The reliability of biopsy-determined grading in laryngeal squamous cell carcinoma

Grading evaluation is becoming increasingly more important in establishing a valid prognosis and in the choice of therapeutical strategies in dealing with squamous laryngeal cancer. It follows, therefore, that grading of bioptic tissue, made before therapy planning, must offer reliable data and correspond to data gathered through grading of the entire neoplasm. Thus the aim of our study carried out on 267 cases was to verify if grading of bioptic tissue corresponds to that of the operatory specimen. In 7% of the cases (19 in 267) bioptic grading overestimated the neoplasm in that post-operatory grading revealed a less differentiated form. On the contrary, in 16% of the cases (43 in 267) bioptic grading underestimated the form since as post-operatory grading showed a more highly differentiated form. It appears clear that these values depend on the clinical extension of the neoplasm in that the difference was inferior in the case of limited neoplasms and greater in that more largely extended ones. Generally speaking then, the less extended the neoplasm (the most frequently observed clinical form), the more coinciding the bioptic evaluation indicating good differentiation with the post-operatory evaluation. On the other hand, bioptic evaluation indicating moderate or poor differentiation is less reliable since it does not coincide with findings in approximately 16% of the neoplasms, above all those most limited (12%). This means that any reductive adoption of therapy planning made on the basis of the degree of differentiation revealed upon bioptic examination is possible only in the case of those forms more advanced with regard to extension.