A decade of laryngeal dysplasia in Paisley, Scotland

Abstract

Laryngeal dysplasia is a known premalignant condition. A recent consensus statement by otorhinolaryngologists and pathologists on the diagnosis and management of laryngeal dysplasia Mehanna et al. (Clin Otol 35:170-176, 2010) identified a need for retrospective data on epidemiological aspects of laryngeal dysplasia as well as responses to treatment. A retrospective search was made on the hospital pathology database for cases of laryngeal dysplasia. Searches were made under "Larynx", "Dysplasia", "Carcinoma in situ" and "Vocal Cord". The search dates were between 1998 to the present day. The returned records were checked with the pathology reports and the case notes of these patients requested for analysis. A proforma was completed for each patient with laryngeal dysplasia. These patients were then anonymised, entered into a spreadsheet and analysed. The initial search returned 937 patients. Of these patients, 505 (54%) had benign laryngeal pathology, 131 (14%) had laryngeal dysplasia and 301 (32%) had invasive cancer on biopsy. Patients who developed malignancy within 3 months of being diagnosed with laryngeal dysplasia were excluded. This left 110 patients for analysis. Of the dysplastic patients, 40 (36%) had mild dysplasia, 31 (28%) had moderate dysplasia and 39 (35%) had severe dysplasia/carcinoma in situ; 70% were male. The median age was 63 (min 21, max 90, ave 62.5); 74 (67%) were smokers or ex-smokers. Progression of dysplasia was seen in 7 (6%) patients. Malignant transformation was seen in 18 (16%) patients. The average time for malignant change was 43 months (min 4 months, max 192 months and median 15.5 months; 73 (66%) patients were treated by microlaryngeal resection, 2 (2%) were treated by vocal cord stripping, 28 (25%) were treated by endolaser therapy, and 1 (1%) patient was treated by using the microdebrider skimming blade and 6 (5%) were treated by radiotherapy. Cure of dysplasia or downgrading of severity in these treatment subgroups was 62 (85%), 2 (100%), 24 (86%), 1 (100%) and 4 (66%), respectively. Our study reiterates that laryngeal dysplasia carries a significant risk of developing malignancy. Management of this condition varies widely. Endolaser resection is becoming more frequently employed in the UK. Our study is biased heavily towards cold steel dissection. Although there is increasing practice in the UK to promote early discharge, we feel it may be safer to keep patients under surveillance for longer periods. Despite this, all patients who returned after discharge or failing to attend with invasive cancer did so with new symptoms.