. J Clin Med 2022; 11:jcm11195789. [PMID: 36233657 PMCID: PMC9571578 DOI: 10.3390/jcm11195789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/09/2022] [Accepted: 09/27/2022] [Indexed: 11/30/2022] Open
Abstract
Background: Vocal fold leukoplakia (VFL), despite our knowledge of its etiopathogenetic factors, and the development of laryngeal visualization, remains a diagnostic and therapeutic challenge. Objective: This research aimed to explore the efficacy of clinical and morphological feature identification in videolaryngoendoscopy (VLE) using a three-tier classification, and videolaryngostroboscopy (VLS) in predicting the risk of VFL malignant transformation. Material and Methods: We examined 98 patients with VFL by flexible endoscopy under VLE and VLS. Morphological characteristics of 123 lesions including the surface, margin, and texture were assessed; then, VFL was subdivided into three types: I—flat and smooth, II—elevated and smooth, and III—rough. Based on the histopathological findings, 76 (61.79%) lesions were classified as low- and 47 (38.21%) lesions as high-grade dysplasia. Results: The inter-rater agreement between two raters evaluating the VFL in VLE was almost perfect (Cohen’s kappa = 0.826; p < 0.00; 95%CI 0.748−0.904). In ROC curve analysis, the AUC difference between Rater I and Rater II was 0.024 (0.726 vs. 0.702). In multivariate analysis, high-risk VFL was positively related to unilateral plaque localization (p = 0.003), the type III VLE classification (p = 0.013), absence of a mucosal wave (p = 0.034), and a positive history of alcohol consumption (p = 0.047). In ROC analysis, VLE had an AUC of 0.726, with a high sensitivity of 95.7% and low specificity of 40.8%. The NPV was high, at 93.9%; however, the PPV was low, at 50%. The proposed logistic regression model including features significant in multivariate analysis showed lower sensitivity (80.9% vs. 95.7%) and lower NPV (86.2% vs. 93.9%); however, the specificity and PPV were improved (73.7% vs. 40.8% and 65.5% vs. 50.0%, respectively). Conclusions: The combination of clinical history with endoscopic (plaque morphology) and stroboscopic examination (mucosal wave assessment) can fairly estimate the degree of dysplasia in VFL and thus is recommended for use in clinical settings. The findings of this study can be used to guide the decision regarding immediate biopsy or watchful waiting.
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14
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Fang Y, Yang Y, Chen M, Chen J, He P, Cheng L, Wu H. Correlating intraepithelial papillary capillary loops of vocal cord leukoplakia with histopathology. Acta Otolaryngol 2022; 142:106-111. [PMID: 34965176 DOI: 10.1080/00016489.2021.2019828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The pathology of vocal fold leukoplakia (VFL) was hard to predict before surgery. OBJECTIVES To investigate the correlation of intraepithelial papillary capillary loops (IPCLs) with the malignant transformation in VFL. MATERIALS AND METHODS The IPCLs in 90 patients were classified according to 2019 Ni classification. Type I-III represented to non- to moderate dysplasia in pathology being viewed as 'benign leukoplasia', type IV-VI represented to severe dysplasia/cancer in situ, cancerization being viewed as 'malignant leukoplasia'. The corresponding relationship of IPCLs with pathology was calculated. RESULTS Forty-one cases were classified as type I-III, the consistency of type I-III with pathology was 61.0%, with 100.0% of type I, 47.1% of type II and 30.0% of type III. 49 cases were classified as type IV-VI, all were 'malignant leukoplasia', the consistency of type IV-VI and pathology was 100.0%. The accuracy of type I-III, IV-VI to predict pathology were 61.0, 100.0%. The sensitivity, specificity, accuracy, positive predictive value, negative predictive value of Ni classification corresponding to 'benign/malignant leukoplasia' was 75.8, 100.0, 82.2, 100.0, 60.0%, respectively. CONCLUSIONS AND SIGNIFICANCE IPCLs of type IV-VI in vocal cord leukoplasia had a close correlation with pathology. The degree of dysplasia was underestimated in type II and type III.
