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Li Z, Lu J, Zhang B, Si J, Zhang H, Zhong Z, He S, Cai W, Li T. New Model and Public Online Prediction Platform for Risk Stratification of Vocal Cord Leukoplakia. Laryngoscope 2024; 134:4329-4337. [PMID: 38828682 DOI: 10.1002/lary.31555] [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: 11/01/2023] [Revised: 05/18/2024] [Accepted: 05/23/2024] [Indexed: 06/05/2024]
Abstract
OBJECTIVE To extract texture features from vocal cord leukoplakia (VCL) images and establish a VCL risk stratification prediction model using machine learning (ML) techniques. METHODS A total of 462 patients with pathologically confirmed VCL were retrospectively collected and divided into low-risk and high-risk groups. We use a 5-fold cross validation method to ensure the generalization ability of the model built using the included dataset and avoid overfitting. Totally 504 texture features were extracted from each laryngoscope image. After feature selection, 10 ML classifiers were utilized to construct the model. The SHapley Additive exPlanations (SHAP) was employed for feature analysis. To evaluate the model, accuracy, sensitivity, specificity, and the area under the receiver operating characteristic (ROC) curve (AUC) were utilized. In addition, the model was transformed into an online application for public use and further tested in an independent dataset with 52 cases of VCL. RESULTS A total of 12 features were finally selected, random forest (RF) achieved the best model performance, the mean accuracy, sensitivity, specificity, and AUC of the 5-fold cross validation were 92.2 ± 4.1%, 95.6 ± 4.0%, 85.8 ± 5.8%, and 90.7 ± 4.9%, respectively. The result is much higher than the clinicians (AUC between 63.1% and 75.2%). The SHAP algorithm ranks the importance of 12 texture features to the model. The test results of the additional independent datasets were 92.3%, 95.7%, 90.0%, and 93.3%, respectively. CONCLUSION The proposed VCL risk stratification prediction model, which has been developed into a public online prediction platform, may be applied in practical clinical work. LEVEL OF EVIDENCE 3 Laryngoscope, 134:4329-4337, 2024.
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Affiliation(s)
- Zufei Li
- Department of Otorhinolaryngology, Head and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jinghui Lu
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Baiwen Zhang
- Institute of Information and Artificial Intelligence Technology, Beijing Academy of Science and Technology, Beijing, 100089, China
| | - Joshua Si
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Hong Zhang
- Department of Pathology, Peking University First Hospital, Beijing, China
| | - Zhen Zhong
- Department of Otorhinolaryngology-Head and Neck Surgery, Peking University First Hospital, Beijing, China
| | - Shuai He
- Department of Otorhinolaryngology, Head and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Wenli Cai
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Tiancheng Li
- Department of Otorhinolaryngology, Head and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
- Department of Otorhinolaryngology-Head and Neck Surgery, Peking University First Hospital, Beijing, China
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Aires MM, Pereira I FY, Silva CD, Pedroso JEDS, Biase NGD, Haddad L. Predictive factors of frozen section in transoral microlaryngeal surgery for suspicious glottic lesions. Braz J Otorhinolaryngol 2024; 90:101434. [PMID: 38848629 PMCID: PMC11192773 DOI: 10.1016/j.bjorl.2024.101434] [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: 11/07/2023] [Revised: 02/24/2024] [Accepted: 03/25/2024] [Indexed: 06/09/2024] Open
Abstract
OBJECTIVE Frozen biopsy may guide surgical intraoperative decisions. We evaluated the accuracy of frozen biopsy for diagnosing benign, dysplastic and malignant laryngeal lesions, compared to paraffin section (gold standard). METHODS Retrospective review of the charts of all patients presenting with laryngeal lesions suspicious of malignancy, who underwent laryngeal microsurgery with frozen biopsy in our institution, between 2015 and 2020. Results of frozen biopsy and paraffin section examinations were compared. RESULTS Among 113 samples of 89 patients, paraffin section diagnosed 23 benign, 31 dysplastic and 59 malignant lesions. The accuracy of the frozen biopsy in identifying dysplasia or malignancy was 80.5% (91/113), and greater for lesions >5 mm (78.8% × 51.5%; p = 0.009). The positive and negative predictive values, sensitivity and specificity were 95.9%, 51.3%, 78.9% and 86.9%, respectively. CONCLUSIONS Frozen section is a reliable tool when malignancy is detected, but almost half of benign results exhibit dysplasia or malignancy in paraffin section. Other clinical parameters should be considered in intraoperative decisions to prevent undertreatment. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Mateus Morais Aires
- Universidade Federal de São Paulo (UNIFESP), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil; Universidade de Pernambuco (UPE), Faculdade de Ciências Médicas, Recife, PE, Brazil
| | - Fábio Yukio Pereira I
- Universidade Federal de São Paulo (UNIFESP), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Camilla Diacópulos Silva
- Universidade Federal de São Paulo (UNIFESP), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - José Eduardo de Sá Pedroso
- Universidade Federal de São Paulo (UNIFESP), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Noemi Grigoletto de Biase
- Universidade Federal de São Paulo (UNIFESP), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil; Pontifícia Universidade Católica de São Paulo (PUC), São Paulo, SP, Brazil
| | - Leonardo Haddad
- Universidade Federal de São Paulo (UNIFESP), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil.
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Fang Y, Li C, Chen M, Chen J, Cheng L, Wu H. NBI Classification Optimization With Morphological Characteristics in Vocal Fold Leukoplakia. EAR, NOSE & THROAT JOURNAL 2024:1455613241272452. [PMID: 39215472 DOI: 10.1177/01455613241272452] [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: 09/04/2024] Open
Abstract
Objectives: To investigate the pathological contribution of vocal fold leukoplakia (VFL) of type II in narrow-band imaging (NBI) classification and morphological characteristics to improve pathological prediction. Material and Methods: The 59 VFL patients with type II in 2019 Ni classification in NBI were included. The pathological reports were collected and divided following 2005 WHO Blue Book. Low-risk VFL contained non-, mild, moderate dysplasia, high-risk VFL included severe dysplasia. The morphological classification and laryngoscopic scoring system were employed to evaluate leukoplakia for pathological prediction. Results: The pathologies contained 1 case of leukoplakia with non-dysplasia, 12 of mild dysplasia, 15 of moderate dysplasia, 8 of severe dysplasia, and 23 of carcinoma. The 30 smooth VFL contained 1 non-dysplasia, 12 mild dysplasia, 14 moderate dysplasia, 2 severe dysplasia, and 1 carcinoma. The 29 rough cases included 1 moderate dysplasia, 6 severe dysplasia, and 22 carcinomas. Laryngoscopic scoring system revealed irregular texture, large size, and thick lesion as factors in relationship with high-risk leukoplakia in univariate (P = .002, <.001, <.001) and multivariate (P = .025, .002, .016) analysis, irregular texture was the most accurate predictor of high-risk VFL pathology. Conclusions and Significance: The pathologies of VFL with type II in NBI classification were hard to be predicted. Morphological irregular/rough texture contributed to predict high-risk pathology in leukoplakia.
