Zapater E, Hernández R, Reboll R, Pérez A, Alba J R, Basterra J
Valencia University General Hospital, ENT Department, Valencia Medical School, Valencia, Spain.
Auris Nasus Larynx. 2009 Jun;36(3):321-5. doi: 10.1016/j.anl.2008.07.007. Epub 2008 Sep 23.
Occasionally, after performing a cordectomy to treat a T1 glottic tumor, the pathologist does not detect carcinomatous cells in the surgical specimen. This study determined how often this happens and analyzed these cases to identify related variables.
Forty-six patients were studied. Data on patient age and gender, tumor T stage and macroscopic surface extension, device used (laser vs. microelectrode dissection (ME)), and presence/absence of a negative cordectomy were compiled. We performed excisional biopsies as a diagnostic procedure.
Tumor stage was carcinoma in situ (Cis; 11 cases), T1a (28 cases), or T1b (7 cases). Nineteen tumors were limited, and 27 were extensive. Twenty-one patients underwent laser surgery, and 25 had ME. There were 12, 21, 4, and 9 types II to V cordectomies, respectively. The pathologist reported 15 negative cordectomies (32.6%). Only tumor extension was significantly associated with a negative cordectomy (p=0.047).
In 32.6% of our cases, the excisional biopsy was diagnostic and therapeutic. This percentage rose to 52.6% in the cases of limited tumors. We recommend performing an excisional biopsy and limited resection of the surgical bed with ME or laser surgery. A pathologist can examine the margins to determine whether the resection should be extended. When choosing radiotherapy, it is better to first perform an incisional biopsy to obtain a diagnosis of carcinoma.
偶尔，在进行声带切除术治疗T1期声门肿瘤后，病理学家在手术标本中未检测到癌细胞。本研究确定了这种情况发生的频率，并对这些病例进行分析以确定相关变量。
对46例患者进行研究。收集患者的年龄和性别、肿瘤T分期和宏观表面扩展情况、使用的设备（激光与微电极切除术（ME））以及是否存在阴性声带切除术的数据。我们进行切除活检作为诊断程序。
肿瘤分期为原位癌（Cis；11例）、T1a（28例）或T1b（7例）。19个肿瘤为局限性，27个为广泛性。21例患者接受了激光手术，25例接受了ME手术。分别有12例、21例、4例和9例II至V型声带切除术。病理学家报告了15例阴性声带切除术（32.6%）。只有肿瘤扩展与阴性声带切除术显著相关（p=0.047）。
在我们的病例中，32.6%的切除活检具有诊断和治疗作用。在局限性肿瘤病例中，这一比例上升至52.6%。我们建议采用ME或激光手术进行切除活检并对手术床进行有限切除。病理学家可以检查切缘以确定是否应扩大切除范围。选择放疗时，最好先进行切开活检以确诊癌症。
