Approach to larynx dysplasia

INTRODUCTION The aim of this study is to identify the management and follow-up strategies for the patients with larynx dysplasia. Generally, dysplasia is one of the important subjects that has not reached a consensus enough for the larynx illnesses. Important efforts have been made to associate with dysplasia patients' histopathologic image and clinical course. In this study, the clinical courses of the patients classified histopathologically according to WHO's dysplasia system and locoregional control ratios were compared statistically and patients' invasive carcinoma progression ratio was identified. Moreover, the efficiency of treatment methods applied to the patients were investigated and discussed by taking the alternative treatment methods in the literature into consideration. METHOD The study group is composed of 59 dysplasia patients histopathlogically diagnosed retrospective research results and operated between 2008 and 2014 in SEAH. The patients' dysplasia status, follow-up time ande applied operation method were identified by scanning operation dates, pathologic reports and laryngoscopic records. When the progression of invasive carcinoma in patients was identified, its exact time was recorded and accordingly Kaplan Meier survival curve was drawed. RESULTS In 9 of 59 patients, invasive carcinoma progression observed. In 2 of 25 mild dysplasia patients, in 3 of 16 severe dysplasia patients and in 4 of 5 CIS patients, the progression of invasive carcinoma was observed. In mild dysplasia patients 18,5 months, in severe dysplasia patients mean 12months, in CIS patients mean 6,7 months, the progression of invasive carcinoma was seen. In none of the 13 patients with hyperplastic larynx lesions (parakeratosis, acantosiz,hyperceratosis), the development of invasive carsinoma was observed.Considering patients' operation methods, partial stribingand follow-up to 38 patients, total stribing and follow-up to 21 patients were performed. Considering the follow-up results, 12 of 36 partial stribing patients had lesions requiring rebiopsy but this number was 13 in 26 total stribing patients. While 9 of 11 patients progressed invasive carcinoma were partial stribing biopsy patients before, this number was only 2 in patients applied stribing. CONCLUSİONS We observed that the progression of invasive carcinoma in CIS patients was highly aggressive when compared to other dysplasia patients. In addition, the malign progression ratio in severe dysplasia patients was no significantly high when compared to mild dysplasia patients. However, there was significiant difference between 3 groups with regard to invasive carcinoma progression time. When we viewed the biopsy methods, we realized that the invasive carcinoma ratio significantly high in rebiopsy of the patients made partial biopsy. When we compared with literature, we observed that the ratio of invasive carcinoma development was smilar to our study, but the time of invasive carsinoma development was shorter than literature