Christoph Arens

Autofluorescence Endoscopy in the Diagnosis of Early Laryngeal Cancer and Its Precursor Lesions

Objectives Because early detection and preoperative assessment of laryngeal cancer and its precursor lesions are essential for curative and function‐preserving surgical treatment, autofluorescence endoscopy has been developed to gain more information about the biologic character of these lesions. The aim of the present study is to investigate a high, representative number of patients and to evaluate the diagnostic potential and the limitations of this method.

Clinical and morphological aspects of laryngeal cysts

To our knowledge only a few defined studies have been carried out on laryngeal cysts. These cysts represent a mixed group of benign laryngeal lesions that can cause diagnostic and therapeutic difficulties. The aim of this study was to characterize their histological structure and localizations in the larynx as well as to discuss theories about their genesis. Between 1973 and 1996, 342 laryngeal cysts were treated at Phillips University of Marburg, while from 1990 to 1996, 74 were treated at Justus Liebig University of Giessen. In all, 416 laryngeal cysts were treated by endolaryngeal microsurgery. All clinical charts were reviewed retrospectively and surgical specimens examined histomorphologically. Findings showed that 58.2% of the laryngeal cysts were located in the glottic area and 18.3% in the ventricular folds. The remainder were located on the aryepiglottic fold (2.2%) and interarythenoid region (0.7%). Two congenital cysts were also treated. Approximately 56% of the laryngeal cysts were lined by squamous cell epithelium, 37% by respiratory epithelium and 7% by oncocytic epithelium. In general, the laryngeal cysts were found to be a collection of inhomogenous lesions from different histogenetic origins with diverse symptoms related to their site and size. On the basis of our investigations, a new classification was established concerning the genesis and development of laryngeal cysts by subdividing cysts into congenital cysts, retention cysts, and inclusion cysts.

CLINICAL VALUE OF OPTICAL COHERENCE TOMOGRAPHY IN LARYNGOLOGY

Optical coherence tomography (OCT) is a new, noninvasive imaging technology for the evaluation of superficial lesions. The objective of this study is to evaluate microlaryngoscopy in combination with OCT compared with microlaryngoscopy alone (ie, without OCT) in supplying a specific diagnosis, predicting invasive tumor growth and epithelial dysplasia in the larynx.

Compact Endoscopy of the Larynx

In order to improve preoperative assessment of suspected precancerous and cancerous lesions of the larynx, we examined 83 patients by compact endoscopy (combination of autofluorescence and contact endoscopy) during microlaryngoscopy in a pilot study. The intraoperative findings were related to histopathologic examination. Cancerous laryngeal mucosa was illuminated during autofluorescence endoscopy by use of blue filtered light (D-light AF system) for optical demarcation of the lesion. After staining the mucosa with methylene blue (1%), we performed contact endoscopy. During autofluorescence examination of the endolaryngeal mucosa, the appearance of precancerous and cancerous lesions varied between opaque light areas and darker reddish areas. By contact endoscopy, it was possible to observe the cells, nuclei, and cytoplasm, as well as different degrees of abnormality. Histopathologic findings of 83 patients revealed laryngeal dysplasia (grade I in 29 patients, grade II in 15, and grade III or carcinoma in situ in 8) and laryngeal cancer (31 patients). In 73 cases (88%), the findings of compact endoscopy corresponded to those of histopathology. In 5 cases, epithelial lesions were overestimated because of inflammation and scarring, and 5 cases were underestimated because of hyperkeratotic thickening of the mucosa covering basal epithelial layers with focal dysplasia of grades II and III, carcinoma in situ, and microinvasive cancer. We conclude that compact endoscopy enables the laryngologist to assess laryngeal cancer and its preceding lesions more accurately during microlaryngoscopy.

Defining phonosurgery: a proposal for classification and nomenclature by the Phonosurgery Committee of the European Laryngological Society (ELS)

The term phonosurgery (PS) refers to any operation designed primarily for the improvement or restoration of voice. It is defined by the intended operative goal, which pertains to quality of life rather than its preservation, and informed consent needs to account for this emphasis. Since the aim is improvement or maintenance of vocal function, it is essential to document voice accurately pre-operatively. As important as the surgery itself is a team approach to perioperative care and rehabilitation. Although not a new concept, the PS portfolio of operations continues to grow rapidly, making this one of the most dynamic field in Laryngology. However, this has also led to confusion regarding terminology and classification, with the result that it is presently difficult to compare results between institutions. The aim of this paper is to establish a practical classification system for PS and to thereby establish a common language for reporting results. We propose four groups of operation: vocal fold surgery (VFS), laryngeal framework surgery (LFS), neuromuscular surgery (NHS) and reconstructive surgery (RCS) (for either partial or total laryngeal replacement).

