The management of Vocal Fold Leukoplakia (VFL) remains problematic. There is no consensus on the indications or the timing for surgery. The objective was to select the most accurate classification for predicting low- and high-risk VFL in White Light Imaging (WLI) and Narrow Band Imaging (NBI) and to establish a diagnostic algorithm with a timely referral for treatment. A total of 259 VFL patients were included in the study; 186 lesions were classified as low-grade and 110 as high-grade dysplasia. The results of WLI acc. to the two-tier and the three-tier Chen 2019 classifications and NBI classifications: ELS, Ni 2011, and Ni 2019 with different cut-off points were compared with the pathological examination (HP). In WLI, the greatest agreement was obtained between type 3 of the three-tier classification and high-grade dysplasia (accuracy, specificity, and PPV: 80.4%, 92.0%, and 81.5%, respectively). Assessing VFL periphery in NBI, cut-off point 5 (Ni 2011 type V) demonstrated a higher accuracy, specificity, and PPV than 4 (83.1%, 93.6%, 85.5% and 77.4%, 74.9%, and 65.4%, respectively). In NBI, we observed higher accuracy, sensitivity, and PPV (84.1%, 93.0%, 85.2% vs. 80.7%, 81.3% and 71.3%, respectively) for cut-off point 5 (Ni 2019 type V and VI) in comparison to the cut-off point 4 group (type IV, V, and VI) (80.7%, 81.3%, 71.3%, respectively), and a higher kappa value (0.68 vs. 0.58) was obtained. We have shown that both the plaque image and the microvascular pattern on the leukoplakia periphery are critical in the diagnosis of high-risk VFL. The most accurate predictor of VFL malignant transformation in WLI is type 3 according to the Chen 2019 classification, while in NBI type V and VI according to the Ni 2019 classification.
Introduction: Tumors of large salivary glands constitute about 2-3% of all head and neck tumors. Their incidence is statistically greater in males than in females, with the first symptoms usually appearing between the 4th and 7th decade of life. Material and methods: The aim of the study was to assess the usefulness of the new classification proposed by ESGS in comparison with the divisions of procedures previously valid in the literature, making a retrospective analysis of patients operated due to benign tumors of large salivary glands in the Department of Otolaryngology, Head and Neck Oncology of the Medical University of Lodz in 2012-2020. The retrospective examination was based on the material consisting of: surgical protocols, histopathological results, imaging results and clinical observations. Results: The material includes 283 patients (141 women and 142 men): 249 patients with parotid gland tumor and 34 patients with submandibular gland tumor. The most common histopathological diagnosis was pleomorphic adenoma, which was found in 105 patients (42.17%) and adenolymphoma diagnosed in 94 patients (37.75%). The most common type of surgery was superficial parotidectomy including total superficial parotidectomy in 86 patients (34.54%) and partial superficial parotidectomy in 49 cases (19.68%). Then, according to the frequency of surgery, extracapsular tumor dissection (ECD) was performed (91 patients - 36.55%). According to the ESGS classification, in most cases parotidectomy I, II (37.34% of all parotidectomies) and parotidectomy II (28.49%) were performed. In case of ECD, all tumors were located at level II. Conclusions: In summary, the new classification is aimed at unifying, but also simplifying the current nomenclature, reducing the existing nomenclature errors. By determining the exact location and extent of the tumor within the parotid gland, it facilitates postoperative monitoring of patients by ENT doctors and those of other specialties. Key words: ESGS classification, parotid gland, parotidectomy, extracapsular tumor dissection
Background: Vocal fold leukoplakia (VFL), despite our knowledge of its etiopathogenetic factors, and the development of laryngeal visualization, remains a diagnostic and therapeutic challenge. Objective: This research aimed to explore the efficacy of clinical and morphological feature identification in videolaryngoendoscopy (VLE) using a three-tier classification, and videolaryngostroboscopy (VLS) in predicting the risk of VFL malignant transformation. Material and Methods: We examined 98 patients with VFL by flexible endoscopy under VLE and VLS. Morphological characteristics of 123 lesions including the surface, margin, and texture were assessed; then, VFL was subdivided into three types: I—flat and smooth, II—elevated and smooth, and III—rough. Based on the histopathological findings, 76 (61.79%) lesions were classified as low- and 47 (38.21%) lesions as high-grade dysplasia. Results: The inter-rater agreement between two raters evaluating the VFL in VLE was almost perfect (Cohen’s kappa = 0.826; p < 0.00; 95% CI 0.748–0.904). In ROC curve analysis, the AUC difference between Rater I and Rater II was 0.024 (0.726 vs. 0.702). In multivariate analysis, high-risk VFL was positively related to unilateral plaque localization (p = 0.003), the type III VLE classification (p = 0.013), absence of a mucosal wave (p = 0.034), and a positive history of alcohol consumption (p = 0.047). In ROC analysis, VLE had an AUC of 0.726, with a high sensitivity of 95.7% and low specificity of 40.8%. The NPV was high, at 93.9%; however, the PPV was low, at 50%. The proposed logistic regression model including features significant in multivariate analysis showed lower sensitivity (80.9% vs. 95.7%) and lower NPV (86.2% vs. 93.9%); however, the specificity and PPV were improved (73.7% vs. 40.8% and 65.5% vs. 50.0%, respectively). Conclusions: The combination of clinical history with endoscopic (plaque morphology) and stroboscopic examination (mucosal wave assessment) can fairly estimate the degree of dysplasia in VFL and thus is recommended for use in clinical settings. The findings of this study can be used to guide the decision regarding immediate biopsy or watchful waiting.
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