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Affiliation(s)
- Yi Fang
- Department of Otorhinolaryngology, Head and Neck Surgery, Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai, China
- Shanghai Key Clinical Disciplines of Otorhinolaryngology, Shanghai, China
| | - Yue Yang
- Department of Otorhinolaryngology, Head and Neck Surgery, Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai, China
- Shanghai Key Clinical Disciplines of Otorhinolaryngology, Shanghai, China
| | - Min Chen
- Department of Otorhinolaryngology, Head and Neck Surgery, Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai, China
- Shanghai Key Clinical Disciplines of Otorhinolaryngology, Shanghai, China
| | - Jian Chen
- Department of Otorhinolaryngology, Head and Neck Surgery, Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai, China
- Shanghai Key Clinical Disciplines of Otorhinolaryngology, Shanghai, China
| | - Peijie He
- Department of Otorhinolaryngology, Head and Neck Surgery, Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai, China
- Shanghai Key Clinical Disciplines of Otorhinolaryngology, Shanghai, China
| | - Lei Cheng
- Department of Otorhinolaryngology, Head and Neck Surgery, Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai, China
- Shanghai Key Clinical Disciplines of Otorhinolaryngology, Shanghai, China
| | - Haitao Wu
- Department of Otorhinolaryngology, Head and Neck Surgery, Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai, China
- Shanghai Key Clinical Disciplines of Otorhinolaryngology, Shanghai, China
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15
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Klimza H, Pietruszewska W, Rosiak O, Morawska J, Nogal P, Wierzbicka M. Leukoplakia: An Invasive Cancer Hidden within the Vocal Folds. A Multivariate Analysis of Risk Factors. Front Oncol 2021; 11:772255. [PMID: 34966677 PMCID: PMC8711120 DOI: 10.3389/fonc.2021.772255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 11/22/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction Discerning the preoperative nature of vocal fold leukoplakia (VFL) with a substantial degree of certainty is fundamental, seeing that the histological diagnosis of VFL includes a wide spectrum of pathology and there is no consensus on an appropriate treatment strategy or frequency of surveillance. The goal of our study was to establish a clear schedule of the diagnostics and decision-making in which the timing and necessity of surgical intervention are crucial to not miss this cancer hidden underneath the white plaque. Material and Methods We define a schedule as a combination of procedures (white light and Narrow Band Imaging diagnostic tools), methods of evaluating the results (a combination of multiple image classifications in white light and Narrow Band Imaging), and taking into account patient-related risk factors, precise lesion location, and morphology. A total number of 259 patients with 296 vocal folds affected by leukoplakia were enrolled in the study. All patients were assessed for three classifications, in detail according to Ni 2019 and ELS 2015 for Narrow Band Imaging and according to Chen 2019 for white light. In 41 of the 296 folds (13.9%), the VFL specimens in the final histology revealed invasive cancer. We compared the results from the classifications to the final histology results. Results The results showed that the classifications and evaluations of the involvement of anterior commissure improve the clinical utility of these classifications and showed improved diagnostic performance. The AUC of this model was the highest (0.973) with the highest sensitivity, specificity, PPV, and NPV (90.2%, 89%, 56.9%, and 98.3%, respectively). Conclusion The schedule that combines white light and Narrow Band Imaging, with a combination of the two classifications, improves the specificity and predictive value, especially of anterior commissure involvement.