Endoscopic high-frequency ultrasound of the larynx.

Abstract Over the last few years the development of new high-frequency ultrasound equipment has improved the application and resolution of endoluminal ultrasound. Following our in vitro study on the anatomical basis of endolaryngeal high-frequency ultrasound we present the preliminary results of our sonographic examinations during microlaryngoscopy in order to characterize clinical applications. For the present study 38 patients underwent endolaryngeal ultrasound examinations. Laryngeal pathology included vocal fold polyps, laryngeal cysts, chronic laryngitis, Reinke’s edema, epithelial dysplasia and cancer. The ultrasound examination was performed during microlaryngoscopy in a standardized pattern. A newly developed ultrasound apparatus was utilized with 10 MHz and 20 MHz catheters. Site, size and depth of the laryngeal lesion were evaluated. In 23 examinations of laryngeal carcinomas tumor size and infiltration could be measured and involvement of the thyroid cartilage or anterior commissure could be visualized. The exact extension of laryngeal cysts could also be seen. Ultrasound added no additional information to the endoscopic impression of the other laryngeal lesions. Present findings suggest that endoluminal high-frequency ultrasound might supplement microlaryngoscopy in the assessment of certain laryngeal lesions, especially for the evaluation of the size and infiltration of laryngeal tumors and to perform a more accurate preoperative staging without using computed tomography or magnetic resonance imaging.

Optical and molecular techniques to identify tumor margins within the larynx

Failure to remove tumor cells from the larynx significantly increases the risk of local recurrence following surgical excision. Healthy tissue must be preserved to optimize long‐term vocal and swallowing function. It is essential to accurately distinguish between healthy mucosa, dysplasia, and invasive carcinoma. Optical and molecular examining technologies have been developed to improve tumor margin identification in vivo. We aimed to review the efficacy of these technologies. Published articles were identified using MEDLINE, EMBASE, and Cochrane central register of controlled trials (CENTRAL). Randomized clinical trials are required to establish the benefit to patients and cost to the health service of using 5‐aminolevulinic acid (ALA)–induced fluorescent imaging, contact endoscopy, and optical coherence tomography (OCT). Furthermore, primary research is required to validate other techniques, such as confocal endomicroscopy and Raman spectroscopy, and to develop their clinical applications in the larynx.

Investigating quality of life and coping resources after laryngectomy

Abstract Surgical procedures and in particular laryngectomy can become a life-saving treatment for patients with laryngeal or hypopharyngeal cancer, but can result in permanent damage. Clinical observation suggests that patients vary considerably in their ways of dealing with this new situation and in their ability to cope. The aim of our interdisciplinary group was to investigate the quality of life of laryngectomy patients and learn about their perceptions, situation and coping mechanisms. The development of an appropriate study design and a measurement strategy is presented. We investigated 29 laryngectomized patients who had joined the local self-help group. The patients were free from tumour disease and were mostly married with children, retired from work and had not graduated from high school. Assessment of the quality of life was performed with the European Organization for Research on Treatment of Cancer questionnaires QLQ-C30 and H+N35 and additional open questions. Analysis of the acquired data showed that family support was judged most important for overcoming the problems of disease and treatment. Deficits in this area were highly correlated with a low overall quality of life. Financial problems resulted because of the high percentage of retirement before or after therapy. We suggest that perioperative support taking these facts into consideration can result in an improved coping process. Further prospective studies are needed to reveal the effect of such measures.

Value of fluorescence endoscopy for the early diagnosis of laryngeal cancer and its precursor lesions.

Fluorescence endoscopy is used for the early detection and delineation of laryngeal cancer and its precursor lesions. No systematic review of these promising imaging techniques has yet been performed.

Value of narrow band imaging in the early diagnosis of laryngeal cancer

Narrow band imaging (NBI) is a new imaging technique for the depiction of tumor‐specific neoangiogenesis. The purpose of the present study was to assess the value of NBI in the early diagnosis of laryngeal cancer.