Vocal Leukoplakia Research Articles

Association of the recurrence of vocal leukoplakia with MDM2-309 variants over a 2-year period: a prospective study

Conclusion: MDM2-309 polymorphism variant genotypes decrease the risk of recurrence in vocal leukoplakia. Objective: The results of a previous study 2 years ago showed the effect of mouse double minute 2 homolog (MDM2) SNP309 polymorphisms in people with laryngeal carcinoma and vocal leukoplakia (a pre-cancerous laryngeal carcinoma lesion). This prospective, clinical trial was performed to assess the relationship between MDM2-309 polymorphism variants and recurrence/cancerization rates in people with vocal leukoplakia over a 2-year period. Participants and method: A total of 61 post-operative patients with vocal leukoplakia participated in this prospective, observational, 2-year, follow-up study, and were genotyped for the MDM2-309 gene using pyrosequencing. Recurrence and cancerization rates were used to assess the relationship between the clinical outcome and the genotype variants. Results: The recurrence rate in the GT genotypes group was lower than that in the normal TT genotype group (17.2% vs 50%, p = 0.05) and there was a significantly lower recurrence rate in the GG genotype group than in the normal TT genotype group (10% vs 50%, p = 0.03). However, there was no statistically significant difference in the cancerization rate between the MDM2-309 variant (GT + GG) genotypes group and the normal TT genotype group (12.2% vs 8.3%, p > 0.05) over the 2-year follow-up period.

Laryngoscopic characteristics in vocal leukoplakia: inter-rater reliability and correlation with histology grading.

Vocal cord leukoplakia is a clinical diagnosis that comprises a spectrum of benignities, premalignancies, and malignancies. Accurate recordings of the visual characteristics of the affected area are important for communication between physicians and are helpful in further management. The objective of this study was to determine the laryngoscopic characteristics among patients with vocal cord leukoplakia and the reliability of examinations between different raters. Retrospective chart review conducted in a tertiary referral center in Taiwan. From January 2010 to April 2013, 107 consecutive patients with vocal leukoplakia who had accepted excisional biopsy were recruited and classified into two groups according to histologic findings. The patients without clear preoperative flexible laryngoscope images stored in the picture archiving and communication system were excluded. There were 68 patients who met the inclusion criteria, and the preoperative laryngoscope images were reviewed by two laryngologists. The inter-rater reliabilities of the recordings were assessed. Correlation between the variables and histologic classification was also performed. The inter-rater reliability of the assessment was significant in the recordings of color, texture, size, hyperemia, thickness, and symmetry (κ = 0.267 to 0.573, P < .05) but not in vocal cord edema. The laryngoscopic findings including color, texture, size, and hyperemia were associated with the grade of dysplasia (P < .05). The specific proposed laryngoscopic characteristics are consistent in the recordings between raters and can be potentially used for stratifying patients' risk. 4.

Observation of clinicopathological characteristics of vocal fold leukoplakia and laryngopharyngeal reflux

To investigate the correlation between clinicopathological characteristics of vocal fold leukoplakia and laryngopharyngeal reflux (LRP). One hundred and thirty-eight patients with vocal leukoplakia who received laryngeal microsurgeries under suspension laryngoscope were recruited in this study. Reflux symptom index (RSI) and reflux finding score (RFS) were measured. The clinical features, pathological characteristics were collected. There were 129 males and 9 females with a mean age of (53.4 ± 11.5) years. The mean age of patients with severe dysplasia/carcinoma and invasive carcinoma was significantly older than that of inflammation/hyperplasia (F = 6.773, P < 0.05) . In 138 patients, 85 patients (61.6%) were pathologically diagnosed as chronic inflammation or squamous epithelium hyperplasia, 18 patients (13.0%) as mild dysplasia, 10 patients (7.2%) as moderate dysplasia, 15 patients (10.9%) as severe dysplasia/carcinoma in situ and 10 patients (7.2%) as invasive carcinoma. One hundred and twenty-nine patients (93.5%) complained of hoarseness with clinical courses between 7 days and 20 years. 68.5% vocal folds with inflammation/hyperplasia showed nearly normal mucosal waves, and 72.7% to 80.0% vocal folds with moderate or more severe dysplasia showed severe reduced mucosal waves. A correlation existed between the severity of pathological type and the decreased extent of mucosal waves (rank correlation coefficient was 0.427, P < 0.001). The prevalence of LPR diagnosed with RSI > 13 or RFS > 7 was 54.3 %, while the positive rate of RSI was 21.7% and that of RFS was 43.5%. There was no significant differences of the positive rates of RSI and RFS among different pathological types (χ² values 3.537 and 7.619 respectively with both P > 0.05). According to RSI evaluation, the most common reflux symptoms were hoarseness (94.9%), throat clearing (68.8%) and globus sensation (62.3%). The most common RFS findings were posterior commissure hypertrophy (79.7%), thick endolaryngeal mucus (77.5%) and vocal fold edema (70.3%). The vocal fold leukoplakia consisted of various pathological types including benign, dysplasia and malignancy. There was a correlation between pathological types and the extent of mucosal waves. About half of the patients with vocal fold leukoplakia existed LPR using RFS and RSI evaluation, but no significant difference of LPR positive rates were observed among different pathological types.

