Correlation Between Clinical Diagnosis and Pathological Diagnosis in Laryngeal Lesions

Applications and challenges of neural networks in otolaryngology (Review)

Artificial Intelligence (AI) has become a topic of interest that is frequently debated in all research fields. The medical field is no exception, where several unanswered questions remain. When and how this field can benefit from AI support in daily routines are the most frequently asked questions. The present review aims to present the types of neural networks (NNs) available for development, discussing their advantages, disadvantages and how they can be applied practically. In addition, the present review summarizes how NNs (combined with various other features) have already been applied in studies in the ear nose throat research field, from assisting diagnosis to treatment management. Although the answer to this question regarding AI remains elusive, understanding the basics and types of applicable NNs can lead to future studies possibly using more than one type of NN. This approach may bypass the actual limitations in accuracy and relevance of information generated by AI. The proposed studies, the majority of which used convolutional NNs, obtained accuracies varying 70-98%, with a number of studies having the AI trained on a limited number of cases (<100 patients). The lack of standardization in AI protocols for research negatively affects data homogeneity and transparency of databases.

Vocal cord lesions classification based on deep convolutional neural network and transfer learning

PURPOSE

Laryngoscopy, the most common diagnostic method for vocal cord lesions (VCLs), is based mainly on the visual subjective inspection of otolaryngologists. This study aimed to establish a highly objective computer-aided VCLs diagnosis system based on deep convolutional neural network (DCNN) and transfer learning.

METHODS

To classify VCLs, our method combined the DCNN backbone with transfer learning on a system specifically finetuned for a laryngoscopy image dataset. Laryngoscopy image database was collected to train the proposed system. The diagnostic performance was compared with other DCNN-based models. Analysis of F1 score and receiver operating characteristic curves were conducted to evaluate the performance of the system.

RESULTS

Beyond the existing VCLs diagnosis method, the proposed system achieved an overall accuracy of 80.23%, an F1 score of 0.7836, and an area under the curve (AUC) of 0.9557 for four fine-grained classes of VCLs, namely, normal, polyp, keratinization, and carcinoma. It also demonstrated robust classification capacity for detecting urgent (keratinization, carcinoma) and non-urgent (normal, polyp), with an overall accuracy of 0.939, a sensitivity of 0.887, a specificity of 0.993, and an AUC of 0.9828. The proposed method also outperformed clinicians in the classification of normal, polyps, and carcinoma at an extremely low time cost.

CONCLUSION

The VCLs diagnosis system succeeded in using DCNN to distinguish the most common VCLs and normal cases, holding a practical potential for improving the overall diagnostic efficacy in VCLs examinations. The proposed VCLs diagnosis system could be appropriately integrated into the conventional workflow of VCLs laryngoscopy as a highly objective auxiliary method.

Correlation of Clinical and Pathological Diagnosis and Inflammatory Markers for Patients Undergoing Laryngeal Microsurgery

BACKGROUND

The purpose of this study was to investigate the rate of concordance between indirect- and direct laryngoscopy and final pathology in patients undergoing laryngeal microsurgery.

STUDY DESIGN

Retrospective case study.

METHODS

This study was conducted in the Otolaryngology clinic of a tertiary center between January 2017 and June 2020. Archives records of 432 patients, who underwent laryngeal microsurgery because of benign and premalignant lesions or malignancy, were examined. The patients were divided into three subgroups according to pathology results: benign lesions, premalignant lesions, and malignancies.

RESULTS

There were 400 laryngeal lesions from 385 patients, that met the inclusion and exclusion criteria, 307 (79.7%) were male and 78 were (20.3%) female. The average age of patients was 52.88 ± 13.21 years. The most common diagnosis was polyp (34.25%) followed by squamous cell carcinoma (27.75%) and Reinke's edema (8.25%) according to final pathology. For the benign laryngeal lesions, a high correlation level was observed regarding the compatibility of the indirect- and direct laryngoscopy diagnosis, and final pathology (P < 0.001). The laryngeal premalignant lesions and malignancies were significantly more common in older age and male gender (P <0.001). Similarly, smoking usage was more frequent in patients with premalignant lesions and malignancy (P <0.001). The neutrophil count, neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, neutrophil to platelet ratio as well as CRP value were significantly higher in malignancy group (P <0.05). On the other hand, lymphocyte ratio was smaller in the malignancy group compared with the benign and premalignant lesions, and this difference was significant (P = 0.016).

