Depth of Invasion Predicts Vocal Fold Motility and Muscle Invasion in Glottic Carcinoma
In brief
Tumor depth >2 mm predicts impaired vocal motion and muscle invasion
In a study of 262 glottic squamous cell cancers, a radiologic depth of invasion greater than 2.1 mm accurately identified patients with reduced vocal-fold mobility and confirmed muscle infiltration, with validation in an external cohort showing 85-94% sensitivity and 76-83% specificity. These objective measurements could replace subjective mobility assessment in future staging, though prospective outcome data are still needed.
- Journal
- The Laryngoscope (Q1)
- Published
- 31 July 2026
- Study design
- Unclassified
- Evidence level
- Level 5, Expert Opinion (CEBM 5)
- Authors
- Elisa Bellini, Claudio Sampieri, Francesco Chu, Marta Filauro, Monica Feltri, Maurizio Boggio, et al.
- PMID
- 42538586
- DOI
- 10.1002/lary.70784
Why clinicians should know about it
- Picked for Pathology and Forensic Medicine (paper of the day, 2 August 2026).
Abstract
OBJECTIVE: Vocal fold motility guides staging of glottic squamous cell carcinoma (SCC) but is subjective and operator dependent. Because impaired mobility reflects tumor depth of invasion (DOI) into the vocal muscle and paraglottic space, objective DOI measurement may better capture aggressiveness and functional impairment. This two-stage study assessed radiologic-pathologic agreement of DOI, derived pathologic DOI (pDOI) thresholds for altered motility and deep muscle infiltration, and externally validated these thresholds, aiming to support a more reproducible staging surrogate. METHODS: Surgically treated glottic SCC from Ospedale Policlinico San Martino (Genoa, Italy) formed the derivation cohort; external validation was performed at the European Institute of Oncology (Milan, Italy). Outcomes included correlation/agreement between radiologic DOI (rDOI) and pDOI, and between pathologic depth of vocal muscle invasion (pDMI). Spearman's ρ, Bland-Altman analysis, and Lin's concordance correlation coefficient (CCC) assessed agreement. ROC analysis (Youden index), likelihood ratios, and Fagan nomograms evaluated diagnostic performance and clinically meaningful thresholds. RESULTS: In 262 derivation cases, rDOI strongly correlated with pDOI (ρ = 0.75; CCC = 0.824). pDOI predicted altered vocal fold motility (AUC 0.725; cutoff 2.1 mm) and accurately predicted muscle invasion (AUC 0.94; cutoff 2.2 mm), whereas pDMI showed moderate prediction of motility (AUC 0.69). In 38 validation cases, correlation remained significant (ρ = 0.56; CCC = 0.56), and Genoa-derived DOI cutoffs were reproducible (sensitivity 85%-94%, specificity 76%-83%). CONCLUSIONS: DOI provides a robust, objective surrogate of functional impairment and muscle infiltration in glottic SCC, with externally validated thresholds that may complement or replace subjective mobility assessment in future staging algorithms.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.