Vocal fold composition and early glottic carcinoma infiltration

Abstract

BackgroundCurrent imaging techniques provide only limited information pertaining to the extent of infiltration of laryngeal carcinomas into vocal fold tissue layers. Therefore, it is needed to seek the contribute to the body of knowledge surrounding examination and characterization in laryngeal carcinoma infiltration.MethodsExcised larynges were collected from 30 male laryngectomy patients with an average age of 43.5 years (ranging 36 to 55 years) and history of smoking (≥10 years) exhibiting T1, T2, or subglottal (normal vocal fold) carcinomas. Vocal folds were preserved via freezing or immersion in paraffin. The depth of the mucosa, submucosa, and muscular layers in both normal vocal folds and tumor tissues of afflicted vocal folds was measured.ResultsThe average depths of the mucosa, submucosa, and muscular layers in normal vocal folds were 0.15 ± 0.06 mm, 2.30 ± 0.59 mm, and 2.87 ± 0.88 mm, respectively. Infiltration measurements of T1 tumors showed a depth of 1.62 ± 0.51 mm and 1.32 ± 0.49 mm in frozen sections and paraffin-embedded samples, respectively. Similarly, T2 tumors showed a depth of 2.87 ± 0.68 mm and 2.58 ± 0.67 mm in frozen sections and paraffin-embedded samples, respectively. T1 and T2 tumors occupied 24.8 ± 10 and 48.5 ± 15 percent of the normal vocal fold depth, respectively.ConclusionThis data provides a baseline for estimating infiltration of laryngeal carcinomas in vocal fold tissue layers, of particular interest to surgeons. This information may be used to assess typical depths of infiltration, thus allowing for more appropriate selection of surgical procedures based on individual patient assessment.

Oncologic outcomes of patients with positive margins after laser cordectomy for T1 and T2 glottic squamous cell carcinoma

“…20,25 A published microscopic analysis of vocal fold infiltration showed a tumoral depth measurement between 1.62 mm and 2.87 mm in frozen sections of 30 patients with T1 and T2 glottic cancer. 6 The average depth to the muscular layer in normal vocal cords was 2.45 mm. These findings regarding the extent of tumor infiltration in the muscular layer provide suggestions for initial inadequate excision in our study, as too close margins could be insufficient to anticipate the breach of the vocal muscle.…”

“…In the literature, 2‐mm margins are often considered to be sufficient for resection of early glottic cancer . A published microscopic analysis of vocal fold infiltration showed a tumoral depth measurement between 1.62 mm and 2.87 mm in frozen sections of 30 patients with T1 and T2 glottic cancer . The average depth to the muscular layer in normal vocal cords was 2.45 mm.…”

“…The extent of tissue removal is a major issue as underestimation of the disease because of limited visualization or inadequate exposure of the lesion may lead to treatment failure . Previous studies have shown that anterior commissure involvement or paraglottic space infiltration through the vocal muscle are challenging . Meanwhile, there is no consensus regarding how wide the clean tissue should be.…”

“…5 Previous studies have shown that anterior commissure involvement or paraglottic space infiltration through the vocal muscle are challenging. 2,6,7 Meanwhile, there is no consensus regarding how wide the clean tissue should be. Surgical margins are also a major concern, but results are discordant.…”