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Affiliation(s)
- Yi Fang
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
- Shanghai Key Clinical Disciplines of Otorhinolaryngology, Shanghai, China
| | - Changjiang Li
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
- Shanghai Key Clinical Disciplines of Otorhinolaryngology, Shanghai, China
| | - Min Chen
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
- Shanghai Key Clinical Disciplines of Otorhinolaryngology, Shanghai, China
| | - Jian Chen
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
- Shanghai Key Clinical Disciplines of Otorhinolaryngology, Shanghai, China
| | - Lei Cheng
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
- Shanghai Key Clinical Disciplines of Otorhinolaryngology, Shanghai, China
| | - Haitao Wu
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
- Shanghai Key Clinical Disciplines of Otorhinolaryngology, Shanghai, China
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Fang Y, Li C, Chen M, Chen J, Cheng L, Wu H. Optimal Pathological Prediction of Vocal Fold Leukoplakia Based on IPCLs and Morphology. Laryngoscope 2024. [PMID: 39172002 DOI: 10.1002/lary.31722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 07/31/2024] [Accepted: 08/08/2024] [Indexed: 08/23/2024]
Abstract
OBJECTIVES To establish a combined classification based on intrapapillary capillary loops (IPCLs) and morphological characteristics to improve the accuracy of pathological prediction of vocal fold leukoplakia (VFL). MATERIAL AND METHODS A prospective research was conducted of VFL patients diagnosed by IPCLs and morphology. The VFL cases were classified as Type I-III based on IPCLs and morphological characteristics. Type I referred to VFL with dendritic vessels but not IPCLs. Type II defined VFL without any IPCLs or vessels and classified by morphology into two subtypes as non-rough Type IIa and rough Type IIb. Type III referred to VFL with IPCLs and classified into two subtypes as Type IIIa with small IPCLs and Type IIIb with large IPCLs or vascular distortion in or around lesions. Predicting pathology accuracy was analyzed. RESULTS 182 eligible patients were recruited. The prediction accuracy rates of VFL pathology were 81.5% according to the 2019 Ni classification. The combined classification includes 4 cases of Type I, 28 Type IIa, 35 Type IIb, 56 Type IIIa, and 59 Type IIIb VFLs. The prediction accuracy rate of combined classification ranged from 95.1% to 97.3% in three observers. The average sensitivity, specificity, positive predictive value, negative predictive value was 97.8%, 86.2%, 97.4%, 88.2%, respectively. The inter-observer agreement varied from 84.1% to 94.0%, and mean area under curve of receiver-operating curve analysis was 0.954. CONCLUSIONS AND SIGNIFICANCE The new combined classification based on IPCLs and morphological characteristics could predict pathology of VFL accurately. LEVEL OF EVIDENCE 4 Laryngoscope, 2024.
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Affiliation(s)
- Yi Fang
- ENT institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
- Shanghai Key Clinical Disciplines of Otorhinolaryngology, Shanghai, China
| | - Changjiang Li
- ENT institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
- Shanghai Key Clinical Disciplines of Otorhinolaryngology, Shanghai, China
| | - Min Chen
- ENT institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
- Shanghai Key Clinical Disciplines of Otorhinolaryngology, Shanghai, China
| | - Jian Chen
- ENT institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
- Shanghai Key Clinical Disciplines of Otorhinolaryngology, Shanghai, China
| | - Lei Cheng
- ENT institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
- Shanghai Key Clinical Disciplines of Otorhinolaryngology, Shanghai, China
| | - Haitao Wu
- ENT institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
- Shanghai Key Clinical Disciplines of Otorhinolaryngology, Shanghai, China
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Wang ML, Tie CW, Wang JH, Zhu JQ, Chen BH, Li Y, Zhang S, Liu L, Guo L, Yang L, Yang LQ, Wei J, Jiang F, Zhao ZQ, Wang GQ, Zhang W, Zhang QM, Ni XG. Multi-instance learning based artificial intelligence model to assist vocal fold leukoplakia diagnosis: A multicentre diagnostic study. Am J Otolaryngol 2024; 45:104342. [PMID: 38703609 DOI: 10.1016/j.amjoto.2024.104342] [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: 02/28/2024] [Accepted: 04/23/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVE To develop a multi-instance learning (MIL) based artificial intelligence (AI)-assisted diagnosis models by using laryngoscopic images to differentiate benign and malignant vocal fold leukoplakia (VFL). METHODS The AI system was developed, trained and validated on 5362 images of 551 patients from three hospitals. Automated regions of interest (ROI) segmentation algorithm was utilized to construct image-level features. MIL was used to fusion image level results to patient level features, then the extracted features were modeled by seven machine learning algorithms. Finally, we evaluated the image level and patient level results. Additionally, 50 videos of VFL were prospectively gathered to assess the system's real-time diagnostic capabilities. A human-machine comparison database was also constructed to compare the diagnostic performance of otolaryngologists with and without AI assistance. RESULTS In internal and external validation sets, the maximum area under the curve (AUC) for image level segmentation models was 0.775 (95 % CI 0.740-0.811) and 0.720 (95 % CI 0.684-0.756), respectively. Utilizing a MIL-based fusion strategy, the AUC at the patient level increased to 0.869 (95 % CI 0.798-0.940) and 0.851 (95 % CI 0.756-0.945). For real-time video diagnosis, the maximum AUC at the patient level reached 0.850 (95 % CI, 0.743-0.957). With AI assistance, the AUC improved from 0.720 (95 % CI 0.682-0.755) to 0.808 (95 % CI 0.775-0.839) for senior otolaryngologists and from 0.647 (95 % CI 0.608-0.686) to 0.807 (95 % CI 0.773-0.837) for junior otolaryngologists. CONCLUSIONS The MIL based AI-assisted diagnosis system can significantly improve the diagnostic performance of otolaryngologists for VFL and help to make proper clinical decisions.
