Objective: To assess the sensitivity and specificity of larngovideostroboscopy (LVS) in the diagnosis of precancerous and malignant lesions of the vocal folds. Material and methods: In 175 patients (128 men and 47 women), aged 19-88 years, mean age 61.5, who were admitted to the clinic with diagnosed premalignant conditions of vocal fold mucosa (leukoplakia, chronic hypertrophic inflammatory lesions) and thickening or tumor on the vocal fold, there was performed LVS before the laryngeal microsurgery. The LVS study included: localization of the leasion, movement of the vocal folds, mucosal wave, shape of glottis clousure, amplitude and symmetry of vocal fold vibration. In the evaluation, a point scale was applied for the individual functional parameters. The scale ranged from 0 to 14. Patients with impaired vocal fold motion or absent mucosal wave were positive on LVS for malignant lesions. Those with limitted mucosal wave were positive on LVS for dysplastic lesions. The results were compared with the final histopathological examination and the sensitivity, specificity, accuracy, positive (PPV) and negative (NPV) predictive value were calculated. Results: On the basis of histopathological examination, benign lesions (normal or inflammatory mucosa) accounted for 20% of diagnoses, hypertrophy and parakeratosis for 28%, low and middle grade dysplasia accounted for 10% and malignant lesions (high-grade dysplasia, pre-invasive cancer, Invasive cancer) was diagnosed in 42% of patients. The overall mean score for LVS was 4.5 and 8.0, respectively for benign and malignant lesions. Sensitivity, specificity, accuracy, PPV and NPV of LVS in detecting malignant lesions were respectively - 95.6%, 23.8%, 61.1%, 57.6% and 83.3% and in detecting both premalignant and malignant lesions were respectively – 90.7%, 31.4%, 78.9%, 84.1% and 45.8%. Conclusions: Because of the high sensitivity of LVS in detecting precancerous and malignant lesions, this method is a very good tool for screening of pathology within the larynx.
Objective: To assess the sensitivity and specificity of larngovideostroboscopy (LVS) in the diagnosis of precancerous and malignant lesions of the vocal folds. Material and methods: In 175 patients (128 men and 47 women), aged 19-88 years, mean age 61.5, who were admitted to the clinic with diagnosed premalignant conditions of vocal fold mucosa (leukoplakia, chronic hypertrophic inflammatory lesions) and thickening or tumor on the vocal fold, there was performed LVS before the laryngeal microsurgery. The LVS study included: localization of the leasion, movement of the vocal folds, mucosal wave, shape of glottis clousure, amplitude and symmetry of vocal fold vibration. In the evaluation, a point scale was applied for the individual functional parameters. The scale ranged from 0 to 14. Patients with impaired vocal fold motion or absent mucosal wave were positive on LVS for malignant lesions. Those with limitted mucosal wave were positive on LVS for dysplastic lesions. The results were compared with the final histopathological examination and the sensitivity, specificity, accuracy, positive (PPV) and negative (NPV) predictive value were calculated. Results: On the basis of histopathological examination, benign lesions (normal or inflammatory mucosa) accounted for 20% of diagnoses, hypertrophy and parakeratosis for 28%, low and middle grade dysplasia accounted for 10% and malignant lesions (high-grade dysplasia, pre-invasive cancer, Invasive cancer) was diagnosed in 42% of patients. The overall mean score for LVS was 4.5 and 8.0, respectively for benign and malignant lesions. Sensitivity, specificity, accuracy, PPV and NPV of LVS in detecting malignant lesions were respectively - 95.6%, 23.8%, 61.1%, 57.6% and 83.3% and in detecting both premalignant and malignant lesions were respectively – 90.7%, 31.4%, 78.9%, 84.1% and 45.8%. Conclusions: Because of the high sensitivity of LVS in detecting precancerous and malignant lesions, this method is a very good tool for screening of pathology within the larynx.
