Management of Laryngeal Premalignant Lesions in the Netherlands

Objectives/Hypothesis: To investigate the current clinical management of laryngeal mucosal premalignant lesions (LMPLs) among otorhinolaryngologists working in university hospitals (tertiary referral centers) and nonuniversity hospitals (secondary referral centers) in The Netherlands. Then to compare the investigated practice with the results published in the literature. Study Design: Cross-sectional study. Methods: A survey was conducted to assess the management of LMPLs. The questionnaire consisted of a systematic series of figures representing the initial presentation of a patient with a leukoplakic lesion at 12 different anatomical locations. The study group consisted of otorhinolaryngologists at all eight tertiary referral centers in The Netherlands (n = 22) and a random selection of otorhinolaryngologists (n = 25) from secondary referral centers throughout the country. Results: Comparing the initial management (surgical excision versus biopsy) preferred by otorhinolaryngologists at tertiary referral centers with that preferred by those at secondary referral centers, significant differences were found for seven anatomical locations. Notable differences were observed concerning the treatment of glottic lesions and the management of mild to moderate dysplasia after biopsy. Among the different tertiary referral centers, no uniform preference in management was noticed. Conclusions: There are significant differences in the management of LPMLs between otorhinolaryngologists at tertiary and secondary referral centers, depending on the location and histopathology of the lesions. Consensus on and development of guidelines concerning the management of LMPLs could be useful to optimize the diagnosis, treatment, and follow-up of these lesions.