Pre- and Intraoperative Evaluation of Glottic Lesions in the Planning of Excisional Biopsy; Personal Experience in 142 Patients

Introduction: Endoscopic clinical appearance of glottic leuko-eritroplakias are non-specific for final diagnosis. Only the pathologic evaluation of the specimen is able to the definitive diagnosis. We present the validity of our work-up using laryngostroboscopy (LS) and intraoperative hydrodissection with saline infusion (HDR) into Reinke’s space before an “en bloc” resection procedure. Methods: 142 patients with vocal cord leuko-eritroplakias observed between January ’03 and December ‘08 underwent to preoperative examination with laryngostroboscopy (LS) and intraoperative work-up employing rigid endoscopes and hydrodissection (HDR) into Reinke’s space, in order to appraise the potential deep invasion of the vocal cord layered structure. Results: After work-up results, we performed CO2 laser cordectomies, according to the European Laryngological Society (ELS) Classification: Type I cordectomy (subepithelial) in 83 Patients, Type II (subligamental) in 30, Type III (transmuscular) in 29 respectively. Histopathological diagnoses demonstrated keratosis without atypia in 47 patients, keratosis with mild atypia in 18, moderate atypia in 13, severe dysplasia in 13, myoblastoma in 1, microinvasive carcinoma, invasive carcinoma in 49, fibromiosarcoma in 1. Discussion: Unilateral glottic leuko-eritroplakias of the vocal cord may be treated with excisional biopsy alone. Lesions ranging from keratosis without atypia to invasive carcinoma without infiltration of the vocal muscle can be safely treated by Type I (subepithelial) or Type II (subligamental) cordectomy. In order to get the best compromise between oncological radicality and preservation of the layered structure of the vocal cord, in our Institution we routinely apply a pre- and intraoperative diagnostic work-up including tests previously described in the literature.