Diagnosis Of Laryngeal Lesions Research Articles

Quantitative laryngoscopy with computer-aided diagnostic system for laryngeal lesions

Laryngoscopes are widely used in the clinical diagnosis of laryngeal lesions, but such diagnosis relies heavily on the physician's subjective experience. The purpose of this study was to develop a computer-aided diagnostic system for the detection of laryngeal lesions based on objective criteria. This study used the distinct features of the image contour to find the clearest image in the laryngoscopic video. First to reduce the illumination problem caused by the laryngoscope lens, which could not fix the position of the light source, this study proposed image compensation to provide the image with a consistent brightness range for better performance. Second, we also proposed a method to automatically screen clear images from laryngoscopic film. Third, we used ACM to segment automatically them based on structural features of the pharynx and larynx, using hue and geometric analysis in the vocal cords and other zones. Finally, the support vector machine was used to classify laryngeal lesions based on a decision tree. This study evaluated the performance of the proposed system by assessing the laryngeal images of 284 patients. The accuracy of the detection for vocal cord polyps, cysts, leukoplakia, tumors, and healthy vocal cords were 93.15%, 95.16%, 100%, 96.42%, and 100%, respectively. The cross-validation accuracy for the five classes were 93.1%, 94.95%, 99.4%, 96.01% and 100%, respectively, and the average test accuracy for the laryngeal lesions was 93.33%. Our results showed that it was feasible to take the hue and geometric features of the larynx as signs to identify laryngeal lesions and that they could effectively assist physicians in diagnosing laryngeal lesions.

Partial laryngectomy and reconstruction with rotation of the epiglottis in the treatment of a rare laryngeal schwannoma: a case report

BackgroundNeurogenic tumors of the larynx are rare, with few cases having been reported in the literature. Schwannomas are responsible for 0.1% of all benign tumors of the larynx. They arise in the sheaths of the peripheral, autonomic, and cranial nerves. The objective of this report is to describe a case of a bulky laryngeal schwannoma, the surgical procedure for its removal, and the long-term patient follow-up.Case presentationA 19-year-old Brazilian woman presented to our institution with a complaint of progressive dyspnea over the preceding year, as well as dysphonia, dysphagia for solids, and globus pharyngeus. Direct rigid laryngoscopy showed a supraglottic tumor obstructing approximately 90% of the larynx. With the symptoms progressing to severe dyspnea, an emergency tracheostomy was performed. After infusion of intravenous contrast, magnetic resonance imaging revealed a mass lesion with intense, heterogeneous contrast enhancement along the posterior wall of the hypopharynx, blocking all of the lumen and measuring 2.8 cm and 2.2 cm at its largest diameters. The image suggested a neoplastic lesion. The patient underwent open surgery for tumor resection. Her postsurgical recovery was uncomplicated. Histopathology and immunohistochemistry revealed the tumor to be a laryngeal schwannoma.ConclusionThe definitive diagnosis of laryngeal lesions can be difficult, and histopathology plays a pivotal role. Laryngeal schwannomas are rare; however, tumors can become large and may ultimately lead to airway obstruction.

Clinical experience of narrow band imaging (NBI) usage in diagnosis of laryngeal lesions.

One of the most recent methods used in imaging of the larynx is narrow band imaging (NBI). NBI enables us to detect specific patterns of pathological angiogenesis suggestive of premalignant or neoplastic lesions. The aim of the study was to compare imaging of laryngeal lesions in white light endoscopy (WLE) and NBI in relation to histopathological examination. 333 patients with laryngeal lesions underwent endoscopic evaluation in WLE and NBI. Sensitivity, specificity, positive and negative predictive value (PPV, NPV) for WLE and NBI were calculated. The diagnostic value for WLE and NBI was evaluated for two assumptions (positive result is:1. severe dysplasia and cancer 2. only cancer) Results: Sensitivity, specificity, PPV, NPV of first assumption were respectively for white light compared to NBI: 95.4% vs 98.5%; 84.2% vs 98.5%; 79.6% vs 97.7% and 96.6% vs 99.0%. The values of second assumption were: 97.4% vs 100%; 79.3% vs 93.5%; 72.6% vs. 89.4% and 98.2% vs. 100.0%. Higher sensitivity was observed for the second assumption, while higher specifity was recorded for the first assumption. Specificity was significantly higher for NBI than for WLE (p<0.001). NBI enables us to detect and differentiate laryngeal lesions, which are invisible in WLE. Endoscopic examination, especially in NBI-mode, is non-invasive, repeatable and remains a useful tool in the daily practice and diagnosis of patients with pathological lesions in the larynx.