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Affiliation(s)
- Hanna Klimza
- Department of Otolaryngology and Laryngological Oncology, Poznań University of Medical Sciences, Poznań, Poland
- *Correspondence: Hanna Klimza,
| | - Wioletta Pietruszewska
- Department of Otolaryngology, Head and Neck Oncology, Medical University of Lodz, Lodz, Poland
| | - Oskar Rosiak
- Balance Disorder Unit, Department of Otolaryngology, Medical University of Lodz, Lodz, Poland
| | - Joanna Morawska
- Department of Otolaryngology, Head and Neck Oncology, Medical University of Lodz, Lodz, Poland
| | - Piotr Nogal
- Department of Otolaryngology and Laryngological Oncology, Poznań University of Medical Sciences, Poznań, Poland
| | - Małgorzata Wierzbicka
- Department of Otolaryngology and Laryngological Oncology, Poznań University of Medical Sciences, Poznań, Poland
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16
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Xu J, Li X, Wu J, Cun J, Ye F. [Risk prediction and malignant transformation in vocal cord leukoplakia based on electronic laryngoscope]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2021; 35:901-904;909. [PMID: 34628812 PMCID: PMC10127698 DOI: 10.13201/j.issn.2096-7993.2021.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Indexed: 11/12/2022]
Abstract
Objective:To investigate the predictive risk factors of vocal fold leukoplakia under electronic laryngoscope and influential factors of malignancy. Methods:A total of 163 cases with vocal cord leukoplakia were analyzed retrospectively. The relationship between the clinical features, including site, size, whether involving the anterior commissure, morphology and pathological grade were analyzed. Then the associations with malignant transformation in vocal cord leukoplakia were evaluated by using multiple Logistic regression analysis. Results:There were one side lesions in 96 cases(58.9%), and bilateral vocal cord lesions in 67 cases(41.1%). The vocal cord leukoplakia with extension less than half of the vocal cord was observed in 135 cases(82.8%) and beyond half of the vocal cord was seen in 28 cases(17.1%). Lesions involving the anterior commissure were 42 cases(25.8%), without involving the anterior commissure were 121 cases(74.2%). According to morphological features, 82 patients(50.3%) had a superficial type, followed by exophytic type(n=65, 39.9%), and ulcerative type(n=16, 9.8%). The pathological type included squamous epithelial simple hyperplasia in 65 cases(39.9%), mild hyperplasia in 44 cases(27.0%), moderate hyperplasia in 31 cases(19.0%), severe hyperplasia and carcinoma in situ in 23 cases(14.1%). 140 cases(85.9%) were in low risk group, and 23 cases(14.1%) were in high risk group. The site of the vocal fold leukoplakia was not associated with the pathological grade(P>0.05), whether the vocal fold leukoplakia range exceeds 1/2 of the total length of the vocal fold, and whether involving the anterior commissure were associated with the pathological grade(both P<0.05). There were statistically significant differences between the pathological grade and the morphological type(P<0.01). Ten cases developed larynx cancer, the ratio of malignant transformation was 6.1%. The multiple Logistic regression showed that whether involving the anterior commissure and histopathological classification were the risk factors of malignant transformation in vocal cord eukoplakia. Conclusion:The pathological results of vocal cord leukoplakia can be predicted by laryngoscopy features. Involving of the anterior commissure and histopathological classification are the risk factors of malignant transformation in vocal cord leukoplakia.
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Affiliation(s)
- Jianhui Xu
- Department of Otorhinolaryngology Head and Neck Surgery,Zhongshan People's Hospital,Zhongshan,528400,China
| | - Xin Li
- Department of Otorhinolaryngology Head and Neck Surgery,Zhongshan People's Hospital,Zhongshan,528400,China
| | - Jianhui Wu
- Department of Otorhinolaryngology Head and Neck Surgery,Zhongshan People's Hospital,Zhongshan,528400,China
| | - Jingjing Cun
- Department of Otorhinolaryngology Head and Neck Surgery,Zhongshan People's Hospital,Zhongshan,528400,China
| | - Fei Ye
- Department of Otorhinolaryngology Head and Neck Surgery,Zhongshan People's Hospital,Zhongshan,528400,China
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17
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Li LJ, Yu Z, Zhu JQ, Wang ML, Li ZX, Yang C, Ni XG. Laryngoscopic characteristics related to the risk of cancerization of vocal cord leukoplakia. Acta Otolaryngol 2021; 141:802-807. [PMID: 34314296 DOI: 10.1080/00016489.2021.1951444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The diagnosis of vocal cord leukoplakia mainly relies on laryngoscopy. The morphology of vocal cord leukoplakia under laryngoscope is closely related to the pathological nature of leukoplakia. The specific manifestations associated with high-risk vocal cord leukoplakia remain to be explored. OBJECTIVE To investigate the characteristics of low-risk and high-risk vocal cord leukoplakia under conventional white light imaging (WLI) laryngoscopy and its correlations with narrow band imaging (NBI) laryngoscopy. METHODS One hundred and seventy-five cases of vocal cord leukoplakia were divided into low-risk and high-risk groups. The characteristics of low-risk and high-risk vocal cord leukoplakia under WLI laryngoscopy and its correlations with NBI laryngoscopy were analyzed. RESULTS Logistic regression analysis showed that thickness and hyperemia were independent factors (p < .05). Hyperemia had a strong consistency with the visualization of spots under NBI laryngoscopy (kappa = 0.758). The sign of hyperemia and the NBI classification had equivalent diagnostic efficacy for predicting the risk of cancerization of vocal cord leukoplakia. CONCLUSION The sign of hyperemia under WLI laryngoscopy is significantly correlated with the visualized spots under NBI laryngoscopy. Hyperemia is an important feature for predicting malignant potential of vocal cord leukoplakia.
