Correlating intraepithelial papillary capillary loops of vocal cord leukoplakia with histopathology.

BACKGROUND: The pathology of vocal fold leukoplakia (VFL) was hard to predict before surgery. OBJECTIVES: To investigate the correlation of intraepithelial papillary capillary loops (IPCLs) with the malignant transformation in VFL. MATERIALS AND METHODS: The IPCLs in 90 patients were classified according to 2019 Ni classification. Type I-III represented to non- to moderate dysplasia in pathology being viewed as 'benign leukoplasia', type IV-VI represented to severe dysplasia/cancer in situ, cancerization being viewed as 'malignant leukoplasia'. The corresponding relationship of IPCLs with pathology was calculated. RESULTS: Forty-one cases were classified as type I-III, the consistency of type I-III with pathology was 61.0%, with 100.0% of type I, 47.1% of type II and 30.0% of type III. 49 cases were classified as type IV-VI, all were 'malignant leukoplasia', the consistency of type IV-VI and pathology was 100.0%. The accuracy of type I-III, IV-VI to predict pathology were 61.0, 100.0%. The sensitivity, specificity, accuracy, positive predictive value, negative predictive value of Ni classification corresponding to 'benign/malignant leukoplasia' was 75.8, 100.0, 82.2, 100.0, 60.0%, respectively. CONCLUSIONS AND SIGNIFICANCE: IPCLs of type IV-VI in vocal cord leukoplasia had a close correlation with pathology. The degree of dysplasia was underestimated in type II and type III.

Clinical utility and effectiveness of a training programme in the application of a new classification of narrow-band imaging for vocal cord leukoplakia: A multicentre study.

OBJECTIVE: To analyse the application of a new narrow-band imaging (NBI) classification in the diagnosis of vocal cord leukoplakia by laryngologists with different levels of laryngoscopic experience and to explore the impact of NBI training programmes on laryngologists' identification of benign and malignant leukoplakia. DESIGN: Prospective multicentre study. SETTING: Tertiary hospitals. PARTICIPANTS: Sixteen laryngologists were divided into less-experienced and experienced groups and received NBI training course. Thirty cases of vocal cord leukoplakia were investigated. MAIN OUTCOME MEASURES: Diagnostic accuracy and interobserver agreement under white light imaging (WLI), before and after NBI training, were analysed among doctors with varying levels of experience. RESULTS: The accuracy in the less-experienced group was significantly lower than that of experience group (0.59 vs 0.69) under WLI. There was no significant difference in the diagnostic accuracy between the less-experienced group and the experienced group before NBI training (0.75 vs 0.74) and after NBI training (0.79 vs 0.83). NBI training could improve the interobserver agreement from fair or moderate to good agreement. CONCLUSION: The new NBI diagnostic classification is helpful for identifying benign and malignant vocal cord leukoplakia. In addition, the NBI training programme can improve the diagnostic accuracy and interobserver agreement of less-experienced doctors to the level of experienced laryngologists.

[Research status and challenges of vocal cord leukoplakia].

Vocal cord leukoplakia is a clinical diagnosis defined as a whitish patch or a plaque on a mucosal surface. Because of the diversity of histopathological types, the complexity and unpredictability risks for malignant transformation, there are still many controversies about its histopathological classification, diagnosis and treatment. The aim of this article is to review the epidemiology, etiology, pathological classification, diagnosis, treatment and prognosis of vocal cord leukoplakia.

A new classification of vocal fold leukoplakia by morphological appearance guiding the treatment.

