ENT Department, Martini Hospital, Turin, Italy.
Acta Otorhinolaryngol Ital. 2012 Jun;32(3):175-81.
At present, it is difficult to identify a gold standard for endoscopic staging of laryngeal cancer, especially considering the large number of endoscopic instruments available. We have coined the term multistep endoscopy to describe a method for staging laryngeal precancerous and neoplastic lesions that sequentially uses several endoscopic tools including high definition white light endoscopy (HDTV), stroboscopy and autofluorescence endoscopy. During the period from November 2007 to November 2009, 140 patients with a suspect laryngeal lesion underwent multistep endoscopy at the Department of Otorhinolaryngology at Martini Hospital in Turin. All patients were subjected to a series of endoscopic examinations in indirect laryngoscopy (white light endoscopy coupled to a HDTV camera, laryngostroboscopy, indirect autofluorescence) followed by white light endoscopy coupled to a HDTV camera and autofluorescence in direct microlaryngoscopy. The aim of the present prospective study was to evaluate the utility of multistep endoscopy in the diagnostic work-up of laryngeal lesions. Multistep endoscopy showed a higher sensitivity and "biological" predictive value in early cancer and precancerous lesions of the larynx (sensitivity, 97.9%; specificity, 90.5%) compared to individual endoscopic tools. It allows for better therapeutic planning of superficial lesions and more accurate orientation when performing mapping biopsies on diffuse lesions. In our opinion, more widespread use of indirect autofluorescence endoscopy during follow-up may be warranted to search for synchronous/metachronous second tumours of the upper aerodigestive tract.
目前，很难确定用于喉癌内镜分期的金标准，尤其是考虑到目前有大量的内镜仪器可供选择。我们创造了“多步骤内镜检查”一词，来描述一种用于分期喉癌前病变和肿瘤病变的方法，该方法依次使用多种内镜工具，包括高清白光内镜（HDTV）、频闪喉镜和自体荧光内镜。在 2007 年 11 月至 2009 年 11 月期间，140 例可疑喉病变患者在都灵 Martini 医院耳鼻喉科接受了多步骤内镜检查。所有患者均接受一系列间接喉镜检查（白光内镜联合高清摄像机、频闪喉镜、间接自体荧光），随后在直接显微喉镜下进行白光内镜联合高清摄像机和自体荧光检查。本前瞻性研究的目的是评估多步骤内镜在诊断喉病变中的应用价值。多步骤内镜检查在早期癌症和喉癌前病变（敏感性 97.9%，特异性 90.5%）中的敏感性和“生物学”预测值均高于单独的内镜工具。它可以更好地为浅层病变制定治疗计划，并在对弥漫性病变进行定位活检时提供更准确的方向。在我们看来，在随访中更广泛地使用间接自体荧光内镜可能是必要的，以寻找上呼吸道的同步/异时性第二肿瘤。