Fine needle aspiration cytology of laryngeal lesions: an experience from tertiary cancer care center

<p class="abstract"><strong>Background:</strong> 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.</p><p class="abstract"><strong>Methods:</strong> 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. </p><p class="abstract"><strong>Results:</strong> Out of 189 cases, aspirates were satisfactory in 146 cases and unsatisfactory in 43 cases. Of the 146 cases, 122 were SCC, pleomorphic adenoma one case, adenoid cystic carcinoma one case, 8 were uncategorized neoplasms and one case was granulomatous inflammation and remaining 14 cases had nonspecific findings.</p><p class="abstract"><strong>Conclusions:</strong> TLFNA is simple, cost effective, less invasive and safe as compared to DL biopsy with less turnaround time for laryngo-pharyngeal lesions. This reduces the number of visits to OT and helps the clinicians in planning the treatment early like RT/CT or surgery. This avoids tracheostomy in borderline airway obstruction cases.</p>

Role of narrow band imaging in the diagnosis of laryngeal lesions: Pilot study from India.

Narrow band imaging (NBI) is a new imaging technique developed to improve the diagnostic accuracy of head and neck cancers by depiction of tumor-specific neo-angiogenesis. The purpose of this study was to assess the value of NBI in the diagnosis of laryngeal lesions. To assess the sensitivity and specificity of combined white light endoscopy (WLE) and NBI compared with WLE alone in the diagnosis of laryngeal lesions. Prospective study. Thirty consecutive patients with various laryngeal lesions scheduled for microlaryngoscopic evaluation underwent WLE followed by NBI. Endoscopic NBI findings were classified into five types (I-V) according to the intraepithelial papillary capillary loop features. Types I-IV are considered benign, whereas type V is considered malignant. The observations were compared with histopathology. Sensitivity, specificity, and positive and negative predictive values for the diagnosis of malignancy (i.e., invasive carcinoma and carcinoma in situ) by means of NBI with WLE were calculated. The sensitivity of WLE combined with NBI (100%) was higher than WLE alone (82.6%) in detecting laryngeal cancers. NBI helped in identifying four malignant lesions missed by WLE alone. Two children with respiratory papillomatosis also demonstrated type V pattern, a potential pitfall, leading to an overall positive predictive value of 92% and a negative predictive value of 100%. Combining NBI with WLE increases the sensitivity of detection of laryngeal cancer and its precursor lesions. NBI is also useful in some benign lesions as well as in post-radiotherapy patients.

Application of narrow band imaging in the detection of premalignant and malignant lesions of the larynx

Objective: To evaluate the role of narrow band imaging (NBI) endoscopy in the diagnosis of laryngeal lesions. Methods: A total of 136 patients with laryngeal lesions were examined by NBI and white light (WLI) endoscopy from July 2016 to May 2017. Sensitivity, specificity, accuracy, and positive predictive value (PPV) and negative predictive value (NPV) of NBI and WLI were calculated. SPSS 20.0 software was used to analyze the data. Results: Compared to WLI, NBI showed higher sensitivity (94.9% vs 83.3%), specificity (95.6% vs 84.4%), PPV (94.9% vs 82.3%), and NPV (95.6% vs 85.4%). There was high consistency of the results etween NBI and pathology (kappa=0.904, P<0.01). However, consistency of the findings between WLI and pathology was relatively weak (kappa=0.677, P<0.01). NBI showed the higher accuracy in diagnoses of both benign lesions (especially for premalignant lesions, P<0.01) and malignant lesions (especially for high-grade intraepithelial neoplasia, P<0.05) than WLI. NBI findings correlated with the pathological results (r=0.739, P<0.01). Conclusions: NBI demonstrates higher accuracy in the detection of premalignant and malignant lesions of the larynx.

