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Screening Laryngeal Dysplasia Using Gynecological Principles

Objective: 1) Devise a pilot study to develop a noninvasive laryngeal screening technique that could be used to detect lesions not readily visible to the unaided eye via a laryngoscope. 2) Extend the validity of the screening technique that is already accepted by the FDA for gynecological and oral cavity dysplasia. Method: Pilot study examining fresh laryngectomy specimens using chemiluminescent staining techniques was undertaken from July to December 2010 at our institution. Specimens were painted with an acetic acid solution and examined under lumenoscopic lighting. Normal appearing and aceto-white areas were biopsied. Results of HPV testing, cytology, and tissue analysis were compared. Results: Four (N = 4) total laryngectomy specimens from patients aged 40 to 81 years old (mean, 57 years) where examined with chemiluminescent staining techniques to detect dysplasia not readily visible. Preoperative cancer stages of these larynges ranged from T2 to T4. There were 3 men and 1 woman, 75% were smokers, and 50% used alcohol. High-risk HPV serotype 16 or 18 was found in 75% of specimens. Dilute acetic acid solution was successful in identifying dysplasia or invasive cancer not visble. HPV 16 stained more intensely than HPV 18. Cytobrush alone was not adequate to detect cells with HPV effect. Conclusion: There seems to be a role for a dilute acetic acid solution in the detection of laryngeal dysplasia. HPV-16 subtypes seem to produce a more dramatic staining pattern. High-risk subtypes found in 75% of laryngectomy specimens. Future research is needed to optimize the described technique.