Garofolo Sabrina, Piazza Cesare, Del Bon Francesca, Mangili Stefano, Guastini Luca, Mora Francesco, Nicolai Piero, Peretti Giorgio
Department of Otorhinolaryngology-Head and Neck Surgery, University of Genoa, Italy.
Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Italy
Ann Otol Rhinol Laryngol. 2015 Apr;124(4):294-8. doi: 10.1177/0003489414556082. Epub 2014 Oct 30.
The high rate of positive margins after transoral laser microsurgery (TLM) remains a matter of debate. This study investigates the effect of intraoperative narrow band imaging (NBI) examination on the incidence of positive superficial surgical margins in early glottic cancer treated by TLM.
Between January 2012 and October 2013, 82 patients affected by Tis-T1a glottic cancer were treated with TLM by type I or II cordectomies. Intraoperative NBI evaluation was performed using 0-degree and 70-degree rigid telescopes. Surgical specimens were oriented by marking the superior edge with black ink and sent to a dedicated pathologist. Comparison between the rate of positive superficial margins in the present cohort and in a matched historical control group treated in the same way without intraoperative NBI was calculated by chi-square test.
At histopathological examination, all surgical margins were negative in 70 patients, whereas 7 had positive deep margins, 2 close, and 3 positive superficial margins. The rate of positive superficial margins was thus 3.6% in the present group and 23.7% in the control cohort (P<.001).
Routine use of intraoperative NBI increases the accuracy of neoplastic superficial spreading evaluation during TLM for early glottic cancer.
经口激光显微手术（TLM）后切缘阳性率较高仍存在争议。本研究探讨术中窄带成像（NBI）检查对TLM治疗早期声门癌浅表手术切缘阳性率的影响。
2012年1月至2013年10月，82例Tis-T1a声门癌患者接受了I型或II型声带切除术的TLM治疗。术中使用0度和70度硬性望远镜进行NBI评估。手术标本通过用黑色墨水标记上缘进行定向，并送交给专门的病理学家。通过卡方检验计算本队列与未进行术中NBI的匹配历史对照组的浅表切缘阳性率之间的差异。
在组织病理学检查中，70例患者的所有手术切缘均为阴性，而7例深部切缘阳性，2例切缘接近，3例浅表切缘阳性。因此，本组浅表切缘阳性率为3.6%，对照组为23.7%（P<0.001）。
术中常规使用NBI可提高TLM治疗早期声门癌时肿瘤浅表扩散评估的准确性。
