Laryngeal Mid-Cord Erythroleukoplakias: How to Modulate the Transoral CO2 Laser Excisional Biopsy

Cancers

Cesare Piazza¹  Filippo Carta²  Roberto Puxeddu²  Andrea Laborai³  Francesco Missale⁴  Francesco Mora⁴  Giampiero Parrinello⁴  Giorgio Peretti⁴ 

[1] Department of Otorhinolaryngology, Maxillofacial and Thyroid Surgery, Fondazione IRCCS, National Cancer Institute of Milan, 20133 Milan, Italy;Department of Otorhinolaryngology—Head and Neck Surgery, University of Cagliari, 09124 Cagliari, Italy;Department of Surgical Sciences and Integrated Diagnostics (DISC), Unit of Otorhinolaryngology, University of Genoa, 16132 Genoa, Italy;IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy;

关键词: laryngeal neoplasms;    narrow band imaging;    Storz professional image enhancement system;    stroboscopy;    saline infusion;    lasers;   

DOI  :  10.3390/cancers12082165

来源: DOAJ

【 摘 要 】

Background: The endoscopic appearance of glottic erythroleukoplakias is non-predictive of their histopathology, potentially ranging from keratosis to invasive squamous cell carcinoma (SCC). The aim of this study was to assess a comprehensive workup for the one-step diagnosis and treatment of mid-cord erythroleukoplakias, using CO₂ laser excisional biopsy. Methods: We evaluated 147 untreated patients affected by 155 mid-cord erythroleukoplakias submitted to excisional biopsy by subepithelial (Type I) or subligamental cordectomy (Type II), across two academic institutions. Patients were evaluated by preoperative videolaryngostroboscopy, pre- and intraoperative videoendoscopy with biologic endoscopy (narrow band imaging, NBI, or the Storz professional image enhancement system, SPIES), either with or without intraoperative saline infusion into the Reinke’s space. Adequacy of treatment was the primary outcome. Results: The histopathologic diagnosis was keratosis in 26 (17%) cases, squamous intraepithelial neoplasia (SIN1-2) in 47 (30%), carcinoma in situ in 21 (14%), and SCC in 61 (39%) patients. The adequacy of treatment across the entire cohort was 89%. The intraoperative saline infusion procedure, facing not clearly suspicious lesions, raised the adequacy of treatment from 60% to 90% (p = 0.006). Conclusions: Excisional biopsy by Type I–II cordectomies, after a comprehensive diagnostic workup, should be accepted as an adequate and cost-effective treatment of unilateral mid-cord glottic erythroleukoplakias.

【 授权许可】

Unknown