Valoración estroboscópica de laringitis crónicas

Systematic review of the diagnostic value of laryngeal stroboscopy in excluding early glottic carcinoma

OBJECTIVE

Laryngeal stroboscopy is an important diagnostic tool in the work-up of patients with phoniatric complaints. The aim of this article was to evaluate the diagnostic value of laryngeal stroboscopy in excluding glottic carcinoma in patients with suspected glottic carcinoma.

DATA SOURCES

PubMed, Embase and the Cochrane Library.

REVIEW METHODS

A systematic literature search was performed in PubMed, Embase and the Cochrane Library. Studies reporting original study data were included. Studies were selected based on predefined inclusion and exclusion criteria and were consequently systematically assessed for their relevance and risk of bias. Studies with low relevance, high risk of bias or both were excluded from analysis. The prevalences, sensitivities, specificities and post-test probabilities of laryngeal stroboscopy for detecting glottic carcinoma were extracted or calculated with data supplied in the articles.

RESULTS

Seven studies, with high relevance and moderate risk of bias, were selected for data extraction. The baseline risk of glottic carcinoma was 25-49% in the included studies. Sensitivity ranged between 80% and 100% and specificity between 25% and 100%. Post-test probabilities of malignancy in case of an abnormal stroboscopy ranged between 35% and 100%. Post-test probabilities of malignancy in case of a normal stroboscopy ranged between 0% and 29%.

CONCLUSION

A normal laryngeal stroboscopic result predicts the absence of invasive carcinoma. Laryngeal stroboscopy can therefore be suggested as a useful supplemental examination in the standard diagnostic work-up for all patients with suspected glottic carcinoma.

Vocal fold hyperplastic lesions: an evaluation of surgical outcome with videolaryngostroboscopy

BACKGROUND

Vocal fold hyperplastic lesions are premalignant lesions that can be treated effectively by removal of the lesions surgically.

AIMS

The aim of this study was to discuss the success of surgery in patients with vocal fold hyperplastic lesions in terms of preserving vibratory function by comparing the preoperative and postoperative videolaryngostroboscopy findings.

STUDY DESIGN

The medical charts and videolaryngostroboscopic recordings of patients diagnosed with hyperplastic lesions on the vocal folds were reviewed retrospectively.

METHODS

Twenty seven patients with unilateral lesions who underwent type1 subepithelial cordectomy were enrolled in the study. The videolaryngostroboscopic recordings were evaluated by three raters who were not the operating surgeon and who were blinded to the histology of patients. To evaluate the videolaryngostroboscopic findings, a form, which is a modification of criteria described by Hirano and Bless, was used. Preoperative and 6th month postoperative videolaryngostroboscopic recordings were compared with each other and with recordings of the control group, which included 50 healthy volunteers.

RESULTS

All videolaryngostroboscopic findings, except false cord vibration, were significantly improved after surgery.

CONCLUSION

The principle of vocal fold surgery in patients with benign lesions is to preserve the vibratory tissue. This principle also applies to patients with hyperplastic lesions that are premalignant. The hydrodissection technique may be beneficial for this purpose.

Getting the basics right-staging in head and neck cancer

The cornerstone of oncology literature and therefore medical practice is the ability to compare outcomes of treatment modalities for different stages of cancer.

The head and neck represents a complicated anatomical region with multiple tumour sites and sub-sites. Modern management necessitates accurate staging to allow meaningful discussion between all members of the multidisciplinary team. Variations in techniques utilized for staging laryngeal cancer may lead to inconsistencies in staging and result in inaccuracies in interpreting comparative interventional studies.

We call for standardisation in assessment of head and neck cancers in order to maximize the accuracy of clinical staging. We suggest a schema that we currently use in our institution for staging of all head and neck cancers and a schema for upper aero-digestive tract endoscopy.