Videolaryngostroboscopy in early vocal fold carcinoma diagnosis

Abstract

Introduction/Objective. Vocal folds are the most common primary site of laryngeal carcinoma. Advancement in diagnostic and therapeutic modalities have provided better prognosis for patients with early glottic carcinoma. We aimed to report the role of videolaryngostroboscopy (VLS) in early diagnosis of vocal fold carcinoma. Methods. Prospective controlled study included 300 dysphonic patients admitted to the tertiary medical center for microlaryngoscopy with biopsy. All patients underwent stroboscopic examination prior to biopsy. VLS findings were classified according to Hirano into four stages, with an adynamic vocal fold segment and absence of vocal fold vibration, suspected for vocal fold carcinoma at stage IV. Histopathological findings have been graded according to Ljubljana classification into simple hyperplasia, abnormal hyperplasia, atypical hyperplasia, and carcinoma in situ. Results. Analysis of VLS findings showed that 41.67% of patients (n = 125/300) had asymmetrical and irregular vocal fold vibration with a mucosal wave reduction (VLS stage III), while an adynamic vocal fold segment and absence of vocal fold vibration (VLS stage IV), suspected for vocal fold carcinoma, was noticed in 17.33% of patients (n = 52/300). Histopathology report showed that vocal fold carcinoma was verified in 5.6% of patients in VLS stage III (n = 7/125), while VLS stage IV carcinoma was detected in 26.92% of patients (n = 14/52). Adynamic segment or entire nonvibrating vocal fold finding predicts early glottic carcinoma with a sensitivity of 66.77%, specificity of 86.4%, and moderate diagnostic accuracy (AUC = 0.844). Conclusion. VLS plays an important role as a timely indicator for microlaryngoscopy with biopsy in diagnosis of vocal fold carcinoma.