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Value of pre- and intraoperative diagnostic methods in suspected glottic neoplasia

  • Laryngology
  • Published:
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A Correction to this article was published on 06 May 2020

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Purpose

Abstract

To evaluate the individual and combined ability of videostroboscopy (VS), high-speed digital imaging (HSDI), enhanced endoscopy (EE) and saline infusion (SI) to predict neoplasia, defined as glottic precursor lesion (GPL) or T1a glottic cancer, in patients suspected for glottic neoplasia.

Methods

A nationwide prospective cohort study of patients treated by cordectomy for suspected GPL or T1a glottic cancer from August 1st 2016 to October 31st 2018 was conducted in the five Danish University Departments of Head and Neck surgery. Sensitivity, specificity, negative and positive predictive values, and area under Receiver Operating Curves (AUC-ROC) were calculated with 95% confidence intervals with respect to the histological diagnosis. Logistic regression with an imputation model for missing data was applied.

Results

261 patients aged 34–91 years participated; 79 (30.3%) with non-neoplasia (i.e., inflammation, papilloma, hyperkeratosis) and 182 (69.7%) neoplasia, hereof 95 (36.4%) with GPL and 87 (33.3%) with T1a glottic cancer. Data from 188 VS, 60 HSDI, 100 preoperative EE, 209 intraoperative EE, and 234 SI were analyzed. In the complete case analysis the AUC-ROC of each diagnostic test was low, but increased when the tests were combined and especially if the combination included EE. However, multinomial logistic regression with imputation showed significant association (p < 0.05) only between age, male gender, and perpendicular vasculature in intraoperative EE, and the endpoint neoplasia.

Conclusions

Intraoperative EE was the most accurate diagnostic method in detecting neoplasia. The prediction ability of methods applied preoperatively was more limited, but improved when test modalities were combined.

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Change history

  • 06 May 2020

    Would like to draw attention to two unfortunate errors that occurred in the paper.

References

  1. Colden D, Zeitels SM, Hillman RE, Jarboe J, Bunting G, Spanou K (2001) Stroboscopic assessment of vocal fold keratosis and glottic cancer. Ann Otol Rhinol Laryngol 110(4):293–298

    Article  CAS  Google Scholar 

  2. Weller MD, Nankivell PC, McConkey C, Paleri V, Mehanna HM (2010) The risk and interval to malignancy of patients with laryngeal dysplasia; a systematic review of case series and meta-analysis. Clin Otolaryngol 35(5):364–372. https://doi.org/10.1111/j.1749-4486.2010.02181.x

    Article  CAS  PubMed  Google Scholar 

  3. Caffier PP, Schmidt B, Gross M, Karnetzky K, Nawka T, Rotter A, Seipelt M, Sedlmaier B (2013) A comparison of white light laryngostroboscopy versus autofluorescence endoscopy in the evaluation of vocal fold pathology. Laryngoscope 123(7):1729–1734. https://doi.org/10.1002/lary.23931

    Article  PubMed  Google Scholar 

  4. Trolle W, Tvedskov JF, Charabi B, Schytte S, Kjaergaard T, Ulhøj BP, Lyhne NM, Lambertsen K, Groentved AM, Mehlum CS, Schultz JH, Overgaard J, Godballe C (2019) Guidelines for management of laryngeal intraepithelial neoplasia (LIN) and T1A-glottic cancer. The Danish Head and Neck Cancer Group (DAHANCA). https://dahanca.dk/assets/files/Pro_VejledningDahanca27.pdf. Accessed 11 June 2019

  5. Peretti G, Piazza C, Berlucchi M, Cappiello J, Giudice M, Nicolai P (2003) Pre- and intraoperative assessment of mid-cord erythroleukoplakias: a prospective study on 52 patients. Eur Arch Oto-rhino-laryngol 260(10):525–528. https://doi.org/10.1007/s00405-003-0584-0

    Article  Google Scholar 

  6. Garofolo S, Piazza C, Del Bon F, Mangili S, Guastini L, Mora F, Nicolai P, Peretti G (2015) Intraoperative narrow band imaging better delineates superficial resection margins during transoral laser microsurgery for early glottic cancer. Ann Otol Rhinol Laryngol 124(4):294–298. https://doi.org/10.1177/0003489414556082

