Malignant Transformation in Glottic Dysplasia Treated With Photoangiolytic LASER – A Systematic Review and Meta-analysis



      This systematic review and meta-analysis seeks to characterize the rate of malignant progression among patients with laryngeal dysplasia treated with photoangiolytic laser and compare to prior systematic reviews of conventional surgical approaches.


      OVIDMedline, Pubmed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Google Scholar were searched, including terms related to patients with vocal fold dysplasia who were treated by angiolytic laser ablation. Some articles already known to authors or identified through hand searching were included.


      Six articles with 155 cases were included. Two studies used potassium titanyl phosphate exclusively, one solely used the pulsed dye laser, and three studies utilized both laser types during the study period. The pooled overall mean of malignant progression for patients with laryngeal dysplasia treated with photoangiolytic laser was 12%, as calculated by conducting a meta-analysis of single arm proportion.


      Laryngeal dysplasia is a premalignant lesion which confers a risk of progression to malignancy. After biopsy to establish the diagnosis there are multiple surgical techniques available for treatment with the goal of lesion eradication and voice preservation. In our review, there is a low malignant transformation rate for patients treated via with photoangiolytic laser.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Voice
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Shanmugaratnam K
        • Sobin L.
        Histological Typing of Tumours of the Upper Respiratory Tract and Ear. 2nd ed. Springer-Verlag, New York, New York1991: 10-13
        • Hellquist H
        • Lundgren J
        • Olofsson J.
        Hyperplasia, keratosis, dysplasia and carcinoma in situ of the vocal cords–a follow-up study.
        Clin Otolaryngol Allied Sci. 1982; 7: 11-27
        • Mehanna H
        • Paleri V
        • Robson A
        • et al.
        Consensus statement by otorhinolaryngologists and pathologists on the diagnosis and management of laryngeal dysplasia.
        Clin Otolaryngol. 2010; 35: 170-176
        • Franco RA
        • Farinelli WA
        • Zeitels SM
        • et al.
        585-NM pulsed dye laser treatment of glottal dysplasia.
        Ann Otol Rhinol Laryngol. 2003; 112: 751-758
        • Zeitels S
        • Burns J
        • Lopez-Guerra G
        • et al.
        Photoangiolytic laser treatment of early glottic cancer: a new management strategy.
        Ann Otol Rhinol Laryngol. 2008; 199: 3-24
        • Weller MD
        • Nankivell PC
        • McConkey C
        • et al.
        The risk and interval to malignancy of patients with laryngeal dysplasia; a systematic review of case series and meta-analysis.
        Clin Otolaryngol. 2010; 35: 364-372
        • Karatayli-Ozgursoy S
        • Pacheco-Lopez P
        • Hillel AT
        • et al.
        Laryngeal dysplasia, demographics, and treatment: a single-institution, 20-year review.
        JAMA Otolaryngol - Head Neck Surg. 2015; 141: 313-318
        • Page MJ
        • McKenzie JE
        • Bossuyt PM
        • et al.
        The PRISMA 2020 statement: an updated guideline for reporting systematic reviews.
        BMJ. 2021; 372: n71
        • Ouzzani M
        • Hammady H
        • Fedorowicz Z
        • et al.
        Rayyan-a web and mobile app for systematic reviews.
        Syst Rev. 2016; 5
      1. Study Quality Assessment Tools. National Heart, Lung and Blood Institute. Available at: Accessed July 3, 2021.

        • Von Hippel PT.
        The heterogeneity statistic I2 can be biased in small meta-analyses.
        BMC Med Res Methodol. 2015; 15: 35
        • Strieth S
        • Ernst BP
        • Both I
        • et al.
        Randomized controlled single-blinded clinical trial of functional voice outcome after vascular targeting KTP laser microsurgery of early laryngeal cancer.
        Head Neck. 2019; 41: 899-907
        • Zeitels S
        • Akst L
        • Burns J
        • et al.
        Office-based 532-nm pulsed KTP laser treatment of glottal papillomatosis and dysplasia.
        Ann Otol Rhinol Laryngol. 2006; 115: 679-685
        • Park YM
        • Jo KH
        • Hong HJ
        • et al.
        Phonatory outcome of 585 nm/pulsed-dye laser in the management of glottic leukoplakia.
        Auris Nasus Larynx. 2014; 41: 459-463
        • Kishimoto Y
        • Suzuki R
        • Kawai Y
        • et al.
        Photocoagulation therapy for laryngeal dysplasia using angiolytic lasers.
        Eur Arch Oto-Rhino-Laryngology. 2016; 273: 1221-1225
        • Lim JY
        • Park YM
        • Kang M
        • et al.
        Angiolytic laser stripping versus CO2 laser microflap excision for vocal fold leukoplakia: long-term disease control and voice outcomes.
        PLoS One. 2018; 13e0209691
        • Koufman JA
        • Rees CJ
        • Frazier WD
        • et al.
        Office-based laryngeal laser surgery: a review of 443 cases using three wavelengths.
        Otolaryngol - Head Neck Surg. 2007; 137: 146-151
        • Nouraei SAR
        • Dorman EB
        • Macann A
        • et al.
        Outcomes of treating early glottic neoplasms with a potassium titanyl phosphate laser.
        Ann Otol Rhinol Laryngol. 2019; 128: 85-95
        • Koss SL
        • Baxter P
        • Panossian H
        • et al.
        Serial in-office laser treatment of vocal fold leukoplakia: disease control and voice outcomes.
        Laryngoscope. 2017; 127: 1644-1651
        • Lahav Y
        • Cohen O
        • Shapira-Galitz Y
        • et al.
        CO2 Laser cordectomy versus KTP Laser tumor ablation for early glottic cancer: a randomized controlled trial.
        Lasers Surg Med. 2020; 52: 612-620
        • Santeerapharp A
        • Song SA
        • Woo P
        • et al.
        Long-term outcomes of aminolevulinic acid photodynamic therapy for treatment of recalcitrant laryngeal premalignant lesions.
        Clin Otolaryngol. 2022; 47: 153-159
        • Isenberg JS
        • Crozier DL
        • Dailey SH.
        Institutional and comprehensive review of laryngeal leukoplakia.
        Ann Otol Rhinol Laryngol. 2008; 117: 74-79
        • Friedman AD
        • Hillman RE
        • Landau-Zemer T
        • et al.
        Voice outcomes for photoangiolytic KTP laser treatment of early glottic cancer.
        Ann Otol Rhinol Laryngol. 2013; 122: 151-158