Phonosurgical resection using submucosal infusion technique for precancerous laryngeal leukoplakia

Kono, Takeyuki; Saito, Koichiro; Yabe, Hiroshi; Ogawa, Kaoru

doi:10.1002/lary.26028

Cited by 10 publications

(8 citation statements)

References 22 publications

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“…Therefore, it requires more careful observation or even more aggressive treatment. On the other hand, Kono et al recommended phonomicrosurgical resection via the submucosal infusion technique as a good method of treatment in patients with vocal fold leukoplakia [18]. According to our experience, the NBI vessel pattern and categorisation of NBI image to “normal” and “suspicious” have the potential to guide the depth of incision in vocal fold leukoplakia.…”

Section: Discussionmentioning

confidence: 86%

Narrow-band imaging (NBI) for improving the assessment of vocal fold leukoplakia and overcoming the umbrella effect

et al. 2017

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BackgroundIt is crucial to find a balance between functional and oncological outcome when choosing an adequate method for the management of vocal fold leukoplakia. Therefore, a detailed examination is a milestone in the decision-making process.AimTo examine whether narrow-band imaging (NBI) can be helpful in vocal fold assessment in the case of leukoplakia and how to overcome the “umbrella effect”- understood as the submucosal vascular pattern hidden under the plaque.Material and methodsProspective cohort of 41 consecutive patients. Inclusion criteria: vocal fold leukoplakia, no previous procedures (surgery, radiotherapy), and preoperative endoscopy with an optical filter for NBI. Two groups: “suspicious” and “normal”, according to the submucosal microvascular pattern of peripheral regions of the mucosa surrounding the plaque, were distinguished. Patients were qualified for a full-thickness or partial-thickness biopsy, respectively. Criteria defining suspected characters were well-demarcated brownish areas with scattered brown spots corresponding to type IV, Va, Vb, and Vc NI classifications.ResultsIn 22/41 (53.7%) patients with “suspected” microvascular pattern, full-thickness biopsy was performed. Moderate and severe dysplasia was revealed in 15 type IV and 7 type Va NI patients. In 19/41 (46.3%) patients with proper NBI vessel pattern treated by partial-thickness biopsy, hyperkeratosis was diagnosed. There was a strong correlation between the NBI pattern and final histology: Chi2 (2) = 41.0 (p = 0.0000).ConclusionThe results demonstrate that NBI endoscopic assessment of the submucosal microvascular pattern of mucosa surrounding the plaque can be an effective method to categorise the risk in vocal fold leukoplakia prior to treatment.

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Section: Discussionmentioning

confidence: 86%

Narrow-band imaging (NBI) for improving the assessment of vocal fold leukoplakia and overcoming the umbrella effect

et al. 2017

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“…Even though a vast number of publications have confirmed noninvasive biological endoscopy, such as narrow-band imaging (NBI) and Storz SPIES [ 30 , 35 , 36 , 37 ], to have great accuracy when predicting the final histopathology results for glottic lesions, a gold-standard policy for the management and follow-up of precancerous laryngeal lesions has not yet been defined [ 38 ]. The NBI technique, for instance, has always, with few exceptions, been assessed alongside VLE [ 39 ].…”

Section: Discussionmentioning

confidence: 99%

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

Leduchowska

Morawska

Pietruszewska

2022

JCM

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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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Section: Discussionmentioning

confidence: 99%

“…In the past, premalignant glottic lesions were removed with the use of a stripping procedure that lacked oncological radicality and had a higher risk of leaving part of the initial lesion. 11 This would require an additional procedure to achieve the complete excision; this is particularly true in the case of an invasive cancer. The introduction of phonomicrosurgery, with the use of submucosal injection, might help surgeons better determine the nature of lesions (ie, premalignant lesion or infiltrative cancer) based on the ease with which a tissue can be lifted by mucoligamentous hydrodissection.…”

Section: Discussionmentioning

confidence: 99%

Phonosurgical Resection Using Submucosal Infusion Technique for Early Glottic Lesions: Diagnostic and Therapeutic Procedure?

Lazio

Vallin

Giannini

et al. 2018

Ann Otol Rhinol Laryngol

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Objectives: The aim of this study was to assess the feasibility of the submucosal infusion combined with microflap dissection via laser CO2 as both a diagnostic and therapeutic procedure for superficial glottic lesions. To define a safe surgical procedure in terms of local control, a morphometric study of surgical margins was performed. Methods: From January 2011 to January 2016, we treated 122 patients with early glottic lesions with phonomicrosurgery. Patients with effective hydrodissection underwent a microflap and type I-II diagnostic cordectomy. In the others, a biopsy was carried out, and in the case of a malignant lesion, a type III to VI cordectomy was performed. Disease-free survival (DFS) for all the lesions was also determined according to comparative assessments of surgical margins. The Voice Handicap Index was used to evaluate functional outcomes. Results: In 27 cases (32%), hydrodissection was effective; specifically, 24 (88.8%) were premalignant lesions, and 3 (11.2%) had a carcinoma. In 56 patients (68%), hydrodissection was not adequate, and a biopsy was performed: 9 (16%) were premalignant and 47 (84%) malignant lesions. The DFS analysis suggests that margins >0.7 mm resulted in a cutoff that can guarantee a safe procedure in the case of effective hydrodissection ( P < .05). Conclusion: Phonomicrosurgery may be both a diagnostic and therapeutic option with oncological efficacy for superficial glottic lesions of undetermined nature when surgical margins exceed 0.7 mm. In case of inadequate hydrodissection, the hypothesis of an infiltrative carcinoma warrants a wider cordectomy.

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Phonosurgical resection using submucosal infusion technique for precancerous laryngeal leukoplakia

Abstract: NA Laryngoscope, 127:153-158, 2017.

Cited by 10 publications

References 22 publications

Narrow-band imaging (NBI) for improving the assessment of vocal fold leukoplakia and overcoming the umbrella effect

Narrow-band imaging (NBI) for improving the assessment of vocal fold leukoplakia and overcoming the umbrella effect

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

Phonosurgical Resection Using Submucosal Infusion Technique for Early Glottic Lesions: Diagnostic and Therapeutic Procedure?

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