{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T23:21:25Z","timestamp":1779924085030,"version":"3.53.1"},"reference-count":25,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2020,8,4]],"date-time":"2020-08-04T00:00:00Z","timestamp":1596499200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: The endoscopic appearance of glottic erythroleukoplakias is non-predictive of their histopathology, potentially ranging from keratosis to invasive squamous cell carcinoma (SCC). The aim of this study was to assess a comprehensive workup for the one-step diagnosis and treatment of mid-cord erythroleukoplakias, using CO2 laser excisional biopsy. Methods: We evaluated 147 untreated patients affected by 155 mid-cord erythroleukoplakias submitted to excisional biopsy by subepithelial (Type I) or subligamental cordectomy (Type II), across two academic institutions. Patients were evaluated by preoperative videolaryngostroboscopy, pre- and intraoperative videoendoscopy with biologic endoscopy (narrow band imaging, NBI, or the Storz professional image enhancement system, SPIES), either with or without intraoperative saline infusion into the Reinke\u2019s space. Adequacy of treatment was the primary outcome. Results: The histopathologic diagnosis was keratosis in 26 (17%) cases, squamous intraepithelial neoplasia (SIN1-2) in 47 (30%), carcinoma in situ in 21 (14%), and SCC in 61 (39%) patients. The adequacy of treatment across the entire cohort was 89%. The intraoperative saline infusion procedure, facing not clearly suspicious lesions, raised the adequacy of treatment from 60% to 90% (p = 0.006). Conclusions: Excisional biopsy by Type I\u2013II cordectomies, after a comprehensive diagnostic workup, should be accepted as an adequate and cost-effective treatment of unilateral mid-cord glottic erythroleukoplakias.<\/jats:p>","DOI":"10.3390\/cancers12082165","type":"journal-article","created":{"date-parts":[[2020,8,4]],"date-time":"2020-08-04T10:45:17Z","timestamp":1596537917000},"page":"2165","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Laryngeal Mid-Cord Erythroleukoplakias: How to Modulate the Transoral CO2 Laser Excisional Biopsy"],"prefix":"10.3390","volume":"12","author":[{"given":"Francesco","family":"Mora","sequence":"first","affiliation":[{"name":"IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy"},{"name":"Department of Surgical Sciences and Integrated Diagnostics (DISC), Unit of Otorhinolaryngology, University of Genoa, 16132 Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0125-6588","authenticated-orcid":false,"given":"Filippo","family":"Carta","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2014Head and Neck Surgery, University of Cagliari, 09124 Cagliari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5357-5348","authenticated-orcid":false,"given":"Francesco","family":"Missale","sequence":"additional","affiliation":[{"name":"IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy"},{"name":"Department of Molecular and Translational Medicine, University of Brescia, 25121 Brescia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5532-3937","authenticated-orcid":false,"given":"Andrea","family":"Laborai","sequence":"additional","affiliation":[{"name":"Department of Surgical Sciences and Integrated Diagnostics (DISC), Unit of Otorhinolaryngology, University of Genoa, 16132 Genoa, Italy"},{"name":"Department of Otorhinolaryngology, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giampiero","family":"Parrinello","sequence":"additional","affiliation":[{"name":"IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cesare","family":"Piazza","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Maxillofacial and Thyroid Surgery, Fondazione IRCCS, National Cancer Institute of Milan, 20133 Milan, Italy"},{"name":"Department of Oncology and Oncohematology, University of Milan, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Puxeddu","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2014Head and Neck Surgery, University of Cagliari, 09124 Cagliari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giorgio","family":"Peretti","sequence":"additional","affiliation":[{"name":"IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy"},{"name":"Department of Surgical Sciences and Integrated Diagnostics (DISC), Unit of Otorhinolaryngology, University of Genoa, 16132 Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,8,4]]},"reference":[{"key":"ref_1","unstructured":"EI-Naggar, A.K., Chan, J.K.C., Grandis, J.R., Takata, T., and Slootweg, P.J. (2017). WHO Classification of Head and Neck Tumors, International Agency for Research on Cancer. [4th ed.]."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1136\/jclinpath-2015-203308","article-title":"miR-19a and SOCS-1 expression in the differential diagnosis of laryngeal (glottic) verrucous squamous cell carcinoma","volume":"69","author":"Marioni","year":"2016","journal-title":"J. Clin. Pathol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1276","DOI":"10.1288\/00005537-199410000-00017","article-title":"Endoscopic laser excisional biopsy for selected glottic carcinomas","volume":"104","author":"Peretti","year":"1994","journal-title":"Laryngoscope"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1007\/s004050050228","article-title":"Endoscopic cordectomy. A proposal for a classification by the working committee, European Laryngological Society","volume":"257","author":"Remacle","year":"2000","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1007\/s00405-007-0279-z","article-title":"Proposal for revision of the European Laryngological Society classification of endoscopic cordectomies","volume":"264","author":"Remacle","year":"2007","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1097\/MOO.0b013e32835908ac","article-title":"Narrow band imaging in endoscopic evaluation of the larynx","volume":"20","author":"Piazza","year":"2012","journal-title":"Curr. Opin. Otolaryngol. Head Neck Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"479","DOI":"10.6004\/jnccn.2018.0026","article-title":"NCCN Guidelines Insights: Head and Neck Cancers, Version 1. 