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Affiliation(s)
- Mei-Ling Wang
- Department of Endoscopy, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Shenzhen, China
| | - Cheng-Wei Tie
- Department of Endoscopy, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Jian-Hui Wang
- Department of Endoscopy, Shanxi Province Cancer Hospital, Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences, Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, China
| | - Ji-Qing Zhu
- Department of Endoscopy, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Bing-Hong Chen
- Department of Endoscopy, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Shenzhen, China
| | - Ying Li
- Department of Endoscopy, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Shenzhen, China
| | - Sen Zhang
- Department of Otolaryngology Head and Neck Surgery, The First Hospital, Shanxi Medical University, Taiyuan, China
| | - Lin Liu
- Department of Otolaryngology Head and Neck Surgery, Dalian Friendship Hospital, Dalian, China
| | - Li Guo
- Department of Otolaryngology Head and Neck Surgery, the First Affiliated Hospital, College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Long Yang
- Department of Otolaryngology, The Second People's Hospital of Baoshan City, Baoshan, China
| | - Li-Qun Yang
- Department of Otolaryngology, The Second People's Hospital of Baoshan City, Baoshan, China
| | - Jiao Wei
- Department of Otolaryngology, Qujing Second People's Hospital of Yunnan Province, Qujing, China
| | - Feng Jiang
- Department of Otolaryngology, Kunming First People's Hospital, Kunming, China
| | - Zhi-Qiang Zhao
- Department of Otolaryngology, Baoshan People's Hospital, Baoshan, China
| | - Gui-Qi Wang
- Department of Endoscopy, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
| | - Wei Zhang
- Department of Endoscopy, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Shenzhen, China.
| | - Quan-Mao Zhang
- Department of Endoscopy, Shanxi Province Cancer Hospital, Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences, Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, China.
| | - Xiao-Guang Ni
- Department of Endoscopy, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
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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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Li H, Zhang S, Zhou S, Bao Y, Cao X, Shen L, Xu B, Gao W, Luo Y. Pepsin enhances glycolysis to promote malignant transformation of vocal fold leukoplakia epithelial cells with dysplasia. Eur Arch Otorhinolaryngol 2023; 280:1841-1854. [PMID: 36380093 PMCID: PMC9988773 DOI: 10.1007/s00405-022-07729-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/26/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE The mechanism underlying malignant transformation of vocal fold leukoplakia (VFL) and the precise role of the expression of pepsin in VFL remain unclear. This study aimed to investigate the effects of acidified pepsin on VFL epithelial cell growth and migration, and also identify pertinent molecular mechanisms. METHODS Immunochemistry and Western blotting were performed to measure glucose transporter type 1 (GLUT1), monocarboxylate transporters 4 (MCT4), and Hexokinase-II (HK-II) expressions. Cell viability, cell cycle, apoptosis, and migration were investigated by CCK-8 assay, flow cytometry and Transwell chamber assay, respectively. Glycolysis-related contents were determined using the corresponding kits. Mitochondrial HK-II was photographed under a confocal microscope using Mito-Tracker Red. RESULTS It was found: the expression of pepsin and proportion of pepsin+ cells in VFL increased with the increased dysplasia grade; acidified pepsin enhanced cell growth and migration capabilities of VFL epithelial cells, reduced mitochondrial respiratory chain complex I activity and oxidative phosphorylation, and enhanced aerobic glycolysis and GLUT1 expression in VFL epithelial cells; along with the transfection of GLUT1 overexpression plasmid, 18FFDG uptake, lactate secretion and growth and migration capabilities of VFL epithelial cell were increased; this effect was partially blocked by the glycolysis inhibitor 2-deoxy-glucose; acidified pepsin increased the expression of HK-II and enhanced its distribution in mitochondria of VFL epithelial cells. CONCLUSION It was concluded that acidified pepsin enhances VFL epithelial cell growth and migration abilities by reducing mitochondrial respiratory complex I activity and promoting metabolic reprogramming from oxidative phosphorylation to aerobic glycolysis.
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Affiliation(s)
- Haitong Li
- Department of Otolaryngology, The Second Affiliated Hospital of Jiaxing University, Jiaxing, 314000, People's Republic of China
| | - Shasha Zhang
- Department of Otolaryngology, College of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, 310003, People's Republic of China
| | - Shuihong Zhou
- Department of Otolaryngology, College of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, 310003, People's Republic of China
| | - Yangyang Bao
- Department of Otolaryngology, College of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, 310003, People's Republic of China
| | - Xiaojuan Cao
- Department of Otolaryngology, The Second Affiliated Hospital of Jiaxing University, Jiaxing, 314000, People's Republic of China
| | - Lifang Shen
- Department of Otolaryngology, College of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, 310003, People's Republic of China
| | - Bin Xu
- Department of Otolaryngology, The Second Affiliated Hospital of Jiaxing University, Jiaxing, 314000, People's Republic of China
| | - Weimin Gao
- Department of Otolaryngology, The Second Affiliated Hospital of Jiaxing University, Jiaxing, 314000, People's Republic of China
| | - Yunzhen Luo
- Department of Otolaryngology, The Second Affiliated Hospital of Jiaxing University, Jiaxing, 314000, People's Republic of China.
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Lou Z, Lou Z, Lv T, Chen Z. Comparison Between Coblation and Microflap Resection of Leukoplakia of the Vocal Fold. J Voice 2022:S0892-1997(22)00350-2. [PMID: 36414529 DOI: 10.1016/j.jvoice.2022.10.025] [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: 07/06/2022] [Revised: 10/31/2022] [Accepted: 10/31/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVES The objective of this study was to compare the recurrence rate and voice improvement of vocal fold leukoplakia (VFL) between microflap resection alone or radiofrequency (RF) Coblation alone. METHODS Patients with VFL intraoperatively treated via microflap resection alone or Coblation alone were enrolled. The recurrence rate, voice assessment, and Videostroboscopic images were compared between the two groups. RESULTS The recurrence rate at postoperative 12 months was 37.7% (26/69) in the microflap resection group and 7.7% (4/52) in the Coblation group; the difference was significant (P < 0.05). The preoperative and postoperative subjective detection data from the two groups showed significant differences, but the Coblation group recovered better compared to the microflap resection group. No Coblation-related complications were found, including postoperative granulation tissue hyperplasia or anterior commissure adhesion. CONCLUSIONS In patients with vocal cord leukoplakia, RF Coblation had a lower recurrence rate and better voice improvement compared with microflap resection.
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Affiliation(s)
- Zhengcai Lou
- Department of Otorhinolaryngology, Yiwu central Hospital, Yiwu city, Zhejiang provice, China.
| | - Zihan Lou
- Department of Otolaryngology Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China; Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China; Otolaryngological Institute of Shanghai Jiao Tong University, Shanghai, China; Shanghai Key Lab Sleep Disordered Breathing, Shanghai,China
| | - Tian Lv
- Department of Otorhinolaryngology, Yiwu central Hospital, Yiwu city, Zhejiang provice, China
| | - Zhengnong Chen
- Department of Otolaryngology Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China; Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China; Otolaryngological Institute of Shanghai Jiao Tong University, Shanghai, China; Shanghai Key Lab Sleep Disordered Breathing, Shanghai,China.
