How accurate is videostroboscopy (VS) in differentiating early glottic cancer from noninvasive lesions?
Bottom Line: Although VS is able to identify almost all patients with cancer, only approximately two-thirds of patients with noninvasive lesions are correctly identified as not having cancer. Authors believe that VS remains the gold standard as a screening procedure for assessing glottic lesions but should be supplemented by further diagnostic procedures due to its inability to correctly identify patients who do not have cancer.
Explore this issue:September 2016
Background: Almost half of all laryngeal cancers are located in the glottis. Premalignant lesions (dysplasia or laryngeal intraepithelial neoplasia [LIN]) often appear as white or red areas, but they may also be benign. While VS may not provide additional information for obvious cancer, for smaller lesions it will raise the suspicion of malignant invasion into the deeper layers of the mucosa.
Study design: Systematic review and meta-analysis of five studies with a total of 307 patients.
Setting: PubMed and Embase databases.
Synopsis: The sensitivities of VS within the single studies ranged from 86% to 100%, and corresponding specificities ranged from 7% to 93%. The meta-analysis showed that the sensitivity of the combined results was 0.96, and the specificity was 0.65. Authors note that this means that the test is generally highly sensitive and is thus able to identify those having the disease. On average, authors found that VS correctly identified 96% of cancers; however, the average specificity indicated that only 65% of the tested population was correctly identified as not having cancer. Limitations include a potential bias against VS from individual studies seeking to demonstrate the superiority of another diagnostic method and potential publication bias.
Citation: Melhum CS, Rosenberg T, Groentved AM, Dyrvig AK, Godballe C. Can videostroboscopy predict early glottic cancer? A systematic review and meta-analysis. Laryngoscope. 2016;126:2079-2084.