Evaluation of vascular features of vocal cords proposed by the European Laryngological Society

Abstract

A newly proposed classification by the European Laryngological Society (ELS) of glottic lesions by narrow-band imaging (NBI) divides their vascular patterns into longitudinal and perpendicular ones. The latter are further subdivided into the wide and narrow patterns. The longitudinal, wide, and narrow patterns are characteristic of benign disease, papilloma, and malignancy, respectively. The aim of the study was to investigate the diagnostic effectiveness of the classification. Forty patients with glottic lesions underwent microlaryngoscopy. The vascular patterns of all vocal cords were defined with NBI. The affected vocal cords were histologically analysed and comprised the arm (A). Unaffected vocal cords were not histologically analysed but followed-up and comprised the arm (B) and were regarded as true negatives if no suspicious changes appeared during the follow-up. The vocal cords from the arm A were categorised into the benign and malignant group according to the histologic result. The ratio of vascular patterns was determined and the groups were statistically compared using the Chi-square test and Fisher’s exact test. Perpendicular changes were observed in 36.6% (9/26) of benign diseases and in 100% (23/23) of cancer conditions (p < 0.001). Wide perpendicular changes appeared only in papillomas (6/6) while narrow ones mostly in malignancies (23/26) and also in benign conditions (3/26) (p < 0.001). The sensitivity, specificity, positive and negative predictive values, and accuracy were 100, 95, 88, 100 and 96%, respectively. The new ELS classification can be used effectively and safely to differentiate malignant from benign disease.

Evaluation of Vascular Patterns Using Contact Endoscopy and Narrow-Band Imaging (CE-NBI) for the Diagnosis of Vocal Fold Malignancy

“…The achieved mean sensitivity of 0.955 and negative predictive value of 0.967 point to a high clinical value in the context of excluding malignancy. The mean specificity of 0.630 and positive predictive value of 0.533 mainly depict the classification of laryngeal papillomatosis (based on vascular patterns) to the neoplastic lesions, in concordance with the findings of previous studies evaluating vascular classification systems using NBI alone [8,16]. The evaluation of a subdivision of PVC according to the shape of their turning points as presented by Sifrer et al was not applied in the present study [8].…”

“…The comparability of the present work to previous studies in the field is low, as most of them used different endoscopic modalities, did not solely focus on vascular pattern changes, and applied other classification systems to categorize them [2,4,26]. The ELS classification system was proved reliable in recent studies on laryngeal lesions using image-enhancing techniques without CE [8,18,21]. Puxeddu et al used CE, mainly in combination with SPIES in different modi (Clara + Chroma to Spectra A and B), for the endoscopic diagnoses of laryngeal and hypopharyngeal lesions.…”

“…This dichotomous distinction can serve in the endoscopic diagnosis of premalignant and malignant vocal fold lesions, as laryngeal papillomatosis can easily be distinguished due to its characteristic macroscopic appearance on conventional WLE or using NBI [7,12]. In addition to that, a further subdivision between wide and narrow-angled points in PVC can assist in the differentiation between (pre)malignant lesions and papillomatosis [6,8]. On the other hand, the detection of such patterns and the identification of PVC are partly subjective and can depend on the clinical experience and learning curve of the observer [5,16].…”

“…A further subdivision between wide or narrow-angled points in PVC can assist in the differentiation between (pre)malignant lesions and papillomatosis. Thus, the endoscopic detection of PVC has a diagnostic relevance and can be crucial for optimizing therapeutic decisions in the context of microlaryngoscopy and laryngeal surgery [6,8].…”

Narrow‐band imaging pattern classification in oral cavity

“…The introduction of specific vascular pattern classes (Arens et al, ; Fujii et al, ; Ni et al, ; Takano et al, ; Wen et al, ) allowed different examiners to adhere to a reference classification and avoid ambiguities. The previous classifications were widely accepted because they were shown to have good concordance with histology (Šifrer et al, ).…”