US-guided transcutaneous tru-cut biopsy of laryngo-hypopharyngeal lesions (original) (raw)
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The Journal of Laryngology & Otology, 2013
Objective:To investigate different strategies for displaying the hypopharynx and oesophageal entrance during laryngoscopy for hypopharyngeal cancer.Patients and methods:A total of 113 patients with hypopharyngeal cancer underwent laryngoscopy prior to surgery. The hypopharynx was displayed by: (1) pulling the anterior cervical skin; (2) having the patient perform the Valsalva balloon-blowing manoeuvre; and (3) injecting oxygen through the biopsy channel to expose the oesophageal entrance. The effect of these methods on visualisation of primary tumour size and extent was assessed.Results:During pronunciation of the letter ‘e', the hypopharynx was displayed in only 33 patients (29.2 per cent); with anterior cervical skin traction plus the balloon-blowing manoeuvre, the hypopharynx was displayed in 106 patients (93.8 per cent; p < 0.001). The combined strategy was superior especially when judging the extent of posterior pharyngeal wall and postcricoid invasion. Oesophageal entra...
Endoscopic approach to hyperplastic laryngeal lesions: a literature review and personal experience
The Egyptian Journal of Otolaryngology, 2023
Background Presently, there is a lot of confusion in the identification and classification and no consensus regarding the management of hyperplastic laryngeal lesions (HLL). Conventional transoral microsurgery has some drawbacks and is not always possible. The purpose of the study was to identify criteria for preoperative detection of HLL with high malignant potential and to assess the effectiveness of flexible endoscopic surgery (FES) in the management of HLL. Methods A review of relevant English literature and a retrospective review of medical records of 37 patients with HLL, treated by FES, was performed. Results Endoscopic and histologic features of HLL are discussed. An endoscopic classification of HLL is proposed: chronic hyperplastic laryngitis (CHL), chronic hyperplastic laryngitis with keratosis (CHLK), leukoplakia, pachydermia, and verrucous neoplasia. The role of FES using different tools in the diagnosis and management of HLL is presented. We applied flexible endoscopic laryngeal surgery (FELS) for 37 patients (ages, from 20 to 77 years, men 34, women 3) with the following types of HLL: CHLK 5, leukoplakia 18, pachydermia 12, verrucous neoplasia 2. Tracheostomy was offered in 1 case of obstructive verrucous neoplasia with subsequent decanulation after successful endoscopic management. According to the data from the literature and our own observations, the following criteria seem to point to a HLL with high malignant potential: verrucous neoplasia, pachydermia, a lesion affecting more than a half of the vocal fold, mucosal hyperemia, high-grade dysplasia in biopsy samples. The expected result (total eradication of the visible lesion) was obtained in all of our cases (mean follow-up period 76 months). Invasive carcinoma developed subsequently in 2 patients that continued to smoke after surgery. All the patients that could be followed-up stated an improvement of their voice after surgery. Conclusion The following criteria can be used for preoperative detection of HLL with high malignant potential: verrucous neoplasia, pachydermia, a lesion affecting more than a half of the vocal fold, mucosal hyperemia, highgrade dysplasia in biopsy samples. Flexible endoscopic surgery, preceded by large flexible forceps biopsy, is a good alternative for HLL management. Diathermy snare is a useful tool for the diagnosis and first-line treatment in selected patients.
