The Role of Modified Killian's Method in the Evaluation of Hypopharyngeal and Supraglottic Cancers

  SFX Search  Permissions and Reprints Abstract Priyanka Schilling Amar

Objectives Hypopharyngeal cancer is one of the upper aerodigestive tract malignancies with the poorest prognosis. The aim of this study was to assess the role of modified Killian's (MK) method in routine, outpatient-based flexible laryngoscopy to improve visualization and assess the extent of supraglottic and hypopharyngeal cancers.

Materials and Methods An observational study was conducted in a tertiary hospital in India where fifty consecutive patients who presented to the outpatient clinic with suspected hypopharyngeal and supraglottic malignancy underwent a conventional laryngoscopy as well as MK method. The site and extent of the tumor on endoscopy were recorded and the videos were graded independently by two investigators on Murono's scale from 1 to 5. A subset of these patients who underwent direct laryngoscopy under general anesthesia was also scored with the above scale. The scores were compared to check the accuracy of flexible laryngoscopy with the MK method in staging cancer.

Statistical Analysis Descriptive statistics were given using mean (standard deviation [SD]) for continuous variables and frequency (percentage) for categorical variables. The difference between the mean scores was analyzed using the paired-t test. The agreement between the scales and the observer, that is, the inter- and intraobserver agreement, was presented with concordance rate and Kappa weighted analysis.

Results In this study, the mean scores of the Murono's scale grading of the conventional method, MK method, and direct laryngoscopy were 1.42 (SD: 0.64), 2.94 (SD: 0.95), and 4.30 (SD: 1.49), respectively, which showed significant improvement in scores with MK method. In addition, the subset analysis demonstrated a significant agreement between direct laryngoscopy and MK method.

Conclusion The MK method is a good diagnostic test and a valuable adjunct to diagnostic flexible laryngoscopy in the evaluation and staging of hypopharyngeal and supraglottic cancers.

Keywords diagnostic flexible laryngoscopy - direct laryngoscopy - hypopharyngeal and supraglottic cancers - modified Killian's method - Murono's scale Note

The study was approved by the Institutional Review Board under the category of study for diagnostic test.


Source(s) of Support

None.


Authors' Contributions

Priyanka Schilling Amar was involved in definition of intellectual content, literature search, clinical studies, data acquisition, data analysis, statistical analysis, and manuscript preparation. Kamran Asif Syed and Rajiv C. Michael contributed to conceptualization, designing, definition of intellectual content, data analysis, manuscript editing and review. Priyanka Schilling Amar provided the guarantee for this manuscript.


Flexible laryngoscopy using the Modified Killian's method is a good and easy diagnostic test for early evaluation of hypopharyngeal and supraglottic cancers by improving the visualization and the office evaluation of head and neck cancers.


Publication History

Article published online:
19 September 2022

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