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Fang Y, Chen M, Li G, Yang Y, He P, Chen J, Cheng L, Wu H. Cancer-associated fibroblast-like fibroblasts in vocal fold leukoplakia suppress CD8 +T cell functions by inducing IL-6 autocrine loop and interacting with Th17 cells. Cancer Lett 2022; 546:215839. [PMID: 35961512 DOI: 10.1016/j.canlet.2022.215839] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/14/2022] [Accepted: 07/25/2022] [Indexed: 11/19/2022]
Abstract
The characteristics of fibroblast cells in head and neck precancerous lesion and its ability to secrete inflammatory cytokines and affect CD8+T cell functions remain unclear. Herein, we reported the existence of fibroblasts in human-derived vocal fold leukoplakia (VFL) with positive staining of fibroblast activation protein (FAP) and α-smooth muscle actin (α-SMA). The fibroblasts from VFL and cancer-associated fibroblasts (CAFs) from head and neck squamous cell carcinoma (HNSCC) displayed similar cellular functions and robust inflammatory cytokine secretions. The effects of fibroblasts from VFL in inducing the apoptosis, depletion of CD8+ T cells and recruitment of regulatory T cells (Treg cells) were observed. We further assessed the autocrine loop within VFL fibroblasts to self-stimulate by secreting IL-6, TGF-β through the IL-6/JAK2/STAT3 pathway. The synergistic stimulation of IL-6 and TGF-β promoted Th17 cell differentiation and IL-17A secretion, which could result in fibroblast activation in another positive loop. Tocilizumab (TOC), a monoclonal antibody targeting IL-6R, managed to suppress the overexpression of both IL-6 and TGF-β in VFL fibroblasts, and thus blocking IL-6 autocrine loop and CAF-Th17 loop in vitro. In a murine model of oral leukoplakia (OL), local injection of TOC inhibited the outgrowth of lesions and showed notable effect in control of OL progression in vivo. Our findings establish a novel rationale for blocking the IL-6/JAK2/STAT3 pathway to inhibit vocal fold (oral) leukoplakia progression and postpone HNSCC tumorigenesis.
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Affiliation(s)
- Yi Fang
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China; Shanghai Key Clinical Disciplines of Otorhinolaryngology, Shanghai, 200031, China
| | - Min Chen
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China; Shanghai Key Clinical Disciplines of Otorhinolaryngology, Shanghai, 200031, China
| | - Guangfei Li
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China; Shanghai Key Clinical Disciplines of Otorhinolaryngology, Shanghai, 200031, China
| | - Yue Yang
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China; Shanghai Key Clinical Disciplines of Otorhinolaryngology, Shanghai, 200031, China
| | - Peijie He
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China; Shanghai Key Clinical Disciplines of Otorhinolaryngology, Shanghai, 200031, China
| | - Jian Chen
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China; Shanghai Key Clinical Disciplines of Otorhinolaryngology, Shanghai, 200031, China.
| | - Lei Cheng
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China; Shanghai Key Clinical Disciplines of Otorhinolaryngology, Shanghai, 200031, China.
| | - Haitao Wu
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China; Shanghai Key Clinical Disciplines of Otorhinolaryngology, Shanghai, 200031, China.
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10
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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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11
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Campello C, Lima-Silva M, de Lima E, Nunes G, Silva H, Dellalibera E, de Britto L, Lemos C, Muniz M. Genetic polymorphisms and protein levels in vocal fold leukoplakia: a systematic review. Braz J Med Biol Res 2022; 55:e11920. [PMID: 35293553 PMCID: PMC8922550 DOI: 10.1590/1414-431x2022e11920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 01/13/2022] [Indexed: 12/03/2022] Open
Abstract
Vocal fold leukoplakia (VFL) has a risk of malignant transformation. Therefore, patients can have symptoms such as dysphonia, vocal strain, difficulty breathing, and dysphagia. Additionally, there is a genetic predisposition that can be associated with genetic polymorphisms. We aimed to evaluate the influence of genetic polymorphisms and protein levels in the etiology of VFL. Our study followed the PRISMA checklist and was registered on PROSPERO database. The questions were: "Are genetic polymorphisms involved in the etiology of VFL? Are protein levels altered in patients with VFL?". Eligibility criteria were case control studies that compared the presence of polymorphisms or/and protein levels of subjects diagnosed with VFL and healthy controls. Of the 905 articles retrieved, five articles with a total of 1038 participants were included in this study. The C allele of the single nucleotide polymorphisms (SNP)-819 T/C IL-10, A allele of the SNP -592 A/C IL-10, CT genotype of the SNP rs11886868 C/T BCL11A, GG genotype of the SNP rs4671393 A/G BCL11A, LL genotype, and L allele of (GT)n repeat polymorphisms of the HO-1 were risk factors for VFL development. Nevertheless, there was a lack of association between VFL and the -1082 A/G IL-10, rs14024 CK-1, and -309 T/G Mdm2 SNPs. The concentrations of the MDM2, BCL11A, and HO-1 proteins were modified, while IL-10 levels were normally expressed in these subjects. In conclusion, most markers evaluated in this review could be potential indicators to develop effective therapies, avoiding a malignant transformation of the lesion.
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Affiliation(s)
- C.P. Campello
- Programa Associado de Pós-Graduação em Fonoaudiologia,
Universidade Federal da Paraíba, João Pessoa, PB, Brasil
- Laboratório de Biologia Molecular, Centro de Oncohematologia
Pediátrica, Hospital Universitário Oswaldo Cruz, Universidade de Pernambuco,
Recife, PE, Brasil
| | - M.F.B. Lima-Silva
- Programa Associado de Pós-Graduação em Fonoaudiologia,
Universidade Federal da Paraíba, João Pessoa, PB, Brasil
| | - E.L.S. de Lima
- Laboratório de Biologia Molecular, Centro de Oncohematologia
Pediátrica, Hospital Universitário Oswaldo Cruz, Universidade de Pernambuco,
Recife, PE, Brasil
- Programa de Pós-Graduação em Ciências da Saúde, Faculdade de
Ciências Médicas, Universidade de Pernambuco, Recife, PE, Brasil
| | - G.R.S. Nunes
- Programa Associado de Pós-Graduação em Fonoaudiologia,
Universidade Federal da Paraíba, João Pessoa, PB, Brasil
| | - H.A.M. Silva
- Laboratório de Biologia Molecular, Centro de Oncohematologia
Pediátrica, Hospital Universitário Oswaldo Cruz, Universidade de Pernambuco,
Recife, PE, Brasil
- Instituto de Ciências Biológicas, Universidade de Pernambuco,
Recife, PE, Brasil
| | - E. Dellalibera
- Laboratório de Biologia Molecular, Centro de Oncohematologia
Pediátrica, Hospital Universitário Oswaldo Cruz, Universidade de Pernambuco,
Recife, PE, Brasil
| | | | - C.A.A. Lemos
- Departamento de Odontologia, Universidade Federal de Juiz de
Fora, Governador Valadares, MG, Brasil
| | - M.T.C. Muniz
- Laboratório de Biologia Molecular, Centro de Oncohematologia
Pediátrica, Hospital Universitário Oswaldo Cruz, Universidade de Pernambuco,
Recife, PE, Brasil
- Instituto de Ciências Biológicas, Universidade de Pernambuco,
Recife, PE, Brasil
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12
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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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13
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Shneyderman M, Snow GE, Davis R, Best S, Akst LM. Readability of Online Materials Related to Vocal Cord Leukoplakia. OTO Open 2021; 5:2473974X211032644. [PMID: 34396027 PMCID: PMC8358515 DOI: 10.1177/2473974x211032644] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 06/26/2021] [Indexed: 11/15/2022] Open
Abstract
Objectives To assess readability and understandability of online materials for vocal cord leukoplakia. Study Design Review of online materials. Setting Academic medical center. Methods A Google search of "vocal cord leukoplakia" was performed, and the first 50 websites were considered for analysis. Readability was measured by the Flesch Reading Ease Score (FRES), Flesch-Kincaid Grade Level (FKGL), and Simple Measure of Gobbledygook (SMOG). Understandability and actionability were assessed by 2 independent reviewers with the PEMAT-P (Patient Education Materials Assessment Tool for Printable Materials). Unpaired t tests compared scores between sites aimed at physicians and those at patients, and a Cohen's kappa was calculated to measure interrater reliability. Results Twenty-two websites (17 patient oriented, 5 physician oriented) met inclusion criteria. For the entire cohort, FRES, FKGL, and SMOG scores (mean ± SD) were 36.90 ± 20.65, 12.96 ± 3.28, and 15.65 ± 3.57, respectively, indicating that materials were difficult to read at a >12th-grade level. PEMAT-P understandability and actionability scores were 73.65% ± 7.05% and 13.63% ± 22.47%. Statistically, patient-oriented sites were more easily read than physician-oriented sites (P < .02 for each of the FRES, FKGL, and SMOG comparisons); there were no differences in understandability or actionability scores between these categories of sites. Conclusion Online materials for vocal cord leukoplakia are written at a level more advanced than what is recommended for patient education materials. Awareness of the current ways that these online materials are failing our patients may lead to improved education materials in the future.
