Serial Excision Does Not Reduce Vocal Fold Laryngeal Dysplasia Grade

What is the pathological evolution and natural history of laryngeal dysplasia, and what is the role of serial excisions in dysplasia grade regression in long-term follow-up?

Background: Vocal fold leukoplakia prevalence in the United States is estimated at 10.2 and 2.1 per 100,000 in males and females, respectively. Pathologic correlation is important because leukoplakia exists on a spectrum from benign hyperkeratosis to premalignant dysplasia to invasive squamous cell carcinoma. As such, most surgeons are reluctant to manage newly diagnosed leukoplakia with watchful waiting, preferring instead to biopsy.

Study design: Retrospective case series of 31 patients treated for vocal fold dysplasia between 1994 and 2013.

Setting: Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston.

Synopsis: Overall 13 patients had unilateral vocal fold dysplasia, whereas 18 patients initially had or developed bilateral dysplasia. In all, four had no dysplasia on initial biopsy, four had mild, six had moderate, six had severe, and 11 had carcinoma in situ (CIS). Eleven had dysplastic lesions that transformed into invasive cancer (two from an initial biopsy showing no dysplasia, one from mild dysplasia, two from moderate dysplasia, and three from severe dysplasia, three from CIS). Three patients’ leukoplakia regressed to no dysplasia (one from mild dysplasia, two from CIS). One patient had no dysplasia at initial and last pathologic evaluation. Longer follow-up time was significantly associated with greater odds of worse dysplasia; however, this trend reversed in stratified analysis. More surgeries were associated with increased disease progression odds; however, this trend also reversed in stratified analysis. Patients with moderate dysplasia, severe dysplasia, or CIS on a prior biopsy had increased odds of the same or worse status after the following surgery. Limitations included lack of a control group, the possibility that excisional biopsies might have altered the disease process, and inconsistent current smoking status and intensity documentation.

Bottom line: There was no evidence that serial excision reduced vocal fold dysplasia grade; rather, longer follow-up duration and more excisions were both associated with worsening dysplasia grades.

Citation: Ahn A, Wang L, Slaughter JC, Nguyen AM, Ossoff RH, Francis DO. Serial full-thickness excision of dysplastic vocal fold leukoplakia: diagnostic or therapeutic? Laryngoscope. 2016;126:923-927.