CONCLUSION

Our study demonstrated a high rate of agreement between the clinical diagnosis and pathology results in patients with benign laryngeal lesions, in contrast to premalignant lesions and malignancies. Also, the neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, neutrophil to platelet ratio as well as CRP were shown to be increased in patients with laryngeal malignancies.

Incidence and malignant transformation of glottic precursor lesions in Denmark

Objectives: Glottic precursor lesion (GPL) is a well-known premalignant condition, but the existing knowledge of incidence and malignant potential is based on subpopulation studies. In this first, nationwide study we report data from all verified cases of GPL in Denmark during a 10-year period with focus on incidence and malignant transformation of GPL.Methods: Patients were identified by a search for GPL in the time period from 01.01.2000 to 31.12.2009 using the Danish Pathology Data Base, Patobank, which is a nationwide source of all cyto- and histopathological data obtained in Denmark. Data were validated and supplemented by medical chart review.Results: A 10-year national cohort of 965 patients (median age 60 years, male-female ratio 2:1) with histologically verified GPL was analyzed. The overall malignant transformation rate was 18.3% (mild dysplasia 7.7%, moderate dysplasia 19.8%, severe dysplasia 28.5%, and carcinoma in situ 40.3%) with a median progression time of 29 months. Eighty-eight percent of patients were active or former smokers. A significantly larger proportion of male patients (24.1%) experienced malignant transformation compared to females (6.6%) (p < .001).Conclusion: This nationwide population-based study of GPL patients confirmed a stable incidence of GPL in Denmark from January 2000 to December 2009 and a considerable malignant potential, correlated to the grading of GPL according to the World Health Organization classification of laryngeal precursor lesions from 2005, WHOC2005. The recent update, WHOC2017, of low-grade versus high-grade lesions may thus contain less nuanced prognostic information than WHOC2005.Level of evidence: 2b retrospective cohort study.

Efficacy of Phonosurgery, Logopedic Voice Treatment and Vocal Pedagogy in Common Voice Problems of Singers

INTRODUCTION

Functional and organic impairments of the singing voice are common career-threatening problems of singers presenting in phoniatric and laryngological departments. The objective was to evaluate the efficacy of phonosurgery, logopedic voice treatment and vocal pedagogy in common organic and functional voice problems of singers, including investigation of the recently introduced parameter vocal extent measure (VEM).

METHODS

In a prospective clinical study, the analysis of treatment outcome in 76 singers [57 female, 19 male; 38 ± 11 years (mean ± SD)] was based on pre- and post-therapeutic voice function diagnostics and videolaryngostroboscopy. Examination instruments included auditory-perceptual voice assessment, voice range profile (VRP), the VEM calculated from area and shape of the VRP, acoustic-aerodynamic analysis, and patients' self-assessment (e.g., Singing Voice Handicap Index).

RESULTS

While 28% of all singers (21/76) presented with functional dysphonia, 72% (55/76) were diagnosed with organic vocal fold changes, of which marginal edema (n = 25), nodules (n = 9), and polyps (n = 8) were the most common pathologic changes. Of the 76 singers, 57% (43) received phonosurgery, 43% (33) had conservative pedagogic (14) and logopedic (19) treatment. Three months post-therapeutically, most parameters had significantly improved. The dysphonia severity index (DSI) increased on average from 6.1 ± 2.0 to 7.4 ± 1.8 (p < 0.001), and the VEM from 113 ± 20 to 124 ± 14 (p < 0.001). Both parameters correlated significantly with each other (r_s = 0.41). Phonosurgery had the largest impact on the improvement of vocal function. Conservative therapies provided smaller quantitative enhancements but also qualitative vocal restoration with recovered artistic capabilities.

CONCLUSIONS

Depending on individual medical indication, phonosurgery, logopedic treatment and voice teaching are all effective, objectively and subjectively satisfactory therapies to improve the impaired singing voice. The use of VEM in singers with functional and organic dysphonia objectifies and quantifies their vocal capacity as documented in the VRP. Complementing the established DSI, VEM introduction into practical objective voice diagnostics is appropriate and desirable especially for the treatment of singers.