title: Laryngeal preneoplastic lesions and cancer: challenging diagnosis. Qualitative literature review and meta-analysis.
abstract: BACKGROUND
  Multi-step cancerogenesis guides laryngeal cancer onset and it includes a wide variety of pre-cancerous lesions macroscopically challenging to identify and distinguish from initial cancerous foci.
  
  
  OBJECTIVE
  Different modalities of diagnostic techniques of laryngeal epithelial lesions exist and they do not offer a single system to make a differential diagnosis. Hence, this meta-analysis aimed to synthesize the validity of each single diagnostic tool to improve laryngeal patient management.
  
  
  METHODS
  A systematic review of literature was led searching for articles mentioning the following terms: larynx, laryngeal precancerous lesions, laryngeal cancer, white light (WL) endoscopy, stroboscopy, contact endoscopy (CE), autofluorescence (AF), ultrasound (US), narrow band imaging (NBI), computed axial tomography (CAT), magnetic resonance imaging (MRI), positron emission tomography (PET), CAT/PET. Then, a quantitative analysis was carried on for paper published after 2005 onward.
  
  
  RESULTS
  The search identified 7215 publications, of which 3616 published after 2005, with a final results of a total of 214 articles stratified and included by our selection criteria. 42 out of 214 articles were selected for quantitative synthesis. 25 out of 41 studies had a good quality score, 16 were fair.
  
  
  CONCLUSIONS
  A comprehensive overview of the most recent advances in laryngeal imaging technology combined with all of the information needed to interpret findings and manage patients with voice disorders can be found herein. Our flow-chart allows clinicians in risk-stratify patients and select proper examination modalities to provide appropriate care. Study limitations, together with possible clinical and research implications have been counted.
authors.affiliation: First Clinic of Otolaryngology, Head and Neck Surgery, Department of Translational Surgery and Medicine, University of Florence, Italy. Electronic address: mannelli.giuditta@gmail.com.
authors.forename: Giuditta
authors.initials: G
authors.lastname: Mannelli
authors.affiliation: Department of Statistics, Informatics and Application "G.Parenti", University of Florence, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Cecconi
authors.affiliation: First Clinic of Otolaryngology, Head and Neck Surgery, Department of Translational Surgery and Medicine, University of Florence, Italy.
authors.forename: Oreste
authors.initials: O
authors.lastname: Gallo
mesh_terms: D003937:Diagnosis, Differential; D006801:Humans; D007822:Laryngeal Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D007828:Laryngoscopy; D008279:Magnetic Resonance Imaging; D049268:Positron-Emission Tomography; D011230:Precancerous Conditions / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D014057:Tomography, X-Ray Computed
keywords: diagnostic imaging; laryngeal cancer; laryngeal lesions diagnosis; laryngeal precancerosis; meta-analysis; systematic review