    Article  PubMed  Google Scholar 

  7. Shoffel-Havakuk H, Lahav Y, Meidan B, Haimovich Y, Warman M, Hain M, Hamzany Y, Brodsky A, Landau-Zemer T, Halperin D (2017) Does narrow band imaging improve preoperative detection of glottic malignancy? A matched comparison study. Laryngoscope 127(4):894–899. https://doi.org/10.1002/lary.26263

    Article  PubMed  Google Scholar 

  8. Hirano M, Yoshida Y, Yoshida T, Tateishi O (1985) Strobofiberscopic video recording of vocal fold vibration. Ann Otol Rhinol Laryngol 94(6 Pt 1):588–590

    Article  CAS  Google Scholar 

  9. Patel R, Dailey S, Bless D (2008) Comparison of high-speed digital imaging with stroboscopy for laryngeal imaging of glottal disorders. Ann Otol Rhinol Laryngol 117(6):413–424. https://doi.org/10.1177/000348940811700603

    Article  PubMed  Google Scholar 

  10. Djukic V, Milovanovic J, Jotic AD, Vukasinovic M (2014) Stroboscopy in detection of laryngeal dysplasia effectiveness and limitations. J Voice 28(2):262.e213–262.e221. https://doi.org/10.1016/j.jvoice.2013.07.006

    Article  Google Scholar 

  11. van Balkum M, Buijs B, Donselaar EJ, Erkelens DC, Goulin Lippi Fernandes E, Wegner I, Grolman W, Janssen LM (2017) Systematic review of the diagnostic value of laryngeal stroboscopy in excluding early glottic carcinoma. Clin Otolaryngol 42(1):123–130. https://doi.org/10.1111/coa.12678

    Article  PubMed  Google Scholar 

  12. Bonilha HS, Desjardins M, Garand KL, Martin-Harris B (2018) Parameters and scales used to assess and report findings from stroboscopy: a systematic review. J Voice 32(6):734–755. https://doi.org/10.1016/j.jvoice.2017.09.018

    Article  PubMed  Google Scholar 

  13. El-Demerdash A, Fawaz SA, Sabri SM, Sweed A, Rabie H (2015) Sensitivity and specificity of stroboscopy in preoperative differentiation of dysplasia from early invasive glottic carcinoma. Eur Arch Oto-rhino-laryngol 272(5):1189–1193. https://doi.org/10.1007/s00405-015-3530-z

    Article  CAS  Google Scholar 

  14. Mehlum CS, Rosenberg T, Groentved AM, Dyrvig AK, Godballe C (2016) Can videostroboscopy predict early glottic cancer? A systematic review and meta-analysis. Laryngoscope 126(9):2079–2084. https://doi.org/10.1002/lary.25745

    Article  PubMed  Google Scholar 

  15. Olthoff A, Woywod C, Kruse E (2007) Stroboscopy versus high-speed glottography: a comparative study. Laryngoscope 117(6):1123–1126. https://doi.org/10.1097/MLG.0b013e318041f70c

    Article  PubMed  Google Scholar 

  16. Kendall KA (2012) High-speed digital imaging of the larynx: recent advances. Curr Opin Otolaryngol Head Neck Surg 20(6):466–471. https://doi.org/10.1097/MOO.0b013e328359840d

    Article  PubMed  Google Scholar 

  17. Arens C, Piazza C, Andrea M, Dikkers FG, Tjon Pian Gi RE, Voigt-Zimmermann S, Peretti G (2016) Proposal for a descriptive guideline of vascular changes in lesions of the vocal folds by the committee on endoscopic laryngeal imaging of the European Laryngological Society. Eur Arch Oto-rhino-laryngol 273(5):1207–1214. https://doi.org/10.1007/s00405-015-3851-y

    Article  Google Scholar 

  18. Kraft M, Fostiropoulos K, Gürtler N, Arnoux A, Davaris N, Arens C (2016) Value of narrow band imaging in the early diagnosis of laryngeal cancer. Head Neck 38(1):15–20. https://doi.org/10.1002/hed.23838