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Affiliation(s)
- Li-Juan Li
- Department of Otorhinolaryngology, The People's Hospital of Wenshan Prefecture, Yunnan, China
| | - Zhan Yu
- Department of Otolaryngology Head and Neck Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ji-Qing Zhu
- Department of Endoscopy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Mei-Ling Wang
- Department of Endoscopy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital and Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Zhi-Xiang Li
- Department of Otorhinolaryngology, The People's Hospital of Wenshan Prefecture, Yunnan, China
| | - Cong Yang
- Department of Otorhinolaryngology, The People's Hospital of Wenshan Prefecture, Yunnan, China
| | - Xiao-Guang Ni
- Department of Endoscopy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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18
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Vocal Fold Leukoplakia: Which of the Classifications of White Light and Narrow Band Imaging Most Accurately Predicts Laryngeal Cancer Transformation? Proposition for a Diagnostic Algorithm. Cancers (Basel) 2021; 13:cancers13133273. [PMID: 34208811 PMCID: PMC8268866 DOI: 10.3390/cancers13133273] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/23/2021] [Accepted: 06/27/2021] [Indexed: 12/12/2022] Open
Abstract
The management of Vocal Fold Leukoplakia (VFL) remains problematic. There is no consensus on the indications or the timing for surgery. The objective was to select the most accurate classification for predicting low- and high-risk VFL in White Light Imaging (WLI) and Narrow Band Imaging (NBI) and to establish a diagnostic algorithm with a timely referral for treatment. A total of 259 VFL patients were included in the study; 186 lesions were classified as low-grade and 110 as high-grade dysplasia. The results of WLI acc. to the two-tier and the three-tier Chen 2019 classifications and NBI classifications: ELS, Ni 2011, and Ni 2019 with different cut-off points were compared with the pathological examination (HP). In WLI, the greatest agreement was obtained between type 3 of the three-tier classification and high-grade dysplasia (accuracy, specificity, and PPV: 80.4%, 92.0%, and 81.5%, respectively). Assessing VFL periphery in NBI, cut-off point 5 (Ni 2011 type V) demonstrated a higher accuracy, specificity, and PPV than 4 (83.1%, 93.6%, 85.5% and 77.4%, 74.9%, and 65.4%, respectively). In NBI, we observed higher accuracy, sensitivity, and PPV (84.1%, 93.0%, 85.2% vs. 80.7%, 81.3% and 71.3%, respectively) for cut-off point 5 (Ni 2019 type V and VI) in comparison to the cut-off point 4 group (type IV, V, and VI) (80.7%, 81.3%, 71.3%, respectively), and a higher kappa value (0.68 vs. 0.58) was obtained. We have shown that both the plaque image and the microvascular pattern on the leukoplakia periphery are critical in the diagnosis of high-risk VFL. The most accurate predictor of VFL malignant transformation in WLI is type 3 according to the Chen 2019 classification, while in NBI type V and VI according to the Ni 2019 classification.
