Laryngeal carcinoma: problems in diagnosis and classification

Premalignant and malignant laryngeal lesions still offer great problems in diagnosis and classification. Early diagnosis is of the utmost importance for a good functional therapeutic result. Microlaryngoscopic techniques have increased the number of premalignant lesions which have been found. Diagnostic aids may be used e.g. toluidine blue staining and exfoliative cytology. Toluidine blue staining compared to the histological findings in 272 biopsy specimens showed an overall sensitivity of 91% but a specificity of only 52%. Exfoliative cytology compared to the histological findings in 420 cases showed an overall sensitivity of 83% and a specificity of 84%. Photometry on the histologic sections allows objective evaluation of nuclear hyperchromasia and polymorphism, which may otherwise by marked microscopically, especially in well differentiated lesions. Full use must be made of our diagnostic tools in classifying invasive carcinomas to enable selection of the most appropriate treatment. Laryngography is the best method to assess vertical tumor involvement. Computed tomography gives information about deep tumor extension and spread of tumor outside the larynx. However, the strength and weaknesses of computed tomography have to be further assessed by comparison with whole organ sections in the transverse plane.