Serial full-thickness excision of XXXX : Diagnostic or therapeutic?

@entity1 @entity5 @entity189 @entity3 @entity12120 @entity3746 @entity285 @entity1141
OBJECTIVES/HYPOTHESIS: A previous study proposed that serial full-thickness excisional biopsies of vocal fold @entity12120 therapeutically decreased @entity1141 grade. The current investigation aimed to 1) analyze the pathological evolution and natural history of these lesions and 2) re-examine the role of serial excisions in @entity1141 grade regression in long-term follow-up. STUDY DESIGN: Retrospective case series. METHODS: @entity1 treated for @entity3746 (1994-2013) with serial full-thickness microflap-type excisions were identified and followed longitudinally. Excluded were those with one excision, @entity3 at initial excision, or history of @entity5 or radiation. Data from surgical procedures, associated pathology, and @entity1 characteristics were recorded. Weighted repeated measures ordinal logistic regression measured associations with pathology findings. RESULTS: Of 55 @entity1 (median age   =   65 years, interquartile range   =   54-73 years, 89% male, 63% ever smokers, 27% @entity285 users), 31 met inclusion criteria. During the study period, @entity1 had two to 44 excisions, with a median time between excisions of 4.0 months. Each additional excision increased odds of higher-grade pathology by 4% (odds ratio   =   1.04, 95% confidence interval   =   1.01-1.06; P   =   .007). A transition model demonstrated that @entity1 with moderate @entity1141 , severe @entity1141 , or @entity189 in situ on a prior biopsy had 2.64-, 5.64-, and 8.73-times increased odds of the same or higher pathology grade at the next excision, respectively. CONCLUSIONS: Data do not support the hypothesis that serial full-thickness excisions decrease @entity1141 grade. Progression of @entity1141 appears to be nonlinear, but higher-grade @entity1141 is more likely to progress to @entity5 . LEVEL OF EVIDENCE: 4 Laryngoscope, 2015.