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Affiliation(s)
| | - Grace E Snow
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ruth Davis
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Simon Best
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Lee M Akst
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
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14
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Liu D, Qian T, Sun S, Jiang JJ. Laryngopharyngeal Reflux and Inflammatory Responses in Mucosal Barrier Dysfunction of the Upper Aerodigestive Tract. J Inflamm Res 2021; 13:1291-1304. [PMID: 33447069 PMCID: PMC7801919 DOI: 10.2147/jir.s282809] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 12/16/2020] [Indexed: 12/29/2022] Open
Abstract
The upper aerodigestive tract (UAT) is the first line of defense against environmental stresses such as antigens, microbes, inhalants, foods, etc., and mucins, intracellular junctions, epithelial cells, and immune cells are the major constituents of this defensive mucosal barrier. Laryngopharyngeal reflux (LPR) is recognized as an independent risk factor for UAT mucosal disorders, and in this review, we describe the components and functions of the mucosal barrier and the results of LPR-induced mucosal inflammation in the UAT. We discuss the interactions between the refluxate and the mucosal components and the mechanisms through which these damaging events disrupt and alter the mucosal barriers. In addition, we discuss the dynamic alterations in the mucosal barrier that might be potential therapeutic targets for LPR-induced disorders.
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Affiliation(s)
- Danling Liu
- Otorhinolaryngology Department, ENT Institute, Eye & ENT Hospital, State Key Laboratory of Medical Neurobiology, NHC Key Laboratory of Hearing Medicine Research, Fudan University, Shanghai 200032, People's Republic of China
| | - Tingting Qian
- Otorhinolaryngology Department, ENT Institute, Eye & ENT Hospital, State Key Laboratory of Medical Neurobiology, NHC Key Laboratory of Hearing Medicine Research, Fudan University, Shanghai 200032, People's Republic of China
| | - Shan Sun
- Otorhinolaryngology Department, ENT Institute, Eye & ENT Hospital, State Key Laboratory of Medical Neurobiology, NHC Key Laboratory of Hearing Medicine Research, Fudan University, Shanghai 200032, People's Republic of China
| | - Jack J Jiang
- Otorhinolaryngology Department, ENT Institute, Eye & ENT Hospital, State Key Laboratory of Medical Neurobiology, NHC Key Laboratory of Hearing Medicine Research, Fudan University, Shanghai 200032, People's Republic of China.,Department of Surgery, Division of Otolaryngology Head and Neck Surgery, University of Wisconsin Medical School, Madison, WI 53792-7375, USA
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15
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Campo F, Ralli M, Di Stadio A, Greco A, Pellini R, de Vincentiis M. Role of Narrow Band Imaging Endoscopy in Preoperative Evaluation of Laryngeal Leukoplakia: A Review of the Literature. EAR, NOSE & THROAT JOURNAL 2020; 101:NP403-NP408. [PMID: 33213196 DOI: 10.1177/0145561320973770] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Leukoplakia is a precancerous lesion considered to be within the spectrum of histopathological results from parakeratosis, through stages of dysplasia to invasive cancer. Narrow band imaging (NBI) endoscopy has been introduced to improve early diagnosis of benign and malignant laryngeal lesions. The aim of this literature review was to evaluate the accuracy of preoperative evaluation of vocal fold leukoplakia with NBI endoscopy in comparison with histology. METHODS A systematic review of the literature was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, using 3 different databases: PubMed, Embase, and Scopus. The included articles in the systematic review were identified combining each of the following terms: "narrow band imaging" OR "NBI," [AND] with each of these terms: "laryngeal leukoplakia," OR "vocal fold leukoplakia," OR "vocal cord leukoplakia." RESULTS The articles that fully met the inclusion criteria were 5 case series, conducted between January 2010 and February 2018, and published between 2017 and 2019. The selected articles included 312 patients (86% males and 14% females), affected by 382 vocal cord leukoplakia, evaluated with NBI endoscopy and that underwent surgical microlaryngoscopy with biopsy. Based on the studies included in the review, accuracy of NBI in predicting malignancy within leukoplakia ranged from 81% to 97.8%, demonstrating to be an accurate method to predict the risk of malignant transformation of vocal fold leukoplakia. CONCLUSION Narrow band imaging can help otolaryngologists in the decision-making process on the necessity to perform a biopsy and transoral surgery or long-term follow-up. Larger studies are necessary to confirm the high association of NBI evaluation of the epithelium surrounding the leukoplakia with the histological diagnosis.
