Glottic Keratosis: Significance and Identification of Laryngoscopic Findings

Abstract

Objective Glottic keratosis poses a challenge because a decision to biopsy must weigh the likelihood of dysplasia and cancer against the voice outcome after biopsy. We determined the significance of laryngoscopic findings and agreement among clinicians to identify those specific findings. Study Design Retrospective case-control study. Setting Tertiary care university hospital. Methods Adults with glottic keratosis with preoperative office laryngoscopies were included. Preoperative videostroboscopies were reviewed by a blinded reviewer. Multivariable logistic regression was used to examine the correlation between laryngoscopic appearance of glottic keratosis and presence or absence of high-grade dysplasia or carcinoma on biopsies. Consensus among head and neck cancer surgeons to detect specific laryngoscopic findings was evaluated by presenting representative laryngoscopies to a blinded cohort. Interrater reliability was calculated using Fleiss’s κ. Results Sixty glottic keratotic lesions met inclusion criteria. On logistic regression, both erythroplakia and aberrant microvasculature like vascular speckling were significantly associated with high-grade dysplasia and carcinoma, P = .002 and P = .03, respectively. Interrater reliability among clinicians to identify erythroplakia and aberrant microvasculature was minimal, κ = 0.35 and κ = 0.29, respectively. Interrater reliability was improved with the use of virtual chromoendoscopy. Conclusion The presence of erythroplakia and aberrant microvasculature in glottic keratosis is associated with the presence of high-grade dysplasia or carcinoma. Virtual chromoendoscopy can be used to improve reliability for detecting erythroplakia and vascular speckling, and this is a potential area for practice-based learning. Clinicians should identify and consider immediate diagnostic biopsy of suspicious glottic keratosis.

Visual Gaze Patterns in the Analysis of Glottic Lesions: Does Experience Increase Diagnostic Accuracy?

“…13 Aberrant microvasculature and erythroplakia have been noted to have significant associations with dysplastic and malignant lesions; however, inter-rater reliability among clinicians to identify such changes was poor. 8 This contrasts to our study, which did not identify differences in the ability of participants to identify vascular abnormalities on flexible laryngoscopy. Interestingly, the overall sensitivity of vascular stippling (a form of vascular aberrancy) and the presence of dysplasia and malignancy was only 51%.…”

“…One would assume that diagnostic accuracy improves with training. However, a study by Anis et al 8 surveyed a group of head and neck surgeons and found poor inter-rater reliability in identifying features associated with carcinoma, such as erythroplakia and aberrant microvasculature. This emphasizes the importance of developing better training tools to prepare and educate the next generation of surgeons.…”

Updates on Larynx Cancer: Risk Factors and Oncogenesis

“…Laryngeal erythroplakia and leukoerythroplakia (leukoarythroplasia) represent red plaque lesions and white-with-red speckled plaque lesions secondary to increased hypervascularity and vascular dilation. Erythroplakia is considered the most important clinical predictor for either presence of malignancy or progression toward carcinoma [ 92 ]. It is also considered to carry dysplastic and malignant potential [ 93 ].…”

Videolaryngoendoscopic and Stroboscopic Evaluation in Predicting the Malignancy Risk of Vocal Fold Leukoplakia

“…One of the challenges in managing VFL is to determine the potential for malignant transformation of the benign and premalignant lesions, and thus to properly assess the need for surgical intervention. The histology and behavior of glottic keratosis can be frustratingly difficult to predict as lesions can present on a spectrum anywhere from completely benign growth to invasive malignancy [ 28 ]. Studies have reported that the clinical diagnosis of leukoplakia represents an approximately 6–7% chance of progressing into carcinoma [ 17 , 29 ].…”

“…Studies have reported that the clinical diagnosis of leukoplakia represents an approximately 6–7% chance of progressing into carcinoma [ 17 , 29 ]. A macroscopic appearance and its correlation with malignancy are of special interest to clinicians due to the potential for guiding decision-making at the time of the initial laryngoscopic examination [ 28 ]. However, even when a leukoplakia does not show a positive histopathological result for dysplasia, there is a 3.6–30% risk that it could develop into an invasive carcinoma [ 19 ].…”