OBJECTIVE: To provide a reference for classification and treatment of vocal cords leukoplakia. METHODS: 640 cases of patients with vocal cords leukoplakia were divided into three groups based on the appearances. There were respectively 81 smooth flat lesions, 155 smooth hypertrophy lesions and 13 rough lesions were treated with conservative methods and 26, 153 and 212 cases were resected surgically for biopsy. RESULTS: A majority of smooth flat leukoplakia lesions were cured by non-operational methods and no atypical hyperplasia. Most of rough lesions were invalid and even progressed treated with conservative therapy and were severe dysplasia or canceration. Although 67.6% smooth hypertrophy lesions were cured or improved by conservative methods and 47% lesions had no or mild dysplasia, over 30% of lesions were still invalid or progressed and over 50% had moderate, severe dysplasia and canceration. By statistical analysis, the appearance of leukoplakia was concordant with pathological changes. CONCLUSIONS: It is suggested that smooth flat vocal cords leukoplakia could be treated with conservative methods and rough lesions should be resected operationally, while for smooth hypertrophy vocal cords leukoplakia could be first followed-up and then adopt measures based on the appearance changes.

Classification of vocal fold leukoplakia by clinical scoring.

BACKGROUND: Vocal cord leukoplakia comprises a variety of lesions. The purpose of this study was to stratify vocal leukoplakias before surgery. METHODS: Patients with an initial diagnosis of vocal leukoplakia who underwent surgical excision at a tertiary referral center in Taiwan were recruited for this study. Their clinical records, including age, sex, preoperative laryngoscopic images in the office setting, and final pathology reports were collected and analyzed. RESULTS: Patient age (p = .010), nonhomogenous lesion texture (p = .001), and existence of hyperemia (p = .014) were identified as independent factors predicting malignancy. A predictive formula was established accordingly. The model showed an excellent discrimination role by receiver operating characteristic curve analysis (area under the curve = 0.86; p < .001). CONCLUSION: This study confirmed the value of a scoring system based on laryngoscopic characteristics and patient age for predicting the histologic results in vocal leukoplakia. It is helpful for classifying vocal leukoplakia and pretreatment planning. © 2016 Wiley Periodicals, Inc. Head Neck 38: E1998-E2003, 2016.

Leucoplasia verrucosa proliferativa e carcinoma verrucoso: semelhanças e diferenças histopatológicas e de proliferação celular por Ki67 / Proliferative verrucous leukoplakia and verrucous carcinoma: histopathological similarities and differences and cell proliferation by Ki67

Carcinoma verrucoso e leucoplasia verrucosa proliferativa, estão entre as lesões que apresentam difícil diagnóstico diferencial devido às semelhanças histopatológicas que ocorrem em determinada fase de evolução. Existe, para tanto, a necessidade de somar dados clínico-epidemiológicos ao histopatológico a fim de se estabelecer o diagnóstico final. A leucoplasia verrucosa proliferativa caracteriza-se por seu acometimento multifocal, grande potencial de recidiva e perfil progressivo que resulta em alto risco de transformação maligna. Por outro lado, o carcinoma verrucoso, variante de baixo grau do carcinoma epidermoide, é unifocal e dificilmente recidiva. A importância de novos estudos acerca das suas duas lesões mencionadas vem a agregar conhecimento de modo a facilitar um correto diagnóstico e, consequentemente, um apurado prognóstico. A leucoplasia verrucosa proliferativa, por se tratar de lesão com alto potencial de transformação maligna, pode evoluir para carcinoma epidermoide invasivo, menos diferenciado e mais agressivo com consequente prognostico obscuro, ao passo que, o carcinoma verrucoso não incorre em metástases e apresenta um prognóstico mais favorável. Isso posto, com o objetivo de aumentar a precisão diagnóstica, o presente trabalho propôs identificar e quantificar em porcentagem os critérios histopatológicos encontrados na leucoplasia verrucosa proliferativa e no carcinoma verrucoso visando diferenciar morfologicamente as lesões dos dois grupos.