Association of interleukin-10 promoter polymorphisms and corresponding plasma levels with susceptibility to laryngeal squamous cell carcinoma.

Interleukin (IL)-10 is critically involved in tumorigenesis. In the present study, the association between the IL-10 −1082/−819/−592 promoter polymorphisms, the plasma IL-10 levels and the risk of laryngeal squamous cell carcinoma (LSCC) was investigated in a prospective, case-control study. In total, 146 patients with LSCC, 61 with vocal leukoplakia and 119 healthy controls were genotyped for the IL-10 gene (IL-10 −1082 A/G, −819 T/C and −592 A/C) using pyrosequencing, and their plasma IL-10 levels were analyzed by ELISA. The patients with LSCC had a significantly higher frequency of AC at position −592 and −819 (OR, 1.82 and P=0.024) compared with the control, and a higher frequency of AG at position −1082 (OR, 2.20 and P=0.037). The patients with advanced LSCC had a significantly higher frequency of AG+GG at position −1082 compared with those with early-stage LSCC (OR, 3.13 and P=0.008 vs. OR, 2.06 and P=0.068). The patients with lymph node metastasis had a significantly higher frequency of AG+GG at position −1082 compared with the patients with no lymph node metastasis (OR, 2.97 and P=0.048 vs. OR, 2.23 and P=0.035). In addition, the patients with high frequencies of each genotype polymorphism had high plasma IL-10 concentrations. The present study indicates that the IL-10 −1082/−819/−592 promoter polymorphisms and corresponding high plasma IL-10 concentrations are associated with LSCC, and that variations in genotype distribution and plasma IL-10 concentrations may be associated with the stage and the lymph node metastasis status of LSCC.

Significance of MDM2-309 Polymorphisms and Induced Corresponding Plasma MDM2 Levels in Susceptibility to Laryngeal Squamous Cell Carcinoma

The tumor suppressor p53 plays a crucial role in maintaining genomic stability and tumor prevention. Murine double-minute 2 (MDM2) oncoprotein plays a pivotal role in regulating p53, and the single-nucleotide polymorphism (SNP) 309T/G SNP in the promoter region of Mdm2 has been shown to be associated with increased risk of cancer. We investigated the association between Mdm2-309 promoter polymorphism, plasma MDM2 levels, and risk of laryngeal squamous cell carcinoma (LSCC). In this case-control study, 146 patients with LSCC, 61 patients with vocal leukoplakia, and 212 healthy controls were genotyped for the Mdm2-309 T/G gene using pyrosequencing. Plasma MDM2 levels were also analyzed by enzyme-linked immunosorbent assay (ELISA). Patients with LSCC had a significantly lower frequency of GT at Mdm2-309 (odds ratio [OR]=0.50, p=0.02) than controls. The proportion of GT heterozygotes in advanced stage cases were less than that in the initial stage patients (OR: 0.36 vs. 0.63; p=0.007 and 0.16). The same result was found between cases with and without lymph node metastases (OR: 0.45 vs. 0.52; p=0.075 and 0.04). Moreover, the plasma Mdm2 concentrations of LSCC patients (343.36±14.8 pg/mL) were significantly higher than those in controls (255.76±8.2 pg/mL; p<0.01) and vocal leukoplakia patients (301.42±8.6 pg/mL; p<0.05). Patients in advanced stages and with lymph node metastasis had higher plasma MDM2 levels, while the GT genotypes (308.06±18.9 pg/mL; p=0.037) had lower MDM2 plasma levels than the TT genotypes (369.00±25.2 pg/mL). The Mdm2 SNP309 G allele is implicated as an important LSCC and a vocal leukoplakia protective factor in the Chinese Han Population, and the proportion of GT genotype was lower in advanced LSCC patients and lymph node metastasis patients. Moreover, Mdm2-309 GT genotype patients had a lower plasma MDM2 level than the TT genotypes.