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Affiliation(s)
- Flaminia Campo
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Massimo Ralli
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | | | - Antonio Greco
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Raul Pellini
- Department of Otolaryngology and Head and Neck Surgery, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Marco de Vincentiis
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
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16
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Cialente F, Grasso M, Ralli M, De Vincentiis M, Minni A, Agolli G, Dello Spedale Venti M, Riminucci M, Corsi A, Greco A. Laryngeal tuberculosis in renal transplant recipients: A case report and review of the literature. Bosn J Basic Med Sci 2020; 20:411-414. [PMID: 32156254 PMCID: PMC7416185 DOI: 10.17305/bjbms.2020.4448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 02/20/2020] [Indexed: 11/21/2022] Open
Abstract
Renal allograft recipients are at greater risk of developing tuberculosis than the general population. A woman with a kidney transplant was admitted to our emergency department with high temperature, dysphonia, odynophagia, and asthenia. The final diagnosis was laryngeal tuberculosis. Multidisciplinary collaboration enabled accurate diagnosis and successful treatment. Laryngeal tuberculosis should be considered in renal allograft recipients with hoarseness. A more rapid diagnosis of tuberculosis in renal transplant recipients is desirable when the site involved, such as the larynx, exhibits specific manifestations and the patient exhibits specific symptoms. In these cases, prognosis is excellent, and with adequate treatment a complete recovery is often achieved.
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Affiliation(s)
- Fabrizio Cialente
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Michele Grasso
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Massimo Ralli
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Marco De Vincentiis
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
| | - Antonio Minni
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Griselda Agolli
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | | | - Mara Riminucci
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Alessandro Corsi
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Antonio Greco
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
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17
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The Variation of Peripheral Inflammatory Markers in Vocal Leukoplakia before and after Recurrence and Canceration. DISEASE MARKERS 2020; 2020:7241785. [PMID: 32831972 PMCID: PMC7422067 DOI: 10.1155/2020/7241785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 04/07/2020] [Accepted: 06/10/2020] [Indexed: 12/20/2022]
Abstract
Background This retrospective study aims at comparing the variation of peripheral inflammatory markers in recurrent and cancerous vocal fold leukoplakia (VFL) and at exploring the potential connection with pathological outcomes. Methods The patients undergoing carbon dioxide laser surgery with postoperative pathological diagnosis of recurrent vocal fold leukoplakia in the last 5 years were included. The clinical data were collected, and neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocytes-to-lymphocyte ratio (MLR) before and after recurrence and canceration were calculated. Related comparison with two-grade pathological classification was made to evaluate their potential connection with postsurgical histopathology and clinical events. Results The data of 193 patients were engaged into research, as 111 in the recurrence group (Group A) and 82 in canceration group (Group B). The NLR, PLR, and MLR were significantly increased in canceration event compared to the first (P = 0.009, 0.004, 0.007, respectively) and penultimate (P = 0.013, 0.041, 0.006, respectively) time when the previous pathologies were leukoplakia. When redividing the Group A according to the two-grade pathological classification, the high-risk groups showed statistically higher NLR and PLR values than low-risk groups in the subgroups with grade changing (P = 0.016, 0.005, 0.007, 0.005, respectively) and subgroups without grade changing (P = 0.020, 0.027, 0.030, 0.029, respectively). Conclusions NLR, PLR, and MLR are reliable biomarkers in the circulation system which show significantly interrelation with the pathological progression of vocal fold leukoplakia. Presurgical evaluation of NLR, PLR, and MLR may have potential values to indicate the following treatment in clinical practice.
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18
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Chen YL, Bao YY, Zhou SH, Yao HT, Chen Z. Relationship Between Pepsin Expression and Dysplasia Grade in Patients With Vocal Cord Leukoplakia. Otolaryngol Head Neck Surg 2020; 164:160-165. [PMID: 32692278 DOI: 10.1177/0194599820938654] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To measure pepsin expression in patients with vocal fold leukoplakia and elucidate its clinical significance. STUDY DESIGN Retrospective analysis of pathologic archive specimens. SETTING Affiliated university hospital. SUBJECTS AND METHODS The study included 45 patients with vocal fold leukoplakia and 19 with vocal fold polyps who underwent surgical treatment between December 2013 and July 2016. Masses were detected on both vocal cords in 5 patients with vocal fold leukoplakia and in 1 patient with vocal fold polyps. Immunohistochemistry was used to assess pepsin expression. In addition, the relationship of pepsin expression level with clinical characteristics of vocal fold leukoplakia was assessed. RESULTS The rate of pepsin expression was high in the polyp group (75%) and the leukoplakia group (68%); however, the difference between groups was not significant (P > .05). Pepsin expression significantly increased according to grade of dysplasia (mild, 57.1%; moderate, 88.9%; severe, 100.0%; P = .034). Similarly, the percentage of lesions that exhibited strongly positive pepsin expression increased with the grade of dysplasia (mild, 37.1%; moderate, 66.7%; severe, 100.0%; P = .005). The leukoplakia recurrence rate was higher in patients with positive pepsin expression than in patients with negative pepsin expression but without a significant difference (P > .05). CONCLUSION Our study suggests that pepsin was associated with the grade of dysplasia of vocal cord leukoplakia. Further investigation with appropriate control groups and controlling for other risk factors, such as smoking or alcohol consumption, is needed.
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Affiliation(s)
- Ya-Lian Chen
- Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.,Department of Otolaryngology, The People's Hospital of Shengzhou City, Shengzhou, China
| | - Yang-Yang Bao
- Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Shui-Hong Zhou
- Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Hong-Tian Yao
- Department of Pathology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Zhe Chen
- Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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19
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Lin C, Zhang S, Lu L, Wang M, Qian X. Diagnostic Value and Pathological Correlation of Narrow Band Imaging Classification in Laryngeal Lesions. EAR, NOSE & THROAT JOURNAL 2020; 100:737-741. [PMID: 32383982 DOI: 10.1177/0145561320925327] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVES To explore the diagnostic value and pathological correlation of narrow band imaging (NBI) classification in laryngeal lesions. METHODS A total of 112 patients (123 lesions) with laryngeal lesions from July 2018 to May 2019 were selected in this study. All patients were examined by NBI and white light imaging endoscopy. The NBI endoscopy was applied to classify the observed lesion sites according to intraepithelial papillary capillary loop pattern. The gold standard of diagnosis was pathological results. To evaluate the consistency of NBI classification and pathological results. RESULTS The sensitivity, specificity, positive predictive value, and negative predictive value of the diagnosis for benign, precancerous, and malignant lesions under the NBI endoscopy were 90.91%, 81.19%, 74.07%, 85.42%; 41.67%, 92.93%, 58.82%, 86.79%; and 93.51%, 65.22%, 91.14%, 68.18%, respectively. There was a high consistency between NBI classification and pathological results (κ = 0.679, P < .001). CONCLUSIONS The NBI classification can improve the accuracy of the diagnosis of laryngeal lesions. It is important for early diagnosis and treatment of vocal cord leukoplakia and laryngeal cancer.