Também buscamos comparar os dados epidemiológicos referentes aos casos inseridos no estudo, dentre eles vinte e dois casos de leucoplasia verrucosa proliferativa, dezoito casos de carcinoma verrucoso e dois casos apresentando tanto leucoplasia verrucosa proliferativa quanto carcinoma verrucoso, casos esses com diagnósticos estabelecidos previamente (baseando-se nos dados epidemiológicos somados ao histopatológico). A utilização de um marcador imuno-histoquímico da atividade proliferativa celular, o Ki67, também permitiu uma análise comparativa entre o comportamento biológico de ambas as lesões através de um ensaio quantitativo e qualitativo. A marcação mostrou-se escassa, mas evidente em células mitóticas da leucoplasia verrucosa proliferativa, mostrando, no entanto, maior número de células positivas no carcinoma verrucoso, estas visíveis nas camadas basal e parabasal. Os resultados do presente trabalho permitiram concluir então que o marcador Ki67 pode auxiliar no diagnóstico diferencial entre leucoplasia verrucosa proliferativa e carcinoma verrucoso. Foi possível depreender também que, histologicamente, o carcinoma verrucoso apresenta maior alteração em sua conformação epitelial, bem como maior número de atipias cito-arquiteturais quando comparado à leucoplasia verrucosa proliferativa, que, apesar de seu aspecto morfológico, evolui no sentido de uma potencial transformação maligna, apresentando, por sua vez, maior freqüência de projeções em gota.

Verrucous carcinoma and proliferative verrucous leukoplakia, are among the injuries presenting difficult differential diagnosis due to histopathological similarities that occur at some stage of evolution. There is a need to add clinical, epidemiological and histopathological data to achieve the final diagnosis. Proliferative verrucous leukoplakia is characterized by its multifocal involvement, great potential for relapse and progressive profile that results in malignant transformation high risk. On the other hand, the verrucous carcinoma, which is considered low-grade variant of squamous cell carcinoma, is unifocal and unlikely to return. The importance of new studies on its two mentioned lesions is to generate knowledge aiming at a correct diagnosis and prognosis. The proliferative verrucous leukoplakia, since it is a lesion with high potential for malignant transformation, can develop into less differentiated and more aggressive invasive squamous cell carcinoma with subsequent poor prognosis, whereas the verrucous carcinoma incurs no metastases and presents a more favorable prognosis. Thus, aimed to increase the diagnostic accuracy, the present work looked for to identify and quantify in percentage the histopathological criteria found on proliferative verrucous leukoplakia and verrucous carcinoma, aiming morphologically differentiate the lesions from both groups.

We also seek to compare the epidemiological data related to cases included in the study, including twenty-two cases of proliferative verrucous leukoplakia, eighteen cases of verrucous carcinoma and two cases showing both proliferative verrucous leukoplakia as verrucous carcinoma, cases with these diagnoses established previously (based on epidemiological data added to histopathology data). Using a cell proliferation immunohistochemical marker, Ki67, we made a comparative analysis between the biological behavior of both lesions by quantitative and qualitative assay. We saw a few strongly positive mitotic cells in samples of proliferative verrucous leukoplakia, and numerous positive cells observed in the basal and parabasal layers of verrucous carcinoma samples. This study results indicate, then, that the Ki67 marker may help in the differential diagnosis between proliferative verrucous leukoplakia and verrucous carcinoma. It was also possible to conclude that, histologically, the verrucous carcinoma shows greater change in its epithelial conformation and a higher number of cyto-architectural atypia when compared to proliferative verrucous leukoplakia, which, despite its morphological appearance, evolves towards a potential malignant transformation, presenting, in turn, higher drop-shaped rete ridges frequency.

Clinical classification and treatment of leukokeratosis of the vocal cords.