    Article  PubMed  Google Scholar 

  19. Mehlum CS, Rosenberg T, Dyrvig AK, Groentved AM, Kjaergaard T, Godballe C (2018) Can the Ni classification of vessels predict neoplasia? A systematic review and meta-analysis. Laryngoscope 128(1):168–176. https://doi.org/10.1002/lary.26721

    Article  CAS  PubMed  Google Scholar 

  20. De Vito A, Meccariello G, Vicini C (2017) Narrow band imaging as screening test for early detection of laryngeal cancer: a prospective study. Clin Otolaryngol 42(2):347–353. https://doi.org/10.1111/coa.12728

    Article  PubMed  Google Scholar 

  21. Zeitels SM (1995) Premalignant epithelium and microinvasive cancer of the vocal fold: the evolution of phonomicrosurgical management. Laryngoscope 105(3):1–51

    Article  CAS  Google Scholar 

  22. Uloza V, Vegiene A, Pribuisiene R, Saferis V (2013) Quantitative evaluation of video laryngostroboscopy: reliability of the basic parameters. J Voice 27(3):361–368

    Article  Google Scholar 

  23. Zwakenberg MA, Dikkers FG, Wedman J, Halmos GB, van der Laan BFAM, Plaat BEC (2016) Narrow band imaging improves observer reliability in evaluation of upper aerodigestive tract lesions. Laryngoscope 126(10):2276–2281. https://doi.org/10.1002/lary.26008

    Article  PubMed  Google Scholar 

  24. Volgger V, Felicio A, Lohscheller J, Englhard AS, Al-Muzaini H, Betz CS, Schuster ME (2017) Evaluation of the combined use of narrow band imaging and high-speed imaging to discriminate laryngeal lesions. Lasers Surg Med 49(6):609–618. https://doi.org/10.1002/lsm.22652

    Article  PubMed  Google Scholar 

  25. Rzepakowska A, Sobol M, Sielska-Badurek E, Niemczyk K, Osuch-Wojcikiewicz E (2019) Morphology, vibratory function, and vascular pattern for predicting malignancy in vocal fold leukoplakia. J Voice. https://doi.org/10.1016/j.jvoice.2019.04.001(Epub ahead of print)

    Article  PubMed  Google Scholar 

  26. Bossuyt PM, Reitsma JB, Bruns DE, Gatsonis CA, Glasziou PP, Irwig L, Lijmer JG, Moher D, Rennie D, de Vet HC, Kressel HY, Rifai N, Golub RM, Altman DG, Hooft L, Korevaar DA, Cohen JF (2015) STARD 2015: an updated list of essential items for reporting diagnostic accuracy studies. BMJ (Clin Res Ed) 351:h5527. https://doi.org/10.1136/bmj.h5527

    Article  Google Scholar 

  27. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG (2009) Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42(2):377–381. https://doi.org/10.1016/j.jbi.2008.08.010

    Article  Google Scholar 

  28. Remacle M, Van Haverbeke C, Eckel H, Bradley P, Chevalier D, Djukic V, de Vicentiis M, Friedrich G, Olofsson J, Peretti G, Quer M, Werner J (2007) Proposal for revision of the European Laryngological Society classification of endoscopic cordectomies. Eur Arch Oto-rhino-laryngology 264(5):499–504. https://doi.org/10.1007/s00405-007-0279-z

    Article  Google Scholar 

  29. White IR, Royston P, Wood AM (2011) Multiple imputation using chained equations: issues and guidance for practice. Stat Med 30(4):377–399. https://doi.org/10.1002/sim.4067

    Article  PubMed  Google Scholar 

  30. Davaris N, Voigt-Zimmermann S, Kropf S, Arens C (2018) Flexible transnasal endoscopy with white light or narrow band imaging for the diagnosis of laryngeal malignancy: diagnostic value, observer variability and influence of previous laryngeal surgery. Eur Arch Oto-rhino-laryngol 276(2):459–466. https://doi.org/10.1007/s00405-018-5256-1

    Article  Google Scholar 

  31. Ni XG, Zhu JQ, Zhang QQ, Zhang BG, Wang GQ (2018) Diagnosis of vocal cord leukoplakia: the role of a novel narrow band imaging endoscopic classification. Laryngoscope 129(2):429–434. https://doi.org/10.1002/lary.27346