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Affiliation(s)
- Chuanyao Lin
- Department of Otolaryngology, Head and Neck Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Jiangsu Provincial Key Medical Discipline (Laboratory), Nanjing, The People's Republic of China.,Research Institute of Otolaryngology, Nanjing, The People's Republic of China
| | - Sisi Zhang
- Department of Otolaryngology, Head and Neck Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Jiangsu Provincial Key Medical Discipline (Laboratory), Nanjing, The People's Republic of China.,Research Institute of Otolaryngology, Nanjing, The People's Republic of China
| | - Ling Lu
- Department of Otolaryngology, Head and Neck Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Jiangsu Provincial Key Medical Discipline (Laboratory), Nanjing, The People's Republic of China.,Research Institute of Otolaryngology, Nanjing, The People's Republic of China
| | - Maohua Wang
- Department of Otolaryngology, Head and Neck Surgery, XiangYa School of Medicine, Central South University, Changsha, The People's Republic of China
| | - Xiaoyun Qian
- Department of Otolaryngology, Head and Neck Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Jiangsu Provincial Key Medical Discipline (Laboratory), Nanjing, The People's Republic of China.,Research Institute of Otolaryngology, Nanjing, The People's Republic of China
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Chen M, Fang Y, Cheng L, Wu H. Helicobacter pylori is associated with poor prognosis of laryngeal precancerous lesion. Auris Nasus Larynx 2019; 47:268-275. [PMID: 31443928 DOI: 10.1016/j.anl.2019.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 07/28/2019] [Accepted: 08/08/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Previous evidence suggested Helicobacter pylori (H. pylori) promoted tumorigenesis by inducing inflammation in gastric premalignant disease. Whether this organism affected the development of head and neck precancerous lesion remains unknown. We performed this study to assess the prognostic impact of H. pylori infection on patients with laryngeal precancerous lesion. METHODS In this prospective study, 41 enrolled patients with laryngeal precancerous lesion were arranged into H. pylori-positive group (n=16) and H. pylori-negative group (n=25). Two poor outcomes were recurrence and malignant transformation. Prognostic impact of H. pylori infection was analyzed using the Univariate Cox proportional hazard model and Cochran-Mantel-Haenszel test. We also analyzed the prognostic value of systemic inflammation-based markers. RESULTS During a median follow-up of 32.9 months, recurrence developed in 8 patients in the H. pylori positive group and 5 patients in the H. pylori negative group (50.0% vs. 20.0%, P=0.026, Log-rank test). Malignant transformation developed in 4 patients in the H. pylori positive group and no patients in the H. pylori negative group (25.0% vs. 0.0%, P=0.005, Log-rank test). H. pylori positive group had a significant higher malignant transformation rate after stratifying on the observed covariates. There was no significant difference of recurrence rate in two groups stratified with laryngopharyngeal reflux, size of lesion, and pathological type (Cochran-Mantel-Haenszel test). The basal levels of lymphocyte counts and neutrophils to lymphocytes ratio were significantly different in patients with H. pylori infection. Moreover, the receiver operating characteristic curve analysis revealed a predictive value of lymphocyte counts and neutrophils to lymphocytes ratio for poor outcomes (areas under the curve, 0.658 and 0.651, respectively). CONCLUSION The data demonstrate a malignant transformation-relevant role of H. pylori in laryngeal precancerous lesion. H. pylori infection combined with laryngopharyngeal reflux, size of lesion, and pathological type might relate to recurrence of laryngeal precancerous lesion. And changes of lymphocyte counts and neutrophils to lymphocytes ratio associated with H. pylori infection might deserve as predictive indicators for poor prognosis of laryngeal precancerous lesion.
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Affiliation(s)
- Min Chen
- Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital of Fudan University and Shanghai Key Clinical Disciplines of Otorhinolaryngology, 83 Fenyang Road, Shanghai, 200031 China
| | - Yi Fang
- Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital of Fudan University and 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 and 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 and Shanghai Key Clinical Disciplines of Otorhinolaryngology, 83 Fenyang Road, Shanghai, 200031 China.
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21
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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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22
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Gumussoy M, Kucuk U. Candidiasis Causing Vocal Fold Leukoplakia: Review of Clinical and Pathological Results of 289 Cases With Vocal Fold Leukoplakia. Ann Otol Rhinol Laryngol 2019; 128:903-910. [DOI: 10.1177/0003489419848792] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Objective: In laryngology practice, vocal fold leukoplakia is frequently evaluated by suspension laryngoscopy and biopsy examination upon the patient’s complaints of hoarseness and dysphonia. The purpose of the present study is to investigate and analyze risk factors, diagnosis, treatment, and follow-up results of cases with Candida leukoplakia. Study Design: Retrospective case control study. Setting: Tertiary medical center. Subjects and Methods: Patients with a diagnosis of vocal fold leukoplakia who underwent direct laryngoscopy and biopsy between 2007 and 2017 and diagnosed as candida or noncandida in their histopathology were assigned into 2 groups. Then they were compared in terms of their demographic characteristics, predisposing factors, diagnosis, treatment, and follow-up results. Results: Of the 289 vocal fold leukoplakia cases, 36 were candida, and 253 were noncandida. The mean age of the patients with Candida leukoplakia was 60.86 years. As for the age groups, the largest group (26.1%) was in the seventh decade ( P < .001). The use of inhaled corticosteroids was a significant risk factor ( P < .001). For their medical therapy, the patients were administered fluconazole 200 mg per day for 3 weeks, and the treatment yielded successful results in 91.66% of them. In 5 of the patients, candida leukoplakia and superficial epithelial dysplasia were observed, and no malignant transformation was observed during a mean follow-up of 28 ± 13 months. Conclusion: Candidiasis causing vocal fold leukoplakia is rare, and we report the findings of the largest published case series to date. Eliminating predisposing factors and administrating oral fluconazole 200 mg for 3 weeks are sufficient for medical treatment.
