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Objective@#To investigate the expression of marker proteins in vocal cord leukoplakia, and to find markers for the early stage of diagnosis and prognosis of precancerous lesions.@*Methods@#The study included 119 cases, 68 cases of vocal cord leukoplakia (22 cases with epithelial simple hyperplasia, 46 cases with epithelial dysplasia), and 51 cases of vocal cords benign lesions(31 cases of vocal cord polyps, 20 cases of Reinke′s edema). The expression of p53, Ki-67, p21, Survivin, p16, p27, PTEN, c-Myc and vascular endothelial growth factor (VEGF) in vocal cords leukoplakia were detected, vocal cord benign lesions (vocal cord polyps and Reinke′s edema) acted as controls, comparing the expression differences of different pathological tissue. Data was analyzed by SPSS 22.0 software.@*Results@#The expression of p53, p16, Ki-67, VEGF in vocal cord benign lesions and vocal cords leukoplakia with epithelial simple hyperplasia did not show significant differences. There was a grading increase in the positive expression of p53, Ki-67 in the vocal cord leukoplakia with epithelial dysplasia contrasting to those in vocal cord benign lesions and vocal cords leukoplakia with epithelial simple hyperplasia (p53: χ2=13.340, P=0.002, Ki-67: χ2=53.386, P=0.000). The expression of p27, PTEN, c-Myc in vocal cord benign lesions and vocal cords leukoplakia with epithelial dysplasia did not show significant differences. There was a grading increase in the positive expression of p21 Survivin in vocal cords leukoplakia with epithelial dysplasia contrasting to those in vocal cord benign lesions (P<0.05). Expression of Survivin in vocal cords leukoplakia with mild-moderate epithelial dysplasia showed a significant increase than those in vocal cord benign lesions (P<0.05). The positive expression grade of p21 showed a rising trend (P=0.073) between the different grades of dysplasia.@*Conclusion@#The positive expression grade of p53, Ki-67, p21 Survivin showed an increase in vocal cords leukoplakia with epithelial dysplasia contrasting to those in vocal cord benign lesions, which might be an implication for evaluating the diagnosis and prognosis of precancerous lesions. Expression of p21 was correlated to the degrees of dysplasia and expression of Survivin showed a significant difference in early stage of epithelial dysplasia contrasting to benign lesions.
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Objective@#To investigate the value of stroboscopy and narrow band imaging (NBI)endoscopy in the diagnosis of vocal cord leukoplakia.@*Methods@#Two hundred and forty-six patients with vocal cord leukoplakia who underwent laryngeal microsurgery and diagnosed by histopathology were recruited between August 2014 and July 2016 in this retrospective study. The diagnostic accuracy of stroboscopy and narrow band imaging endoscopy in the diagnosis of vocal cord leukoplakia was compared. SPSS21.0 software was used to analyze the data.@*Results@#A significantly positive correlation was found between the decrease grade of mucosal wave and the histopathological diagnosis(Spearman r=0.526, P<0.01). A significantly positive correlation was found between the lesion classified by detailed morphologic findings of epithelial microvessel and the histopathological diagnosis(Spearman r=0.480, P<0.01). The sensitivity of stroboscopy for detecting severe dysplasia, carcinoma and invasive carcinoma was 92.73%, higher than NBI endoscopy. The specificity of NBI endoscopy was 90.55%, higher than stroboscopy. The results of logistic regression analysis showed: the positive pathological type risk in the group with mucosal waves severely reduced and absent was 3.906 and 19.737 times higher than the group with mucosal waves slightly reduced. In the group with mucosal waves severely reduced and absent, significant difference was observed when combined use of NBI endoscopy(P<0.001, P=0.047).@*Conclusions@#In the diagnosis of vocal cord leukoplakia, stroboscopy is useful for detecting severe dysplasia, carcinoma and invasive carcinoma with high sensitivity. In the group with mucosal waves severely reduced and absent, combined use of NBI endoscopy was able to improve the diagnostic accuracy.
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Objective To investigate the value of clinical characteristics in diagnosis of vocal fold paralysis (VFP) and arytenoid dislocation .Methods Eighty - eight patients of VFP and 27 patients of arytenoid dislocation were studied , by comparing the causes , laryngeal morphologic characteristics and laryngeal electromyography (LEMG) .Results The causes of 88 VFP patients included surgery (45 cases) ,neck trauma(2 cases) ,idiopathic causes(16 cases) ,infection(16 cases) ,and tumor invasion - related(9 cases) .Of the 27 arytenoid dislocation pa‐tients ,24 had a history of endotracheal intubation and the others had a history of gastric tube insertion .The vocal folds were mostly fixed at the paramedian position ,followed by the abducent position and the median position .No significant differences were found in laryngeal morphologic characteristics between the two groups ,including vocal fold shape , glottis vertical symmetry , mucosal waves , supraglottic compensation , glottis closure and arytenoid movement .The LEMG of VFP patients appeared as denervation patterns ,reinnervation potentials ,or electrical si‐lence ;the recruitment patterns appeared as mix or simple patterns ;the evoked potentials were absent .Of the VFP patients ,54 cases(61 .36% % )were found synkinesis of involved posterior cricoarytenoid and two of them also in ‐volved thyroatenoid .The patients with synkinesis had lower percentage of vocal fold bowing and higher percentage of glottic vertical asymmetry compared to the ones without synkinesis .Of the VFP patients whose cause was surgery or neck trauma ,the median - position fixed vocal folds were mostly observed in the patients with duration of less than 1 month or with synkinesis .Of the 27 arytenoid dislocation patients ,20(74 .07% )showed normal LEMG pat‐terns and 7(25 .93% )showed apparent LEMG abnormality on the affected side .Conclusion The causes of vocal fold paralysis and arytenoid dislocation are different .Laryngeal morphologic characteristics have limitations in distinguis‐hing vocal fold paralysis from arytenoid dislocation .The shape and position of involved vocal folds of the VFP pa‐tients are correlated with duration ,nerve regeneration and synkinesis .
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<p><b>OBJECTIVE</b>To investigate the correlation between clinicopathological characteristics of vocal fold leukoplakia and laryngopharyngeal reflux (LRP).</p><p><b>METHODS</b>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.</p><p><b>RESULTS</b>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%).</p><p><b>CONCLUSIONS</b>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.</p>