Primary vaginal cancer is a rare disease constituting approximately 2% of gynaecological malignancies. Most vaginal cancers are in fact metastases from adjacent organs, mostly cervix and vulva and, much less frequently, bladder, sigmoid colon or rectum. Major part (80%) of primary vaginal cancers are squamous cell carcinomas located usually in the upper 1/3 of the vagina. Little is known about aetiology of this tumour. The patients’ age range is wide with preinvasive lesions affecting predominantly the younger age group. VAINlesions are mostly asymptomatic and are first detected by an abnormal PAP-smear. Location of the lesion can be defined by colposcopy. Surgical excision or ablation of atypical epithelium using CO2 laser or radiation therapy are usually highly effective. It is probably unnecessary to treat VAIN 1 and VAIN 2 lesions unless they are persistent. All VAIN 3-lesions should be actively treated. In the case of histologically proven cancer, radiotherapy combining external and internal sources of radiation is the treatment of choice in most centres. In young women the key issue is to prevent radiation-induced castration. Recent studies show that conservative treatment options sparing reproductive and sexual function in young women at an early stage of the disease are feasible and effective. In more advanced stages radiation therapy is indicated, but survival rates obtained are worse than in cervical cancer patients. Tumour morphology, grade and stage are important prognostic factors. Common background factors with no prognostic significance are prior hysterectomy, other gynaecological malignancies and pelvic irradiation. Better understanding of prognostic factors and biologic tumor markers may help to discriminate between low- and high-grade tumours and to develop guidelines for tayloring tumour- and patient-specific therapies.
PL
Pierwotny rak pochwy jest rzadko występującym nowotworem, stanowiącym około 2% wszystkich nowotworów złośliwych narządu rodnego. Większość przypadków raka pochwy to de facto przerzuty z sąsiednich narządów, najczęściej z szyjki macicy, sromu, a rzadziej z pęcherza, okrężnicy esowatej i odbytnicy. Mniej więcej w 80% przypadków jest to rak płaskonabłonkowy, zlokalizowany zazwyczaj w górnej 1/3 pochwy. Etiologia tego nowotworu nie jest do końca poznana. Występuje on u pacjentek w szerokim przedziale wiekowym, przy czym postacie przedinwazyjne stwierdza się głównie u kobiet młodszych. Zmiany typu VAIN (pochwowe nowotworzenie śródnabłonkowe) są zwykle bezobjawowe, najczęściej rozpoznaje się je na podstawie nieprawidłowego wyniku badania cytologicznego metodą Papanicolaou. W celu lokalizacji zmiany wykonuje się badanie kolposkopowe. Do skutecznych metod leczniczych zalicza się chirurgiczne usunięcie zmienionego nabłonka, zabieg przy użyciu lasera CO2 i radioterapię. Leczenie zmian w stadium VAIN 1 i VAIN 2 prawdopodobnie nie jest konieczne, z wyjątkiem przypadków długotrwale utrzymujących się, natomiast zmiany w stadium VAIN 3 należy aktywnie leczyć. W większości przypadków histologicznie potwierdzonego raka pochwy leczeniem z wyboru stosowanym w licznych ośrodkach jest radioterapia z zastosowaniem kombinacji źródeł zewnętrznych i wewnętrznych. Ważnym aspektem terapii, szczególnie u kobiet młodych, jest zapobieganie popromiennej kastracji. Badania wykazały, że nowe strategie terapeutyczne oszczędzające funkcje rozrodcze i płciowe u kobiet w młodszym przedziale wiekowym, u których zdiagnozowano raka płaskonabłonkowego górnej części pochwy we wczesnej fazie choroby, są możliwe do przeprowadzenia i skuteczne. W bardziej zaawansowanym stadium choroby, podobnie jak u pacjentek z rakiem szyjki macicy, wskazana jest radioterapia, jednak uzyskiwane wskaźniki przeżywalności są gorsze niż u chorych na raka szyjki. Ważnymi czynnikami prognostycznymi są: morfologia guza, jego stopień złośliwości i stadium zaawansowania klinicznego. Często cytowane czynniki, niemające znaczenia rokowniczego, obejmują: stan po histerektomii, współistnienie innych nowotworów narządu rodnego i stan po napromienieniu miednicy. Znajomość czynników prognostycznych i rosnąca wiedza o dodatkowych markerach biologicznych mogą być pomocne w różnicowaniu przypadków o wysokiej i niskiej złośliwości oraz w indywidualizacji leczenia, które będzie uwzględniało zarówno potrzeby pacjenta, jak i cechy nowotworu.
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