    Article  PubMed  Google Scholar 

  32. Barnes L, Reichart P, Sidransky D (eds) (2005) World Health Organization classification of tumours, 2nd edn. In: (IARC). Iafric (ed) Pathology and genetics. Head and neck tumors. IARC Press, Lyon, pp 140–143

  33. Gale N, Hille J, Jordan RC, Nadal A, Williams MD (2017) Chapter 3: tumours of the hypopharynx, larynx, trachea and parapharyngeal space. In: El-Naggar AK, Grandis JR, Takata T, Slootweg PJ (eds) WHO classification of head and neck tumours, vol 9, 4th edn. International Agency for Research on Cancer Lyon, France, pp 91–93

  34. Lukes P, Zabrodsky M, Lukesova E, Chovanec M, Astl J, Betka JA, Plzak J (2014) The role of NBI HDTV magnifying endoscopy in the prehistologic diagnosis of laryngeal papillomatosis and spinocellular cancer. Biomed Res Int 2014:285486. https://doi.org/10.1155/2014/285486

    Article  PubMed  PubMed Central  Google Scholar 

  35. Puxeddu R, Sionis S, Gerosa C, Carta F (2015) Enhanced contact endoscopy for the detection of neoangiogenesis in tumors of the larynx and hypopharynx. Laryngoscope 125(7):1600–1606. https://doi.org/10.1002/lary.25124

    Article  PubMed  Google Scholar 

  36. Sun C, Han X, Li X, Zhang Y, Du X (2017) Diagnostic performance of narrow band imaging for laryngeal cancer: a systematic review and meta-analysis. Otolaryngol Head Neck Surg 156(4):589–597. https://doi.org/10.1177/0194599816685701

    Article  PubMed  Google Scholar 

  37. Rzepakowska A, Sielska-Badurek E, Cruz R, Sobol M, Osuch-Wojcikiewicz E, Niemczyk K (2018) Narrow band imaging versus laryngovideostroboscopy in precancerous and malignant vocal fold lesions. Head Neck 40(5):927–936. https://doi.org/10.1002/hed.25047

    Article  PubMed  Google Scholar 

  38. Stanikova L, Satankova J, Kucova H, Walderova R, Zelenik K, Kominek P (2017) The role of narrow-band imaging (NBI) endoscopy in optical biopsy of vocal cord leukoplakia. Eur Arch Oto-rhino-laryngol 274(1):355–359. https://doi.org/10.1007/s00405-016-4244-6

    Article  CAS  Google Scholar 

  39. Sifrer R, Rijken JA, Leemans CR, Eerenstein SEJ, van Weert S, Hendrickx JJ, Bloemena E, Heuveling DA, Rinkel R (2018) Evaluation of vascular features of vocal cords proposed by the European Laryngological Society. Eur Arch Oto-rhino-laryngol 275(1):147–151. https://doi.org/10.1007/s00405-017-4791-5

    Article  Google Scholar 

  40. Ni XG, He S, Xu ZG, Gao L, Lu N, Yuan Z, Lai SQ, Zhang YM, Yi JL, Wang XL, Zhang L, Li XY, Wang GQ (2011) Endoscopic diagnosis of laryngeal cancer and precancerous lesions by narrow band imaging. J Laryngol Otol 125(3):288–296. https://doi.org/10.1017/s0022215110002033

    Article  PubMed  Google Scholar 

  41. Piazza C, Cocco D, De Benedetto L, Del Bon F, Nicolai P, Peretti G (2010) Narrow band imaging and high definition television in the assessment of laryngeal cancer: a prospective study on 279 patients. Eur Arch Oto-rhino-laryngol 267(3):409–414. https://doi.org/10.1007/s00405-009-1121-6

    Article  Google Scholar 

  42. Stanikova L, Walderova R, Jancatova D, Formanek M, Zelenik K, Kominek P (2018) Comparison of narrow band imaging and the Storz Professional Image Enhancement System for detection of laryngeal and hypopharyngeal pathologies. Eur Arch Oto-rhino-laryngol 275(7):1819–1825. https://doi.org/10.1007/s00405-018-4987-3

