A New Strategy for Endoscopic Staging of Laryngeal Carcinoma: Multistep Endoscopy

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.