Eckel Hans Edmund, Simo Ricard, Quer Miquel, Odell Edward, Paleri Vinidh, Klussmann Jens Peter, Remacle Marc, Sjögren Elisabeth, Piazza Cesare
Department of Oto-Rhino-Laryngology, Klagenfurt General Hospital, Klagenfurt am Wörthersee, Austria.
Department of Otorhinolaryngology Head and Neck Surgery, Guy's and St Thomas' Hospital, London, UK.
Eur Arch Otorhinolaryngol. 2021 Jun;278(6):1723-1732. doi: 10.1007/s00405-020-06406-9. Epub 2020 Oct 14.
To give an overview of the current knowledge regarding the diagnosis, treatment, and follow-up of laryngeal dysplasia (LD) and to highlight the contributions of recent literature. The diagnosis of LD largely relies on endoscopic procedures and on histopathology. Diagnostic efficiency of endoscopy may be improved using videolaryngostroboscopy (VLS) and bioendoscopic tools such as Narrow Band Imaging (NBI) or Storz Professional Image Enhancement System (SPIES). Current histological classifications are not powerful enough to clearly predict the risk to carcinoma evolution and technical issues such as sampling error, variation in epithelial thickness and inflammation hamper pathological examination. Almost all dysplasia grading systems are effective in different ways. The 2017 World Health Organization (WHO) system should prove to be an improvement as it is slightly more reproducible and easier for the non-specialist pathologist to apply. To optimize treatment decisions, surgeons should know how their pathologist grades samples and preferably audit their transformation rates locally. Whether carcinoma in situ should be used as part of such classification remains contentious and pathologists should agree with their clinicians whether they find this additional grade useful in treatment decisions. Recently, different studies have defined the possible utility of different biomarkers in risk classification. The main treatment modality for LD is represented by transoral laser microsurgery. Radiotherapy may be indicated in specific circumstances such as multiple recurrence or wide-field lesions. Medical treatment currently does not have a significant role in the management of LD. Follow-up for patients treated with LD is a fundamental part of their care and investigations may be supported by the same techniques used during diagnosis (VLS and NBI/SPIES).
概述目前关于喉发育异常（LD）的诊断、治疗及随访的知识，并突出近期文献的贡献。LD的诊断很大程度上依赖于内镜检查和组织病理学检查。使用视频喉镜频闪检查（VLS）以及窄带成像（NBI）或史托斯专业图像增强系统（SPIES）等生物内镜工具，可提高内镜检查的诊断效率。目前的组织学分类在明确预测癌变风险方面不够有力，诸如采样误差、上皮厚度变化及炎症等技术问题妨碍了病理检查。几乎所有发育异常分级系统都以不同方式发挥作用。2017年世界卫生组织（WHO）系统应会有所改进，因为它的可重复性略高，且非专科病理学家应用起来更容易。为优化治疗决策，外科医生应了解其病理学家如何对样本进行分级，最好在当地审核样本的转化率。原位癌是否应作为此类分类的一部分仍存在争议，病理学家应与临床医生就他们是否认为这一额外分级对治疗决策有用达成一致。最近，不同研究确定了不同生物标志物在风险分类中的可能效用。LD的主要治疗方式为经口激光显微手术。在特定情况下，如多次复发或广泛病变，可能需要放疗。目前药物治疗在LD的管理中作用不大。对接受LD治疗的患者进行随访是其护理的重要组成部分，诊断期间使用的相同技术（VLS和NBI/SPIES）可辅助进行检查。