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19
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A multi-scale recurrent fully convolution neural network for laryngeal leukoplakia segmentation. Biomed Signal Process Control 2020. [DOI: 10.1016/j.bspc.2020.101913] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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20
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Fang Y, Yang Y, Chen M, He P, Cheng L, Chen J, Wu H. Elevated peripheral inflammatory markers are related with the recurrence and canceration of vocal fold leukoplakia. Eur Arch Otorhinolaryngol 2019; 276:2857-2864. [PMID: 31367834 DOI: 10.1007/s00405-019-05576-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 07/17/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To evaluate the predictive value of preoperative peripheral inflammatory markers in patients with vocal fold leukoplakia. METHODS A retrospective study was performed of the patients diagnosed with vocal fold leukoplakia and who accepted carbon dioxide (CO2) laser resection in our center in the last 10 years. We calculated the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and monocyte-to-lymphocyte ratio (MLR) after collecting and analyzing the clinical, histopathological and laboratory data. The potential relation between blood indexes and clinical events as recurrence or canceration was evaluated. RESULTS A total of 589 patients were involved, including 300 cases without recurrence (group A), 198 with recurrence but not canceration (group B) and 91 transformed into squamous cancer (group C). Baseline analysis of NLR, PLR, and MLR showed no difference among the three groups before the first surgery. But all the indexes significantly elevated in groups B (P < 0.001, < 0.001, 0.023, respectively) and C (P = 0.009, 0.004, 0.007, respectively) in the last operation. The receiver-operating curve (ROC) analysis showed NLR as a potential marker of canceration of leukoplakia (AUC = 0.837) and the cutoff value was 2.505. When regrouping with pathological outcomes, severe dysplasia and squamous cell carcinoma (SCC) groups both revealed a higher level of NLR, PLR, and MLR comparing to the no dysplasia, mild dysplasia, and moderate dysplasia groups. NLR, PLR, and MLR in high-risk group (moderate, severe dysplasia and carcinoma) also elevated comparing to low-risk group (no dysplasia, mild dysplasia) (P = 0.039, 0.011, 0.007, respectively). CONCLUSIONS The peripheral inflammatory markers NLR, PLR, and MLR are closely connected with the development of vocal fold leukoplakia. NLR may be a potential marker to predict the poor outcomes (recurrence or canceration) of patients in first surgery.
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Affiliation(s)
- Yi Fang
- Department of Otorhinolaryngology-Head and Neck Surgery (Shanghai Key Clinical Disciplines of Otorhinolaryngology), Eye, Ear, Nose and Throat Hospital of Fudan University, Fenyang Road Num 83, Xuhui District, Shanghai, 200031, China.,Shanghai Key Clinical Disciplines of Otorhinolaryngology, Shanghai, 200031, China
| | - Yue Yang
- Department of Otorhinolaryngology-Head and Neck Surgery (Shanghai Key Clinical Disciplines of Otorhinolaryngology), Eye, Ear, Nose and Throat Hospital of Fudan University, Fenyang Road Num 83, Xuhui District, Shanghai, 200031, China.,Shanghai Key Clinical Disciplines of Otorhinolaryngology, Shanghai, 200031, 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, Fenyang Road Num 83, Xuhui District, Shanghai, 200031, China.,Shanghai Key Clinical Disciplines of Otorhinolaryngology, Shanghai, 200031, China
| | - Peijie He
- Department of Otorhinolaryngology-Head and Neck Surgery (Shanghai Key Clinical Disciplines of Otorhinolaryngology), Eye, Ear, Nose and Throat Hospital of Fudan University, Fenyang Road Num 83, Xuhui District, Shanghai, 200031, China.,Shanghai Key Clinical Disciplines of Otorhinolaryngology, Shanghai, 200031, 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, Fenyang Road Num 83, Xuhui District, Shanghai, 200031, China.,Shanghai Key Clinical Disciplines of Otorhinolaryngology, Shanghai, 200031, 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, Fenyang Road Num 83, Xuhui District, Shanghai, 200031, China. .,Shanghai Key Clinical Disciplines of Otorhinolaryngology, Shanghai, 200031, 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, Fenyang Road Num 83, Xuhui District, Shanghai, 200031, China. .,Shanghai Key Clinical Disciplines of Otorhinolaryngology, Shanghai, 200031, China.
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