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

Nikolaos Davaris,Alfredo Illanes,Michael Friebe,Nazila Esmaeili,Axel Boese,Anke Lux,Christoph Arens

doi:10.3390/cancers12010248

Nikolaos Davaris, Alfredo Illanes + Show 5 more

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https://doi.org/10.3390/cancers12010248

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Abstract

The endoscopic detection of perpendicular vascular changes (PVC) of the vocal folds has been associated with vocal fold cancer, dysplastic lesions, and papillomatosis, according to a classification proposed by the European Laryngological Society (ELS). The combination of contact endoscopy with narrow-band imaging (NBI-CE) allows intraoperatively a highly contrasted, real-time visualization of vascular changes of the vocal folds. Aim of the present study was to determine the association of PVC to specific histological diagnoses, the level of interobserver agreement in the detection of PVC, and their diagnostic effectiveness in diagnosing laryngeal malignancy. The evaluation of our data confirmed the association of PVC to vocal fold cancer, dysplastic lesions, and papillomatosis. The level of agreement between the observers in the identification of PVC was moderate for the less-experienced observers and almost perfect for the experienced observers. The identification of PVC during NBI-CE proved to be a valuable indicator for diagnosing malignant and premalignant lesions.

Highlights

Changes in the morphology and three-dimensional spread of vocal fold vessels result from various functional, mechanical, or neoplastic stimuli and have been associated with the development of benign or malignant laryngeal pathologies, such as recurrent respiratory papillomatosis or laryngeal carcinoma [1,2,3]
It differentiates between two main categories: longitudinal and perpendicular vascular changes
This study explores the value of the intraoperative detection of perpendicular vascular changes (PVC) using narrow-band imaging (NBI)-Contact endoscopy (CE) in terms of investigating its association to specific histological diagnoses, the level of interobserver agreement in the interpretation of vascular patterns using the European Laryngological Society (ELS) classification, and its diagnostic effectiveness in detecting laryngeal malignancy

Summary

Introduction

Changes in the morphology and three-dimensional spread of vocal fold vessels result from various functional, mechanical, or neoplastic stimuli and have been associated with the development of benign or malignant laryngeal pathologies, such as recurrent respiratory papillomatosis or laryngeal carcinoma [1,2,3]. Proposed in 2015 a simplified approach to the classification of vascular patterns of vocal folds [6]. It differentiates between two main categories: longitudinal and perpendicular vascular changes. Perpendicular vascular changes (PVC), which represent intracapillary papillary capillary loops (IPCL), develop perpendicularly towards the mucosa as a result of neoplastic stimuli and have been associated with papillomatosis, premalignant, and malignant lesions. 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]

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