Pathological examination of cordectomy specimens: analysis of negative resection.
OBJECTIVE
Occasionally, after performing a cordectomy to treat a T1 glottic tumor, the pathologist does not detect carcinomatous cells in the surgical specimen. This study determined how often this happens and analyzed these cases to identify related variables.


METHODS
Forty-six patients were studied. Data on patient age and gender, tumor T stage and macroscopic surface extension, device used (laser vs. microelectrode dissection (ME)), and presence/absence of a negative cordectomy were compiled. We performed excisional biopsies as a diagnostic procedure.


RESULTS
Tumor stage was carcinoma in situ (Cis; 11 cases), T1a (28 cases), or T1b (7 cases). Nineteen tumors were limited, and 27 were extensive. Twenty-one patients underwent laser surgery, and 25 had ME. There were 12, 21, 4, and 9 types II to V cordectomies, respectively. The pathologist reported 15 negative cordectomies (32.6%). Only tumor extension was significantly associated with a negative cordectomy (p=0.047).


CONCLUSIONS
In 32.6% of our cases, the excisional biopsy was diagnostic and therapeutic. This percentage rose to 52.6% in the cases of limited tumors. We recommend performing an excisional biopsy and limited resection of the surgical bed with ME or laser surgery. A pathologist can examine the margins to determine whether the resection should be extended. When choosing radiotherapy, it is better to first perform an incisional biopsy to obtain a diagnosis of carcinoma.
Zapater
E
E
Valencia University General Hospital, ENT Department, Valencia Medical School, Valencia, Spain. ezapaterlatorre@yahoo.es
Hernández
R
R
Reboll
R
R
Pérez
A
A
Alba
J R
JR
Basterra
J
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D002278:Carcinoma in Situ / Q000473:pathology* / Q000601:surgery*; D005260:Female; D005931:Glottis / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D007822:Laryngeal Neoplasms / Q000473:pathology* / Q000601:surgery*; D007825:Laryngectomy / Q000379:methods*; D053685:Laser Therapy / Q000379:methods; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D014827:Vocal Cords / Q000473:pathology* / Q000601:surgery*; D055815:Young Adult