Literature Review: A Roundup of Important Recent Studies

Setting: Department of Otolaryngology, Asan Medical Center, Seoul, Republic of Korea.

Synopsis: The authors demonstrated that

SUVmax obtained by FDG-PET was an independent predictor of survival and was indicative of hypoxic status. In this study, hypermetabolic lesions were not detected on FDG-PET. The authors suggest this may be because these cases had shallow depth (< 3 mm). SUV higher than 5.05 and a high SUVmax were strongly associated with reduced disease-free survival and overall survival by multivariate analysis. In multivariate analysis that included SUVmax, HIF-1α was a significant predictor of disease-free survival.

Bottom line: High SUV on FDG-PET may correlate with poor prognosis.

Reference: Han MW, Lee HJ, Cho KJ, et al. Role of FDG-PET as a biological marker for predicting the hypoxic status of tongue cancer. Head Neck. 2012;34:1395-1402.

—Reviewed by Jonas Johnson, MD

Laryngeal Visualization in Dysphonic Patients Superior to HPE Alone

Are history and/or physical examination sufficient to guide clinical decision making regarding the timing of examinations for dysphonic patients?

Background: Not all tests achieve the same diagnostic accuracy. Traditionally, laryngeal visualization has been the gold standard for determining the best treatment for hoarseness. However, recently published clinical guidelines suggest that visualization may be delayed in the absence of serious underlying conditions or prolonged symptoms, implying that history is integral in risk stratification and determination of the timing of laryngoscopy.

Study design: Expert survey.

Setting: NYU Voice Center, Department of Otolaryngology and Division of Biostatistics, New York University School of Medicine, New York City.

Synopsis: Six laryngologists were presented with eight patient vignettes that included history and physical examination (HPE), laryngoscopy and stroboscopy. Questions were posed regarding diagnosis and management plans, with operative findings via direct laryngoscopy employed as a comparator. The diagnostic accuracy of HPE was 5 percent, while the accuracy following both flexible laryngoscopy and stroboscopy was 68.3 percent. Taking a specific diagnosis (cancer), HPE alone identified only 33 percent of cases, while both laryngoscopy and stroboscopy identified 100 percent of cases. The authors noted that one of the main complaints about the recently published guidelines is that in patients with no concerning comorbidity identified via HPE, there is a three-month allowance for observation prior to visualization.

Bottom line: Laryngeal visualization through flexible laryngoscopy and stroboscopy in dysphonic patients is more accurate than HPE alone in determining the diagnosis of patients with hoarseness.