| The disease development of laryngeal cancer often presents a dynamic process,that is,changes from benign lesions to precancerous lesions,carcinoma in situ to invasive cancer.Therefore,in the diagnosis and treatment of laryngeal cancer,the correct diagnosis and treatment of precancerous lesions of the larynx is also very important.Histopathology is the gold standard for determining benign and malignant for pathologic nature,so biopsy of invasive superficial mucosa is difficult to avoid.If we can improve the accuracy and value of predicting non-histologic dysplasia,low-grade dysplasia,high-grade dysplasia,and lesions that have progressed to invasive cancer prior to interventions such as laryngeal mucosal biopsy,we can reduce the cost of directly involved injuries,the cost of hospitalization,and the risks associated with surgery and anesthesia.In the process of occurrence and development of vocal cord lesions,their texture,color,thickness and roughness,size,symmetry,vocal cord mucosal waves,amplitude,etc.are different,and the research on the correlation between their morphology and histopathological hitotype also confirms the predictive value of these characteristic manifestations.NBI is an emerging optical enhancement technique to highlight microvessels on the surface of the mucosa,which has been shown to have high sensitivity and specificity in the diagnosis of early vocal cord carcinoma and precancerous lesions,which can guide biopsy,improve the true positive rate of biopsy,and avoid reverse resurrection test.It can also identify local recurrence early and improve the negative rate of intraoperative resection margin.However,when the blood vessels under the lesion are occluded,vascular striae cannot be observed,and false negatives are easy to occur.Strobe laryngoscope determines the nature of vocal cord lesions through changes in mucosal waves and amplitudes.The degree of reduction of mucosal waves is positively correlated with the degree of malignancy of the lesion.However,studies have shown that some vocal cord mucosal waves with mild to moderate dysplasia completely disappear,indicating that the degree of mucosal wave reduction is not equivalent to the malignancy and depth of invasion of vocal cord mucosal lesions.Strobe laryngoscopes have high sensitivity and low specificity.At present,there are many studies on the use of NBI and strobe laryngoscope for early vocal cord lesions,but the results show that the characteristics of the two examination devices determine their inherent defects and cannot be avoided.The joint application of the two devices is of great significance in early laryngeal cancer.Part one:Evaluation and analysis of the efficacy of strobe laryngoscopic wave scanning on vocal cord polyp surgeryObjective:To investigate the value of strobe laryngoscopic wave scanning in the evaluation of surgical efficacy in patients with benign vocal cord lesions.Methods : A total of 40 patients with benign vocal cord lesions in the Department of Otorhinolaryngology-Head and Neck Surgery in our hospital from February 2021 to November 2021 were enrolled.The relevant parameters of laryngeal wave scanning before,1 month and 2 months after surgery were statistically analyzed.Results : The preoperative open quotient(OQ),amplitude symmetry index(ASI)and phase symmetry index(PSI)were significantly different in the surgical group compared with the postoperative group(P<0.05,a=0.05).There were no significant differences in temporal periodicity index(TPI)and amplitude periodicity index(API)between preoperative and postoperative 1month and 2 months postoperative(P>0.05).Most patients with vocal cord polyps have mild to moderate voice impairment,and the voice gradually improves over time.Conclusion : The glottis closure and vocal cord movement of patients with vocal cord polyps are improved compared with preoperative conditions,and laryngeal wave scanning can quantitatively evaluate vocal cord movement,which can effectively evaluate the surgical efficacy of patients with vocal cord polyps.Part two: Prediction of early glottic laryngeal cancer and precancerous lesions by strobe laryngoscopy combined with narrowband imaging endoscopyObjective: The purpose of this study is to explore the value of the combination of narrowband imaging endoscopy and stroboscopic laryngoscope in the clinical diagnosis of early glottic carcinoma and its precancerous lesions.Methods: Select the patients who visited the otolaryngology head and neck surgery of our hospital from March 2021 to August 2022,who complained of hoarseness or found glottic lesions in the examination,and the patients who found glottic lesions in the electronic laryngoscope.At the same time,NBI endoscopy and stroboscopic laryngoscopy should be improved to evaluate the nature of the patient’s lesions.Those with surgical indications should be admitted for surgical biopsy.Then,according to the histopathological results as the diagnostic and gold standard,the sensitivity,specificity,false negative rate,false positive rate,accuracy,positive predictive value and negative predictive value were used as the main evaluation indicators to evaluate the accuracy of the two technical methods and the advantages of their combined application.Results: A total of 60 patients were enrolled,including 56 males and 4females,aged 41-79 years,with an average of 58.8±9.3 years,a course of disease from 0 to 24 months,and a median of 6 months.Among them,58 cases had hoarseness as the main complaint,1 case with pharyngeal foreign body sensation as the main complaint,and 1 case due to nasal obstruction and runny nose.Among them,29 were accompanied by chronic pharyngitis symptoms such as pharyngeal foreign body sensation and sore throat,and 41 had a smoking index greater than 400.Among the 60 patients,36 had unilateral vocal cord lesions and 24 had bilateral vocal cord lesions,for a total of 84 vocal cord lesions.The sensitivity of strobe laryngoscopy detection was 85.71% and specificity was 80.35%.The sensitivity of NBI endoscopic detection was88.46%,and the specificity was 89.66%.Spearman correlation analysis was performed on the degree of mucosal wave attenuation and IPCL classification with the degree of pathological malignancy,and the correlation coefficients r were 0.664 and 0.731,respectively,showing a significant positive correlation(P<0.001).The sensitivity of strobe laryngoscopy combined with NBI endoscopy was 91.66%,and the specificity was 93.33%.The ROC curved areas under the ROC curve of strobe laryngoscopy,NBI endoscopy and white light imaging combined with narrowband imaging were 0.867(95%CI: 0.787~0.946),0.898(95%CI: 0.817~0.978),0.941(95%CI: 0.887~0.994),respectively,and the area under the curve was higher than that of the single method,and the difference was statistically significant(P<0.05).Strobe laryngoscopy combined with NBI endoscopy is more effective than one method alone.Conclusion:(1)The stroboscopic laryngoscope has high accuracy in evaluating the lesions with normal or slightly weakened mucosal waves,and it is not easy to miss diagnosis,while the lesions with significantly weakened or even disappeared mucosal waves also have false positive results.(2)Narrow-band imaging endoscopy is accurate and specific in judging the nature of the lesions without obvious covering on the surface.When the lesions show that pseudomembranous,keratinizing and other substances block the vessels on the negative mucosal surface,the diagnostic efficiency decreases.(3)If there is no obvious reduction or disappearance of the anterior mucosal wave or thick obstruction on the vocal cord surface,the stroboscopic laryngoscopy or NBI examination can be performed separately.If there is a single method,the efficacy of the single method will be reduced,and the combined application can be used to improve the efficacy.The combination of the two examination methods has important value in the early diagnosis of laryngeal cancer and precancerous lesions,and can reduce unnecessary surgical biopsy. |
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