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Affiliation(s)
- Murat Gumussoy
- Department of Otolaringology Head and Neck Surgery, University of Health Sciences, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
| | - Ulku Kucuk
- Department of Pathology, University of Health Sciences, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
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23
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Flexible transnasal endoscopy with white light or narrow band imaging for the diagnosis of laryngeal malignancy: diagnostic value, observer variability and influence of previous laryngeal surgery. Eur Arch Otorhinolaryngol 2018; 276:459-466. [PMID: 30569190 PMCID: PMC6394425 DOI: 10.1007/s00405-018-5256-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 12/14/2018] [Indexed: 12/15/2022]
Abstract
Purpose Flexible transnasal endoscopy is a common examination technique for the evaluation of laryngeal lesions, while the use of narrow band imaging (NBI) has been reported to enhance the diagnostic value of white light endoscopy (WLE). The purpose of this study is to assess observer variability and diagnostic value of both modalities and investigate the possible influence of previous laryngeal surgery on the detection rates of laryngeal malignancy. Methods The study was based on the retrospective evaluation of 170 WLE and NBI images of laryngeal lesions by three observers in a random order. The histopathological diagnoses serve as the gold standard. Results In identifying laryngeal malignancy, the sensitivity of NBI proved to be higher than that of WLE (93.3% vs. 77.0%). NBI was also superior to WLE in terms of accuracy (96.3% vs. 92%) and diagnostic odds ratio (501.83 vs. 120.65). Both modalities had a specificity of 97.3%. The inter-observer agreement was substantial (kappa = 0.661) for WLE and almost perfect (kappa = 0.849) for NBI. Both WLE and NBI showed a high level of intra-observer agreement. The sensitivity was significantly lower in images with history of previous laryngeal surgery compared to those without. Conclusions Flexible transnasal endoscopy has been proved to be a valuable tool in the diagnosis of laryngeal malignancy. The use of NBI can increase the sensitivity and observer reliability in that context and can also provide a diagnostic gain in cases with previous laryngeal surgery
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Zhang C, Gong T, Wang J, Chou A, Jiang JJ. Topical Application of 5-Aminolevulinic Acid Is Sufficient for Photodynamic Therapy on Vocal Folds. Laryngoscope 2018; 129:E80-E86. [PMID: 30408178 DOI: 10.1002/lary.27437] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To evaluate the feasibility of topical photodynamic therapy (PDT) using 5-aminolevulinic acid (5-ALA) for vocal fold leukoplakia. STUDY DESIGN Ex vivo and in vivo. METHODS 5-ALA was applied topically as a 20% solution to ex vivo canine vocal folds. The penetration depth and concentrations of 5-ALA in tissue were quantified using frozen sectioning and fluorescamine derivatization after 5-ALA contact incubation or topical spraying. Then, 5-ALA solution was sprayed on leporine vocal folds once, twice, or given systemically in vivo. Protoporphyrin IX (PPIX) location was visualized using fluorescence microscopy, and PPIX concentrations were measured using a fluorescent quantitative method. Hematoxylin and eosin (H&E) staining was performed to visualize the histological changes of vocal folds after PDT for each group. RESULTS Topical incubation of 15 minutes with 5-ALA achieved a penetration depth of over 2 mm and similar concentrations within the superficial 500 μm of epithelium, compared with longer incubation times. Topical spraying of 5-ALA produced sufficient concentrations in vocal folds, but the retention time is short. An in vivo leporine model showed that laryngeal spraying of 20% 5-ALA induced similar penetration depth and concentrations of PPIX compared to systemic administration of 5-ALA. Two sprays of 20% 5-ALA solution with an interval of 30 minutes are needed to produce complete exfoliation of vocal fold epithelium. CONCLUSION Topical PDT with laryngeal spraying of 20% 5-ALA solution achieves sufficient therapeutic effects and is potentially applicable for the treatment of vocal fold leukoplakia. LEVEL OF EVIDENCE NA Laryngoscope, 129:E80-E86, 2019.
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Affiliation(s)
- Chi Zhang
- Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China
| | - Ting Gong
- Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China
| | - Jiajia Wang
- Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China
| | - Adriana Chou
- the Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, U.S.A
| | - Jack J Jiang
- Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China.,the Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, U.S.A
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Abstract
Dysphonia is altered voice quality, pitch, loudness, or vocal effort that impairs communication or decreases voice-related quality of life. Hoarseness is vocal roughness and a possible manifestation of dysphonia. This article uses the broader term dysphonia because it reflects of a wide range of voice complaints, with or without vocal roughness. Dysphonia is often caused by benign conditions but may also be the sentinel symptom of a serious or progressive condition requiring immediate diagnosis and management. The role of laryngeal visualization in assessment and diagnosis for these patients is critical.
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Affiliation(s)
- Sandra Stinnett
- The University of Tennessee Health Science Center, Department of Otolaryngology-Head and Neck Surgery, 910 Madison Avenue, Suite 408, Memphis, TN 38163, USA.
| | | | - Lee M Akst
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, 601 North Caroline Street, 6th Floor, Baltimore, MD 21287, USA
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Ni XG, Zhu JQ, Zhang QQ, Zhang BG, Wang GQ. Diagnosis of vocal cord leukoplakia: The role of a novel narrow band imaging endoscopic classification. Laryngoscope 2018; 129:429-434. [PMID: 30229933 DOI: 10.1002/lary.27346] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 05/22/2018] [Indexed: 01/11/2023]
Affiliation(s)
- Xiao-Guang Ni
- Department of Endoscopy; National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing China
| | - Ji-Qing Zhu
- Department of Endoscopy; National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing China
| | - Qing-Qing Zhang
- Department of Endoscopy; National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing China
| | - Bao-Gen Zhang
- Department of Endoscopy; National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing China
| | - Gui-Qi Wang
- Department of Endoscopy; National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing China
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Kostev K, Jacob LE, Kalder M, Sesterhenn AM, Seidel DU. Association of laryngeal cancer with vocal cord leukoplakia and associated risk factors in 1,184 patients diagnosed in otorhinolaryngology practices in Germany. Mol Clin Oncol 2018; 8:689-693. [PMID: 29725537 PMCID: PMC5920511 DOI: 10.3892/mco.2018.1592] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 03/20/2018] [Indexed: 11/06/2022] Open
Abstract
The aim of the present study was to analyze the association between laryngeal cancer and vocal cord leukoplakia in a large nationwide practice database. The study sample included 1,184 patients aged 18-90 years from 113 otorhinolaryngology practices in Germany who were diagnosed with vocal cord leukoplakia between 2007 and 2014. The rates of laryngeal cancer diagnosis within 5 years and the associated risk factors were analyzed. Within 6 months of initial diagnosis of vocal cord leukoplakia, 11% of the patients were diagnosed with laryngeal cancer. Between 7 months and 5 years after the diagnosis of leukoplakia, laryngeal cancer was diagnosed in 7.6% of the patients. Overall, within 5 years of leukoplakia diagnosis, 18.6% of the patients were diagnosed with laryngeal cancer (26.1% of men and 6.3% of women; P<0.001). Moreover, 31.3% of patients aged >65 years, 16.1% of patients aged 50-65 years and 7.6% of patients aged <50 years were diagnosed with laryngeal cancer (P<0.001). Patients aged >65 and those aged 50-65 years had a higher risk of being diagnosed with laryngeal cancer [odds ratio (OR)=4.90 and 2.55, respectively]. Furthermore, the risk of being diagnosed with laryngeal cancer was higher in men compared with that in women (OR=4.09). In the present real-world analysis, the rate of laryngeal cancer underlying vocal cord leukoplakia at first diagnosis appeared to be higher compared with the secondary malignant transformation rate occurring later during the course of the disease. Risk factors for laryngeal cancer included advanced age and male sex.
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Affiliation(s)
- Karel Kostev
- Department of Epidemiology, Quintiles IMS, D-60598 Frankfurt, Germany
| | | | - Matthias Kalder
- Department of Gynecology and Obstetrics, Philipps University of Marburg, D-35037 Marburg, Germany
| | - Andreas M. Sesterhenn
- Department of Otorhinolaryngology, Head and Neck Surgery, Solingen Municipal Hospital, D-42653 Solingen, Germany
| | - David Ulrich Seidel
- Department of Otorhinolaryngology, Head and Neck Surgery, Solingen Municipal Hospital, D-42653 Solingen, Germany
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