Association of IL-10 promoter polymorphism and plasma levels with susceptibility to vocal cords leukoplakia

To investigated the association between interleukin-10(IL-10)-1082/-819/-592 promoter polymorphism, plasma IL-10 levels and risk of vocal leukoplakia. A case-control study of 61 patients with vocal cords leukoplakia and 119 healthy subjects were performed. Genotypes for the IL-10 gene (IL-10 -1082 G/A, -819 C/T and -592 C/A) were determined using pyrosequencing and plasma IL-10 levels were analyzed by ELISA. Smoking and alcohol consumption increased the risk of vocal leukoplakia (OR = 4.73, 95%CI:2.4-9.1;OR = 5.70, 95%CI:2.9-11.2, P < 0.01) . Patients with vocal cord leukoplakia had significantly higher frequencies of AC at -592 and -819 (OR = 1.93, 95%CI:0.97-3.81, P = 0.05) and AG at -1082(OR = 2.14, 95%CI:0.87-5.27, P = 0.092) than control. Vocal leukoplakia patients had higher concentration of plasma IL-10 (21.6 ± 0.5) pg/ml (X(-) ± s) than controls (19.0 ± 1.1)pg/ml(t = 2.08, P = 0.043) and the haplotype containing the G allele was associated with higher plasma IL-10 concentrations (24.3 ± 5.7) pg/ml compared with the ATA haplotype(19.9 ± 4.7) pg/ml (t = -2.64, P = 0.008). IL-10-1082/-819/-592 promoter polymorphism and high concentration of plasma IL-10 are associated with vocal cord leukoplakia, and the concentration of plasma IL-10 is associated with the genotypes of IL-10 promoter polymorphism.

Radiofrequency Coblation for Treatment of Vocal Cords Leukoplakia

Radiofrequency Coblation for Treatment of Vocal Cords Leukoplakia Background: The aim of the present study was to evaluate the use of radiofrequency coblation surgery as a practical alternative to conventional surgery of vocal cords leukoplakia. Methods: Ninety-five patients affected by vocal cords leukoplakia were enrolled. Vocal cords leucoplakia was initially diagnosed by laryngoscopy and successively confirmed by radiofrequency coblation excision for histologic assessment. All the patients were subjected to voice assessment and the Jitter, Shimmer, F0, MPT and DSI values were used as sensitive indicators for voice assessment of patients with vocal cords leucoplakia. Results: The mean leukoplakia resection time was 23.14 ± 5.36 minutes. 83 (87.37%) patients were “clinically” healed as 78.95% (75/95) the histological results shows chronic mucosal inflammation or squamous epithelial hyperplasia without dysplasia, as well as 8 (8.42%) patients with mild dysplasia. Conclusions: Radiofrequency coblation is a useful surgical technique, as effective as, or even superior to, other surgical techniques when dealing with patients suffering from vocal cords leukoplakia with potentially fewer adverse effects and subsequent improved quality of life for patients.

Increased expression of Rab coupling protein in squamous cell carcinoma of the head and neck and its clinical significance.

The role of Rab coupling protein (RCP) has not been previously investigated in squamous cell carcinoma of the head and neck (SCCHN). The aim of this study was to explore RCP protein expression and its clinicopathological significance in SCCHN. RCP protein expression in 95 SCCHN samples, 18 vocal nodule epithelia and 16 leukoplakia epithelia samples was analyzed by immunohistochemistry and correlated with clinicopathological parameters and patient outcome. Our data indicated that vocal nodule epithelia, leukoplakia epithelia and SCCHN showed a gradual increase in the expression of RCP protein. RCP overexpression was significantly associated with T classification, clinical staging, lymph node metastasis and recurrence. Survival analysis revealed that a high RCP expression was significantly correlated with shorter overall survival and disease-free survival. In conclusion, RCP protein may contribute to the malignant progression of SCCHN, and serves as a novel prognostic marker in patients with SCCHN.