2018","volume":"16","author":"Colevas","year":"2018","journal-title":"J. Natl. Compr. Cancer Netw."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1454","DOI":"10.6004\/jnccn.2014.0142","article-title":"Head and neck cancers, version 2.2014","volume":"12","author":"Pfister","year":"2014","journal-title":"J. Natl. Compr. Cancer Netw."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1007\/s00405-003-0584-0","article-title":"Pre- and intraoperative assessment of mid-cord erythroleukoplakias: A prospective study on 52 patients","volume":"260","author":"Peretti","year":"2003","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1097\/MOO.0b013e328344b3ed","article-title":"Biologic endoscopy: Optimization of upper aerodigestive tract cancer evaluation","volume":"19","author":"Piazza","year":"2011","journal-title":"Curr. Opin. Otolaryngol. Head Neck Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1819","DOI":"10.1007\/s00405-018-4987-3","article-title":"Comparison of narrow band imaging and the Storz Professional Image Enhancement System for detection of laryngeal and hypopharyngeal pathologies","volume":"275","year":"2018","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1177\/0003489414556082","article-title":"Intraoperative narrow band imaging better delineates superficial resection margins during transoral laser microsurgery for early glottic cancer","volume":"124","author":"Garofolo","year":"2015","journal-title":"Ann. Otol. Rhinol. Laryngol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1177\/000348941212100407","article-title":"Subepithelial vocal fold infusion: A useful diagnostic and therapeutic technique","volume":"121","author":"Burns","year":"2012","journal-title":"Ann. Otol. Rhinol. Laryngol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"3723","DOI":"10.1007\/s00405-017-4708-3","article-title":"Laser-assisted surgery of the upper aero-digestive tract: A clarification of nomenclature. A consensus statement of the European Laryngological Society","volume":"274","author":"Remacle","year":"2017","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1207","DOI":"10.1007\/s00405-015-3851-y","article-title":"Proposal for a descriptive guideline of vascular changes in lesions of the vocal folds by the committee on endoscopic laryngeal imaging of the European Laryngological Society","volume":"273","author":"Arens","year":"2016","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1215","DOI":"10.1097\/00005537-200007000-00028","article-title":"Transoral CO2 laser for surgical management of glottic carcinoma in situ","volume":"110","author":"Damm","year":"2000","journal-title":"Laryngoscope"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"811","DOI":"10.1177\/000348940111000902","article-title":"Regression of laryngeal dysplasia after serial microflap excision","volume":"110","author":"Scheweinfurth","year":"2001","journal-title":"Ann. Otol. Rhinol. Laryngol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"923","DOI":"10.1002\/lary.25609","article-title":"Serial full-thickness excision of dysplastic vocal fold leukoplakia: Diagnostic or therapeutic?","volume":"126","author":"Ahn","year":"2016","journal-title":"Laryngoscope"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"298","DOI":"10.3389\/fonc.2018.00298","article-title":"Single stage transoral laser microsurgery for early glottic cancer","volume":"8","author":"Hamzany","year":"2018","journal-title":"Front. Oncol."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Davaris, N., Lux, A., Esmaeili, N., Illanes, A., Boese, A., Friebe, M., and Arens, C. (2020). Evaluation of vascular patterns using contact endoscopy and narrow-band imaging (CE-NBI) for the diagnosis of vocal fold malignancy. Cancers, 12.","DOI":"10.3390\/cancers12010248"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1600","DOI":"10.1002\/lary.25124","article-title":"Enhanced contact endoscopy for the detection of neoangiogenesis in tumors of the larynx and hypopharynx","volume":"125","author":"Puxeddu","year":"2015","journal-title":"Laryngoscope"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1016\/j.jvoice.2013.07.006","article-title":"Stroboscopy in detection of laryngeal dysplasia effectiveness and limitations","volume":"28","author":"Djukic","year":"2014","journal-title":"J. Voice"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1177\/000348940111000401","article-title":"Stroboscopic assessment of vocal fold keratosis and glottic cancer","volume":"110","author":"Colden","year":"2001","journal-title":"Ann. Otol. Rhinol. Laryngol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"820","DOI":"10.1177\/000348940111000904","article-title":"Oncological results of endoscopic resections of Tis and T1 glottic carcinomas by carbon dioxide laser","volume":"110","author":"Peretti","year":"2001","journal-title":"Ann. Otol. Rhinol. Laryngol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1177\/000348940311200212","article-title":"Vocal outcome after endoscopic cordectomies for Tis and T1 glottic carcinomas","volume":"112","author":"Peretti","year":"2003","journal-title":"Ann. Otol. Rhinol. Laryngol."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/12\/8\/2165\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T09:54:16Z","timestamp":1760176456000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/12\/8\/2165"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,8,4]]},"references-count":25,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2020,8]]}},"alternative-id":["cancers12082165"],"URL":"https:\/\/doi.org\/10.3390\/cancers12082165","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,8,4]]}}}