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Pathologically Negative Excision for Biopsy-Proven Early Glottic Carcinoma
Richard Tjahjono1,2, Navid Ahmadi3,4,5, Faruque Riffat1,3,2
1Department of Otolaryngology Head and Neck Surgery, Westmead Hospital, Sydney, Australia.
Summary
Diagnostic biopsy alone may eradicate early glottic carcinoma in some patients. Endoscopic laser excision (ELE) revealed no cancer cells in 21.5% of cases, with no recurrences after repeat ELE.
Area of Science:
- Otolaryngology
- Oncology
- Surgical Pathology
Background:
- Early glottic carcinoma diagnosis and treatment are critical for patient outcomes.
- Endoscopic laser excision (ELE) is a common treatment modality for early glottic cancer.
- Pathologic discrepancies between initial biopsy and post-excision specimens can occur.
Purpose of the Study:
- To determine the incidence of pathologically negative excisions following ELE for biopsy-proven early glottic carcinoma.
- To assess the recurrence rate and outcomes in patients with pathologically negative excisions.
Main Methods:
- Retrospective analysis of 121 patients with biopsy-proven early glottic squamous cell carcinoma treated with ELE.
- Review of initial biopsy and post-ELE histopathologic findings.
- Analysis of disease recurrence and outcomes following repeat ELE when necessary.
Main Results:
- 38.0% (carcinoma in situ), 33.9% (T1a), and 34.7% (T1b) were noted in initial biopsies.
- 21.5% of patients had pathologically negative excisions after ELE.
- 11.5% of patients with negative excisions experienced recurrence, all disease-free after repeat ELE.
Conclusions:
- A significant proportion of early glottic carcinomas may be small volume and potentially eradicated by diagnostic biopsy alone.
- Pathologically negative excisions after ELE warrant careful follow-up, but repeat ELE appears effective for managing recurrences.
- This finding suggests a potential for de-escalation of treatment in select cases of early glottic carcinoma.