Laryngofiberoscope-aided YAG laser in the treatment of vocal cord lesions

Objective To explore the clinical use of laryngofiberoscope-aided YAG laser in the treatment of vocal cord lesions. Methods 482 patients with vocal cord lesions (317 vocal cord polyps,143 vocal nodules, 11 Reinkes edema, 6 vocal papillomas, 3 vocal fold cysts, 1 vocal abscess, and 1vocal leukoplakia) were treated with YAG laser under the aid of a laryngofiberoscope. Results Of the 482patients 421 were cured after the first treatment and 51 after the second therapy. 9 patients gave up the second treatment. One patient with vocal leukoplakia needed three courses of therapy for cure. Conclusions Laryngofiberoscope-aided YAG laser is accurate, simple, and effective in the treatment of vocal cord lesions. Overdose of laser radiation and bleeding in the radiation area should be avoided. Key words: Vocal cord lesions; YAG laser; Laryngofiberoscope ST-T

Current practice and feasibility in microlaryngeal surgery: microsurgical pressing excision technique

Since the introduction of endolaryngeal microsurgery, several basic microsurgical techniques have been described for the removal of benign vocal fold lesions. These techniques include conventional incision or dissection, bimanual retraction and cutting, microflap technique and the CO2 laser. Until recently, only a few microsurgical methods have emerged as new choices for the treatment of benign vocal fold lesions. This article introduces an innovative method that can precisely remove benign sessile vocal fold lesions with epithelial keratosis or hyperplasia without jeopardizing the intermediate or deep layer of the lamina propria. Instead of using conventional vertically opening microinstruments, this microsurgical pressing excision technique (MPET) utilized two pairs of custom-made horizontally left-opening or right-opening, curved microscissors/curved cupped microforceps to remove right or left vocal fold lesions accordingly. Using one instrument at a time, the lesion was subsequently removed with the microscissors and microforceps in a press-evert-cut manner. Among a total of 553 cases, the treatment results were satisfactory, with 520 (94%) patients retaining a satisfactory/normal (G0) voice 2 months postoperatively. More importantly, no patient's voice was worse postoperatively. This technique has several advantages: utilizing one instrument at a time can maximize exposure of the narrow endoscopic view, adjusting the pressing force makes precise excision easy in a well controlled horizontal plane. The MPET is particularly useful for removing sessile vocal nodules (especially those with epithelial keratosis), epithelial hyperplasia and leukoplakia in patients with difficult endolaryngeal exposure. This could be a well tolerated and precise microsurgical technique.

Accuracy of Laryngeal Examination during Upper Gastrointestinal Endoscopy for Premalignancy Screening: Prospective Study in Patients with and without Reflux Symptoms

Gastroesophageal reflux disease may be associated with laryngeal damage caused by reflux material. The aim of this study was to investigate the accuracy of laryngeal examinations during routine upper gastrointestinal endoscopy as a method of screening for major laryngeal injury in a series of patients with reflux symptoms. A total of 100 consecutive patients with reflux symptoms and 100 control individuals underwent upper gastrointestinal endoscopy with standard or high-resolution magnifying video endoscopes. Any laryngeal abnormalities were initially identified by the gastroenterologist before the scope was inserted into the esophagus. All of the examinations were recorded on video and subsequently reevaluated by an otorhinolaryngologist. All of the patients underwent standard laryngoscopy as a reference procedure. All of the patients completed the study. The sensitivity, specificity, negative predictive value, and positive predictive value of the preliminary laryngeal exploration for detecting laryngeal abnormalities (such as laryngitis and vocal leukoplakia) were 90%, 90%, 92%, and 89%, respectively. High-resolution magnifying endoscopy had a higher sensitivity and specificity than standard endoscopy for detecting laryngeal pathology. Two patients were found to have laryngeal leukoplakia. This study shows that preliminary diagnosis of laryngeal disorders can be accurately carried out by the gastroenterologist when patients are undergoing upper endoscopy for reflux symptoms. This approach could also be helpful for the timely diagnosis of major reflux-related laryngeal disease.