Überlegungen und Untersuchungen zur Klassifikation glottischer Karzinome*

Abstract

Since 1972, the principles of the T classification of glottic carcinomas have remained unchanged. Nevertheless, discrepancies between T-classification and post-therapeutic pT classification are reported repeatedly and doubts have been expressed about the reliability of this system. Our T classification is based on pathohistological investigations performed 20 years ago. Therefore, the origin of the above-mentioned discrepancies must be sought in the definition and the clinical diagnostics. First, problems of the T classification of glottic cancer are analyzed and discussed on the basis of conditions which must be fulfilled by each classification: (1) clearly defined boundaries of the anatomical regions; (2) clearly defined rules for classification; (3) practicability for the clinician as well for the pathologist and comparability for both, and (4) prognostic relevance. Second, a new definition of the glottic region is proposed. It should be confined to the extension of the vocal ligaments, their anterior commissure and the medial surface of the arytenoid cartilages, including Reinke's space and the epithelial layer covering all the described areas. This is because the glottic region is confined to anatomical areas with reduced lymphatic drainage and a connective tissue barrier. The proposal is based on an anatomical and morphometric investigation of 154 larynx specimens. Third, 403 glottic carcinomas, treated between 1970 and 1984 were classified by the current T classification and histologically by pT classification (UICC 1987). By comparing these two classifications it was established that the early carcinomas had been overestimated and the advanced carcinomas underestimated.(ABSTRACT TRUNCATED AT 250 WORDS)

Carcinoma of the Anterior Commissure of the Larynx: II. Proposal of a New Staging System

“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] The absence of a universally accepted anatomic and clinical definition of the AC region and the lack of consideration of AC involvement in the principal T stages by the current T classifications of glottic cancer (AJC,21 UICC22) add much to the problem. Since a careful analysis of the human larynx during development allowed us to identify the AC subsite with better detail than previously known, as shown in part I of this paper, 23 we have tried to transfer the results of that study to clinical medicine, as follows.…”

Revision of classification of laryngeal cancer, is it long overdue?

“…The T 4 category includes vocal fold tumours extending to the trachea, to the hypopharynx, the oropharynx, the soft tissues of the neck and all tumours penetrating the outer perichondrium of the laryngeal cartilages or the thy- rohyoid or cricothyroid membranes (Harrison, 1984;Meyer-Breiting and Burkhardt, 1988;Meyer-Breiting, 1990). However infiltration of the pre-epiglottic and paraglottic spaces as far as the thyrohyoid ligament is not to be regarded as 'extralaryngeal' extension.…”

“…Unfortunately the TNM classification for laryngeal carcinoma has undergone little change since the time of Denoix. It still contains the many 'intrinsic weaknesses' already deplored by Sir Donald Harrison in his Semon Lecture in 1974-as well as some other flaws (Atkinson and Bridger, 1976;Sessions and Ogura, 1976;Shepherd, 1976;Kleinsasser, 1983Kleinsasser, , 1986Kleinsasser, , 1988Glanz, 1984Glanz, , 1986Richard, 1985;Meyer-Breiting and Burkhardt, 1988;Meyer-Breiting, 1990).…”

“…Histological examination of the surgical specimens has shown that despite of a careful pre-operative diagnosis 10 to 20 per cent of small vocal fold carcinomas are overestimated, whereas 30 to 50 per cent of larger carcinomas in the categories T 2 to T 4 are underestimated (Glanz, 1985(Glanz, , 1989Meyer-Breiting, 1990). These failures in TNM classification are less often the result of unsatisfactory pre-therapeutic diagnostic procedures than the result of basic mistakes inherent in the UICC classification system.…”