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. 2012 Jun;32(3):175-81.

A new strategy for endoscopic staging of laryngeal carcinoma: multistep endoscopy

E Crosetti  1 , F Pilolli, G Succo
Affiliations

A new strategy for endoscopic staging of laryngeal carcinoma: multistep endoscopy

E Crosetti et al. Acta Otorhinolaryngol Ital. 2012 Jun.

Abstract
in English, Italian

At present, it is difficult to identify a gold standard for endoscopic staging of laryngeal cancer, especially considering the large number of endoscopic instruments available. We have coined the term multistep endoscopy to describe a method for staging laryngeal precancerous and neoplastic lesions that sequentially uses several endoscopic tools including high definition white light endoscopy (HDTV), stroboscopy and autofluorescence endoscopy. During the period from November 2007 to November 2009, 140 patients with a suspect laryngeal lesion underwent multistep endoscopy at the Department of Otorhinolaryngology at Martini Hospital in Turin. All patients were subjected to a series of endoscopic examinations in indirect laryngoscopy (white light endoscopy coupled to a HDTV camera, laryngostroboscopy, indirect autofluorescence) followed by white light endoscopy coupled to a HDTV camera and autofluorescence in direct microlaryngoscopy. The aim of the present prospective study was to evaluate the utility of multistep endoscopy in the diagnostic work-up of laryngeal lesions. Multistep endoscopy showed a higher sensitivity and "biological" predictive value in early cancer and precancerous lesions of the larynx (sensitivity, 97.9%; specificity, 90.5%) compared to individual endoscopic tools. It allows for better therapeutic planning of superficial lesions and more accurate orientation when performing mapping biopsies on diffuse lesions. In our opinion, more widespread use of indirect autofluorescence endoscopy during follow-up may be warranted to search for synchronous/metachronous second tumours of the upper aerodigestive tract.

Oggi resta indubbiamente difficile identificare il gold standard procedurale per la stadiazione endoscopica del carcinoma laringeo, data l'ampia disponibilità di strumenti diagnostici endoscopici. Abbiamo coniato il termine di multistep endoscopy per definire un metodo di stadiazione endoscopica del carcinoma laringeo, utilizzando sequenzialmente diverse tecniche di endoscopia: endoscopia a luce bianca ad alta definizione (HDTV), stroboscopia ed endoscopia ad autofluorescenza). Nel periodo novembre 2007 - novembre 2009 presso la clinica di otorinolaringoiatria dell'Ospedale "Martini" di Torino, sono stati sottoposti a multistep endoscopy 140 pazienti, con diagnosi di sospetta neoformazione laringea. Tutti i pazienti sono stati sottoposti in successione ad una serie di esami endoscopici in laringoscopia indiretta (endoscopia a luce bianca con telecamera-HDTV, laringostroboscopia, endoscopia ad autofluorescenza) e successivamente in corso di microlaringoscopia diretta (MLD) ad endoscopia a luce bianca con telecamera HDTV ed endoscopia ad autofluorescenza. Lo scopo del presente studio prospettico è stato quello di valutare il guadagno diagnostico fornito dalla multistep endoscopy nel work-up diagnostico delle lesioni laringee. La multistep endoscopy ha mostrato una maggiore sensibilità e predittività "biologica" sulle lesioni iniziali e sui precursori delle neoplasie della laringe (sensibilità: 97,9%; specificità: 90,5%) rispetto alle singole metodiche endoscopiche, consentendo una migliore pianificazione terapeutica di lesioni superficiali ed un più accurato orientamento delle biopsie di mappaggio di lesioni diffuse. A nostro parere, in futuro, si potrà assistere ad un impiego più estensivo dell'endoscopia ad autofluorescenza indiretta anche nel follow-up, per la ricerca sistematica di secondi tumori sincroni/metacroni.

Keywords: Laryngeal cancer staging; Laryngeal endoscopy; Multistep endoscopy.

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Figures

Fig. 1.
Fig. 1.
Indirect autofluorescence endoscopy with 70° rigid telescope: the normal mucosa has a classic green colour.
Fig. 2.
Fig. 2.
Indirect autofluorescence endoscopy with 70° rigid telescope: right vocal cord polyp. The lesion does not show any colour differences other than normal green colour. Of interest is the intense red fluorescence caused by the keratotic component.
Figs. 3a, 3b.
Figs. 3a, 3b.
Indirect endoscopy with 70° rigid telescope (white light + autofluorescence): left vocal cord neoplastic lesion (carcinoma in situ).
Figs. 3a, 3b.
Figs. 3a, 3b.
Indirect endoscopy with 70° rigid telescope (white light + autofluorescence): left vocal cord neoplastic lesion (carcinoma in situ).
Figs. 4a, 4b.
Figs. 4a, 4b.
Indirect endoscopy with 70° rigid telescope (white light + autofluorescence): left vocal cord neoplastic lesion.
Figs. 4a, 4b.
Figs. 4a, 4b.
Indirect endoscopy with 70° rigid telescope (white light + autofluorescence): left vocal cord neoplastic lesion.
Fig. 5.
Fig. 5.
Indirect autofluorescence endoscopy with 70° rigid telescope: right vocal cord hyperkeratosis (without dysplasia). The intense red fluorescence should be noted.
Figs. 6a, 6b.
Figs. 6a, 6b.
Indirect endoscopy with 70° rigid telescope (white light + autofluorescence): the exam is negatively influenced by narrow oropharyngeal anatomy.
Figs. 6a, 6b.
Figs. 6a, 6b.
Indirect endoscopy with 70° rigid telescope (white light + autofluorescence): the exam is negatively influenced by narrow oropharyngeal anatomy.
Figs. 7a, 7b.
Figs. 7a, 7b.
Direct autofluorescence endoscopy with 70° rigid telescope (white light + autofluorescence) after CO2 laser vestibulectomy. The neoplastic lesion on the right vocal cord extends to the homolateral ventricle.
Figs. 7a, 7b.
Figs. 7a, 7b.
Direct autofluorescence endoscopy with 70° rigid telescope (white light + autofluorescence) after CO2 laser vestibulectomy. The neoplastic lesion on the right vocal cord extends to the homolateral ventricle.
See this image and copyright information in PMC

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