Clinical significance of high resolution ultrasonography vis-à -vis laryngoscopy in laryngeal pathologies

Introduction: Larynx is a seat of a host of benign and malignant conditions. Conventionally, otolaryngologists have relied upon laryngoscopy in making a diagnosis. However, this simple doctor's office tool suffers from several limitations and flaws. In such a clinical landscape, a completely nonintrusive high-resolution ultrasonography examination can play a significant complementary role by defining the precise extent of the pathologic process. This prospective cross-sectional study, possibly the first of its kind in India, endeavours to define this synergetic relationship. Patients and Methods: A total of 60 patients with diverse undiagnosed laryngeal pathologies were taken up for the study. Those with proven laryngeal carcinoma and (or) past laryngeal surgery were excluded. Results: HRUS was found to be valuable in detecting laryngeal growth (78.57%), vocal cord polyp (66.67%), vocal cord nodule (10%), vocal cord palsy/paresis (66.67%), chronic laryngitis (17.64%), and Reinke's edema (50%). Conclusion: Compared to laryngoscopy, the role of HRUS is limited except in laryngeal lesions such as laryngeal growth and vocal cord polyp. HRUS can augment rather than replace conventional laryngoscopy in the diagnosis of laryngeal lesions.

Comparative Study between the Surgeon's Intraoperative Evaluation and Histopathology for Diagnosis of Laryngeal Lesions.

Objective. To compare the surgeon's evaluation and histopathology for diagnosis of laryngeal lesions. Material. A clinical survey was distributed to laryngeal surgeons, ENT clinicians, and students in 2013 at the Department of Otorhinolaryngology in Rostock. Participants were asked to anonymously identify laryngeal pathologies and to assess the severity of the lesion starting from hyperplasia and inflammation over moderate dysplasia to early laryngeal cancer. Images of similar clinical laryngeal lesions were demonstrated in a multiple-choice modus to assess the surgeon's intraoperative evaluation. The questionnaires were digitally processed and evaluated. The results were correlated with histopathology and compared between experienced laryngeal surgeons, clinicians inexperienced in laryngeal surgery, and medical students from the Medical Faculty of the University of Rostock. Results. Sensitivity and specificity varied among the various groups, being highest in experienced laryngeal surgeons. In this group, sensitivity, specificity, positive and negative predictive value, and accuracy were 85%, 56%, 44%, 90%, and 65%, respectively. In 4% and 31%, laryngeal disease was underdiagnosed and overdiagnosed, respectively. In this group, Kappa statistics resulted in Kappa 0.32 (P < 0.001). Conclusion. This clinical survey clearly demonstrates that conformity between histopathology and evaluation of the laryngeal lesion depends on the surgeon's experience.

Value of high resolution ultrasonography in assessment of laryngeal lesions

Objective: The aim of this study is to evaluate the value of high resolution ultrasonography (HRUS) in diagnosis of various laryngeal lesions which already diagnosed with rigid endoscopy. Study design: Prospective study with control group. Patients and methods: Sixty-six patients were suffering from throat symptoms and pre-examined by rigid endoscopy under local anesthesia and diagnosed to have a laryngeal lesion and 32 volunteers compose the control group. All 98 persons (patients and control groups) were examined by HRUS. Results: HRUS was helpful in describing various laryngeal lesions, vocal fold polyps (17) 25.7%, glottic cancer (6) 9.1%, epiglottic enlargement (2) 3.1% and one patient had laryngocele (1.5%). HRUS was highly significant in diagnosis of subglottic lesions (10) 15.2%. Also vocal fold mobility can be demonstrated by HRUS. While interarytenoid lesions (17) 25.8% and small laryngeal lesions as vocal fold nodules (13) 19.6% were difficult to be described. Conclusion: Rigid endoscopy in laryngeal examination gives us large, bright image but it is difficult to diagnose patients with a sensitive gag reflex, patients with neck or jaw diseases or stridor and very difficult in infants and children. HRUS is an alternative method in diagnosis of some laryngeal lesions, and it is superior in the diagnosis of small subglottic lesions.

