European Laryngological Society position paper on laryngeal dysplasia Part II: diagnosis, treatment, and follow-up
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REVIEW ARTICLE
European Laryngological Society position paper on laryngeal dysplasia Part II: diagnosis, treatment, and follow‑up Hans Edmund Eckel1 · Ricard Simo2 · Miquel Quer3 · Edward Odell4 · Vinidh Paleri5 · Jens Peter Klussmann6 · Marc Remacle7 · Elisabeth Sjögren8 · Cesare Piazza9 Received: 16 March 2020 / Accepted: 16 May 2020 © The Author(s) 2020
Abstract Purpose of review To give an overview of the current knowledge regarding the diagnosis, treatment, and follow-up of laryngeal dysplasia (LD) and to highlight the contributions of recent literature. Summary The diagnosis of LD largely relies on endoscopic procedures and on histopathology. Diagnostic efficiency of endoscopy may be improved using videolaryngostroboscopy (VLS) and bioendoscopic tools such as Narrow Band Imaging (NBI) or Storz Professional Image Enhancement System (SPIES). Current histological classifications are not powerful enough to clearly predict the risk to carcinoma evolution and technical issues such as sampling error, variation in epithelial thickness and inflammation hamper pathological examination. Almost all dysplasia grading systems are effective in different ways. The 2017 World Health Organization (WHO) system should prove to be an improvement as it is slightly more reproducible and easier for the non-specialist pathologist to apply. To optimize treatment decisions, surgeons should know how their pathologist grades samples and preferably audit their transformation rates locally. Whether carcinoma in situ should be used as part of such classification remains contentious and pathologists should agree with their clinicians whether they find this additional grade useful in treatment decisions. Recently, different studies have defined the possible utility of different biomarkers in risk classification. The main treatment modality for LD is represented by transoral laser microsurgery. Radiotherapy may be indicated in specific circumstances such as multiple recurrence or wide-field lesions. Medical treatment currently does not have a significant role in the management of LD. Follow-up for patients treated with LD is a fundamental part of their care and investigations may be supported by the same techniques used during diagnosis (VLS and NBI/SPIES). Keywords Carcinoma in situ · Dysplasia · Laryngeal intraepithelial neoplasia · Laryngeal carcinoma · Laser surgery · Radiotherapy
* Elisabeth Sjögren [email protected] 1
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Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Cologne, Germany
Department of Oto‑Rhino‑Laryngology, Klagenfurt General Hospital, Klagenfurt am Wörthersee, Austria
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Department of Otorhinolaryngology Head and Neck Surgery, Guy’s and St Thomas’ Hospital, London, UK
Department of Otorhinolaryngology, Head and Neck Surgery, CH Luxembourg, Luxembourg, Belgium
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Department of Otorhinolaryngology and Head and Neck Surgery, Hospital de la Santa Creu i Sant Pau. Universitat Autònoma de Barcelona, Barcelona, Spain
Department of Otorhinolaryngo
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