BACKGROUND: Leukokeratosis of the vocal cords is a clinical descriptive diagnosis, which includes a group of squamous intraepithelial lesions of the vocal cord mucosa. We investigated the clinical classification and treatment efficacy of leukokeratosis of the vocal cords. METHODS: We conducted a retrospective analysis of the medical history, laryngoscopic examinations, morphological features under a surgical microscope, and pathology results of 360 cases of leukokeratosis of the vocal cords to examine correlations among treatment modalities, therapeutic effects, and clinical features. RESULTS: All cases were divided into four types based on symptoms, examination results, and treatment efficacies as follows: 21 patients had type I inflammatory leukoplakia and their vocal cord morphology and voice quality recovered after conservative therapies; 76 patients had type II frictional polyps and received CO2 laser submucosal cordectomy; 68 patients had type III sulcus vocalis and received mucosal slicing with dredging; and 195 cases had type IV simple leukokeratosis and received partial subligamental cordectomy with CO2 lasers or transmuscular cordectomy. Our treatment achieved a surgical cure rate of 90.9% (308/339), with a recurrence rate of 9.1% (31/339) and malignant transformation rate of 6.5% (22/339). All cancerous transformations occurred in type IV patients. CONCLUSION: Choosing conservative or CO2 laser surgery based on the morphological characteristics of squamous epithelial lesions of keratinized vocal cord mucosa can maximally protect voice quality, reduce complications, and improve the cure rate.

[Clinical classification and management of squamous intraepithelial lesions of the vocal cord].

OBJECTIVE: To discuss the clinical classification of the squamous intraepithelial lesions (SILs) of vocal cord and their outcomes after different therapeutic procedures. METHODS: Three hundred and forty-three patients with the SILs of vocal cord were enrolled. Based on the history of the diseases, macroscopic appearance by video rhino aryngoscopic, stroboscopic and microlaryngoscopic examination, and pathological findings, the correlation of clinical features, treatment modalities and treatment effect of the vocal cord SILs were discussed. RESULTS: According to the morphological characteristics, 343 patients were divided into four types. TypeI, leukoplakia combined with inflammation (n = 19); type II, leukoplakia combined with polyps by friction (n = 72); type III, leukoplakia combined with sulcus vocalis (n = 64); type IV, keratosis (n = 188). Patients with type I lesions were treated by medications. The vocal cord configuration and the voice of the patients in type I returned to normal after treatment. Patients with type II, III, IV lesions were treated by CO(2) laser. Type II were treated by subepithelial cordectomy, type III by mucosa slicing with dredging, type IV by sub ligament cordectomy or trans muscular cordectomy. The cure rate of patients with type II, III, IV lesions was 90.7% (294/324) after single surgery, the recurrent rate was 9.3% (30/324). Twenty-one patients (11.2%), all in type IV, developed carcinogenesis. Eight cases were diagnosed in the first surgery and 13 cases in the second. Among the 13 cases diagnosed in the second surgery, 2 cases had partial laryngectomy for the third surgery. CONCLUSIONS: Since the squamous intraepithelial lesions of vocal cord manifested differently, conservative treatment or CO(2) laser surgery should be used. In this way, a less invasive procedure, better recovery of the voice and less complication could be expected.

[Peculiarities of protein Ki-67 expression in cases of leukoplakia and epidermoid cancer of oral mucous membrane].

There were presented results of the study directed to disclosure of malignant cell changes criterion in cases of oral mucous membrane leukoplakia with different degrees of neoplastic transformation according to WHO-2005 classification of squamous intraepithelial neoplasia (SIN). With the help of immunohistochemical method proliferation in different layers of oral mucous membrane epithelium was evaluated. It was established that most important for diagnostics was the correspondence of proliferating cells in parabasal and basal epithelium layers. Figure less than 1 was corresponding to normal epithelium and SIN1, between 1 and 2 was corresponding to SIN2, 2 and more was characteristic itoSIN3.

[Laryngeal leukoplakias (author's transl)]. / Leukoplakien des Kehlkopfes. Histologisch-zytologische Klassifizierung.

A histologic and cytologic classification of laryngeal dysplastic leukoplakias is described. The basic knowledge has been gained by the experience in the diagnosis of portio-carcinoma. Histologic and cytologic illustrations of different dysplastic stages are shown. The final classification including the clinical description is achieved by cytology and histology.