Value of Ultrasonagraphy in Diagnosis of Laryngeal Lesions

Objective: Evaluate the value of high-resolution ultrasonography (HRUS) in diagnosis of various laryngeal lesions. Method: A prospective study done from March 2010 to July 2011 on 66 patients suffering from voice changes, pre-examined by rigid endoscopy and diagnosed to have a laryngeal lesion, and 32 volunteers composed the control group. All 98 persons (patients and control groups) were examined by HRUS. Results: HRUS was helpful in describing various laryngeal lesions as vocal cord nodules (13) 19.6%, vocal cord polyps (17) 25.7%, epiglottal enlargement (2) 3.03%, and vocal cord mass (6) 9.09%. It was highly significant in diagnosis of early subglottic lesions—(10) 15.2%—that were missed by rigid endoscopy. Also, vocal cords mobility can be demonstrated by HRUS. However, interarytenoid edema (18) 27.3% was difficult to detect. Conclusion: Rigid endoscopy is difficult to diagnose laryngeal lesions in patients with sensitive gag reflex, neck or jaw diseases, and stridor and in infants. HRUS is an alternative method in diagnosis of some laryngeal lesions in these patients, and it is superior in the diagnosis of small subglottic lesions.

Contact Endoscopy - A promising tool for evaluation of laryngeal mucosal lesions

Early diagnosis of laryngeal cancer is important for favourable treatment outcome. Due to morbidity and difficulties associated with surgical biopsy, a need has always been felt for an easy, non invasive yet accurate tool for knowing histopathological nature of mucosal lesions. Contact Endoscopy (CE) is one such technique which is capable of providing real time and magnified images of cellular structure of superficial layers of various mucosal surfaces with obvious advantages and potential for wide clinical application. In this review, a summary of role and efficacy of CE in diagnosis, treatment and follow up of various laryngeal mucosal lesions is presented. We searched Pubmed, Medline, Cochrane and Google scholar for articles on CE for mucosal lesions of larynx. For better understanding of the technique, articles on CE of other non-laryngeal sites of head and neck were also reviewed. Article selection was limited to human studies without restriction to language and year of publication. Reference lists from identified articles were also searched. Six prospective original articles, three descriptive studies and one review article on CE of laryngeal lesions are included in this review and their findings summarized. Common findings on examination of cellular architecture and vascular patterns described by various authors are also tabulated. The literature revealed high sensitivity (90-94.7%), specificity (81-100%) and accuracy (88-94%) of CE in diagnosis of laryngeal lesions across the published studies. CE is a promising non invasive tool for evaluation of laryngeal mucosal lesions. However, further prospective, randomized, double blinded studies as well as research to improve the technique to overcome the existing limitations are required before defining its precise role in clinical practice.

Automatic segmentation of clinical OCT images for the determination of epithelial thickness changes in laryngeal lesions

Automated classification of laryngeal lesions using optical coherence tomography data can be helpful in making a faster and safer diagnosis. A change in the epithelial layer thickness seems to be an effective indicator for laryngeal cancer and its precursors. Lesions with different grades of malignancy were scanned with a time domain OCT system during microlaryngoscopy. Every diagnosis was confirmed by performing a biopsy. Each OCT image was separately segmented, manually by an expert and automatically by a segmentation algorithm. Values for the maximal and average epithelial thickness as well as the standard deviations were compared for both segmentations. The results show a thickening of the epithelium from normal over dysplastic to cancerous tissue. The values for the automatic segmentation are in good agreement with expert segmentation. In conclusion, automatic segmentation can be used for epithelial thickness measurements as a promising indicator for laryngeal cancer. It would also be possible to extract other characteristics like standard deviation or signal attenuation within the segments. Thus, we laid the foundation for computer-aided diagnosis of laryngeal lesions.