Imaging of the larynx and hypopharynx
European Journal of Radiology, 2008
The purpose of this article is to review currently used imaging protocols for the evaluation of pathologic conditions of the larynx and hypopharynx, to describe key anatomic structures in the larynx and hypopharynx that are relevant to tumor spread and to discuss the clinical role of Computed Tomography (CT), Magnetic Resonance Imaging (MRI) and PET CT in the pretherapeutic workup and posttherapeutic follow-up of patients with squamous cell carcinoma of this region. A detailed discussion of the characteristic neoplastic submucosal invasion patterns, including extension to the preepiglottic space, paraglottic space and laryngeal cartilages and the implications of imaging for tumor staging and treatment planning is provided. The present article also reviews less common tumors of this region, such as chondrosarcoma, lymphoma, minor salivary gland tumors and lipoma. As the majority of non-neoplastic conditions do not require imaging the role of CT and MRI is discussed in some particular situations, such as to delineate cysts and laryngoceles, abscess formation in inflammatory conditions, to evaluate laryngeal and hypopharyngeal involvement in granulomatous and autoimmune diseases, and to evaluate the extent of laryngeal fractures due to severe blunt trauma.
Fine needle aspiration cytology of laryngeal lesions: an experience from tertiary cancer care center
International Journal of Otorhinolaryngology and Head and Neck Surgery
Background: Squamous Cell Carcinoma (SCC) comprises about 95% of laryngeal malignancies. Translaryngeal Fine Needle Aspiration Cytology (TLFNAC) of endolaryngeal and hypopharyngeal malignancies helps in early diagnosis. Although the diagnosis of a malignancy is often self-evident to a clinician, a tissue diagnosis is a must for starting treatment. TLFNAC helps the clinicians to plan the management at the earliest. Hence this study is to evaluate the utility of percutaneous translaryngeal FNAC in diagnosis of laryngeal lesions.Methods: 189 Cases of Translaryngeal FNACs done during the period of Jan 2014 to Dec. 2015 were retrieved from the cytology register. FNAC was always done after Head and Neck radiology image studies. Usual FNA procedure was followed. FNA done with or without guidance and at times with clinician’s assistance. Smears stained with MGG and Pap stain, and cytomorphological diagnosis was made. Results: Out of 189 cases, aspirates were satisfactory in 146 cases and u...
The Spectrum of Laryngeal Neoplasia: The Pathologist's View
Pathology - Research and Practice, 2002
liferation at one end to frankly invasive carcinoma at the other, with a number of intermediary stages bridging these extremes. The principal types of alteration that will be considered in this review are epithelial hyperplasia (keratosis), atypical hyperplasia, dysplasia, carcinoma in situ, and overt invasive cancer [8]. Paralleling these microscopic findings, but with less diagnostic specificity, is a range of gross changes. The surface alterations seen at surgery, or during laryngoscopic examination, range from smooth, white or reddened focal thickenings, sometimes roughened by keratosis, to irregular verrucous or ulcerated, white-pink lesions suggestive of cancer.
Transoral flexible laryngoscope biopsy: Safety and accuracy
World Journal of Otorhinolaryngology - Head and Neck Surgery, 2018
To determine the accuracy of transoral flexible laryngoscope (TFL) biopsy and also to identify the safety as office based procedure in terms of complications. Methods: This is a diagnostic study; the type of intervention is outpatient department based biopsy of laryngeal lesions. All patients seen in ENT outpatient department of Lyari General Hospital with suspicious lesions of Larynx were referred for Transoral Flexible Laryngoscopy Biopsy under local anesthesia. The specimens were sent for histopathology. The patients with benign pathology or carcinoma in situ were referred for direct laryngoscopy and biopsy. The sensitivity and specificity were calculated and the frequencies of complications were monitored to determine the complication rate. Results: During the course of study a total of 47 patients underwent TFL biopsy in office settings. Out of these patients 16 patients were referred for direct laryngoscopy biopsy. The study population included 32 men and 15 women with ages ranging from 28 to 52 years and mean of (39 AE 6) years. Among 43 patients squamous cell carcinoma was the final diagnosis in 31 patients. In the rest of 12 patients' dysplasia and benign lesion was the diagnosis in 9 and 3 patients respectively. These 12 patients underwent direct laryngoscopy biopsy and 10 of them diagnosed with invasive carcinoma rest had benign lesions. Hence the specificity was 75.6% and sensitivity was 100%. None of the patients developed any serious complication.