Histopathological variability and the prognosis of laryngeal premalignant lesions / 中华耳鼻咽喉头颈外科杂志

ABSTRACT

<p><b>OBJECTIVE</b>To investigate the histopathological subjective difference of laryngeal epitheliual premalignant lesions and to analyze the prognosis of every grade of laryngeal epitheliual premalignant lesion.</p><p><b>METHODS</b>According to 2005 WHO classification system, 237 cases of laryngeal epitheliual premalignant lesions were reviewd by 3 pathologists, meanwhile, the histopathological consistency among 3 pathologists was estimated with κ-statistics method. The Kaplan-Meier survival analysis were performed to assess the prognosis of every grade of laryngeal epitheliual premalignant lesion with follow-up data.</p><p><b>RESULTS</b>There was totally a moderate consistency among 3 pathologists (κ values: 0.598 9), the histopathological difference was mainly between mild dysplasia and moderate dysplasia and between severe dysplasia and carcinoma in situ. The follow-up duration was between 18-120 months, and the median follow-up duration was 38 months. The carcinoma trsnformation rate was 8.44% (20/237) with an average malignant transformation duration of (19.45 ± 7.32) months, which was increased with the degree of dysplasia(mild dysplasia:1.67%, moderate dysplasia:3.57%, severe dysplasia:10.60%, carcinoma in situ:18.18%), no difference could be found between mild and moderate dysplasia, between moderate and severe dysplasia; Moreover, there was no difference between severe dysplasia and carcinoma in situ (P > 0.05).</p><p><b>CONCLUSIONS</b>The histopathological variability brought the uncertainty for classification of laryngeal epitheliual premalignant lesions, which might have an impact on clinical management of laryngeal epitheliual premalignant lesions; there was obvious difference in carcinoma transformation between low-risk and high-risk laryngeal epitheliual premalignant lesions, and more attention on treatment and prognosis assessment should be paid for severe dysplasia as carcinoma in situ.</p>