    Article  CAS  Google Scholar 

  43. Mannelli G, Cecconi L, Gallo O (2016) Laryngeal preneoplastic lesions and cancer: challenging diagnosis. Qualitative literature review and meta-analysis. Crit Rev Oncol Hematol 106:64–90. https://doi.org/10.1016/j.critrevonc.2016.07.004

    Article  PubMed  Google Scholar 

  44. Bertino G, Cacciola S, Fernandes WB Jr, Fernandes CM, Occhini A, Tinelli C, Benazzo M (2015) Effectiveness of narrow band imaging in the detection of premalignant and malignant lesions of the larynx: validation of a new endoscopic clinical classification. Head Neck 37(2):215–222. https://doi.org/10.1002/hed.23582

    Article  PubMed  Google Scholar 

  45. Ni XG, Wang GQ, Hu FY, Xu XM, Xu L, Liu XQ, Chen XS, Liu L, Ren XL, Yang Y, Guo L, Gu YJ, Hou J, Zhang JW, Yang Y, Xing B, Ren J, Guo HQ (2019) Clinical utility and effectiveness of a training program in the application of a new classification of narrow band imaging for vocal cord leukoplakia: a multicenter study. Clin Otolaryngol. https://doi.org/10.1111/coa.13361(Epub ahead of print)

    Article  PubMed  Google Scholar 

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Acknowledgements

This study was funded by grants from the Region of Southern Denmark and the University of Southern Denmark.

Author information

Authors and Affiliations

  1. Department of ORL Head and Neck Surgery and Audiology, Odense University Hospital, J. B. Winsløwsvej 4, 5000, Odense, Denmark

    Camilla Slot Mehlum, Ågot Møller Grøntved, Gita Jørgensen, Bahareh Bakhshaie Philipsen & Christian Godballe

  2. Department of Otorhinolaryngology-Head and Neck Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200, Aarhus N, Denmark

    Thomas Kjaergaard

  3. Department of Head and Neck Surgery, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark

    Nina Munk Lyhne

  4. Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Lykkebækvej 1, 4600, Køge, Denmark

    Andreas Peter Schjellerup Jørkov & Preben Homøe

  5. Department of Otorhinolaryngology, Head and Neck Surgery, and Audiology, Rigshospitalet, University Hospital of Copenhagen and University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark

    Jesper Filtenborg Tvedskov & Kristian Hveysel Bork

  6. OPEN-Open Patient Data Explorative Network and Department of Clinical Research, Odense University Hospital and University of Southern Denmark, J. B. Winsløwsvej 9, 5000, Odense, Denmark

    Sören Möller

Authors
  1. Camilla Slot Mehlum
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Contributions

All authors contributed to the study conception, design and data collection. Material preparation and analysis were performed by CSM, CG and SM. The first draft of the manuscript was written by CSM and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Camilla Slot Mehlum.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the 1964 Helsinki declaration and its later amendments. According to Danish legislation no ethical approval was needed. Informed consent was obtained from all individual participants included in the study.

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Appendix

Appendix

Measured variables.

Patient characteristics.

Age, gender, tobacco use, inclusion date, surgical department.

Preoperative diagnostic set-up (explanatory variables marked with *).

VS:

Lesion type (elevated yes/no, exophytic yes/no)*.

Mucosal wave (normal/reduced/absent)*.

HSDI:

Mucosal wave (normal/reduced/absent)*.

EE:

Vascular changes (perpendicular vessels yes/no/unknown)*.

Surgical procedure: (explanatory variables marked with *).

Intraoperative EE used (yes/no).

If yes: vascular changes (perpendicular vessels yes/no/unknown)*.

SI used (yes/no).

If yes: lesion adherent to ligament (yes/partly/no)*.

Histology (response variable):

Non-neoplasia, mild dysplasia, moderate dysplasia, severe dysplasia, carcinoma in situ, invasive carcinoma, other invasive cancer.

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Mehlum, C.S., Kjaergaard, T., Grøntved, Å.M. et al. Value of pre- and intraoperative diagnostic methods in suspected glottic neoplasia. Eur Arch Otorhinolaryngol 277, 207–215 (2020). https://doi.org/10.1007/s00405-019-05698-w

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