Abstract
IntroductionDiscerning the preoperative nature of vocal fold leukoplakia (VFL) with a substantial degree of certainty is fundamental, seeing that the histological diagnosis of VFL includes a wide spectrum of pathology and there is no consensus on an appropriate treatment strategy or frequency of surveillance. The goal of our study was to establish a clear schedule of the diagnostics and decision-making in which the timing and necessity of surgical intervention are crucial to not miss this cancer hidden underneath the white plaque.Material and MethodsWe define a schedule as a combination of procedures (white light and Narrow Band Imaging diagnostic tools), methods of evaluating the results (a combination of multiple image classifications in white light and Narrow Band Imaging), and taking into account patient-related risk factors, precise lesion location, and morphology. A total number of 259 patients with 296 vocal folds affected by leukoplakia were enrolled in the study. All patients were assessed for three classifications, in detail according to Ni 2019 and ELS 2015 for Narrow Band Imaging and according to Chen 2019 for white light. In 41 of the 296 folds (13.9%), the VFL specimens in the final histology revealed invasive cancer. We compared the results from the classifications to the final histology results.ResultsThe results showed that the classifications and evaluations of the involvement of anterior commissure improve the clinical utility of these classifications and showed improved diagnostic performance. The AUC of this model was the highest (0.973) with the highest sensitivity, specificity, PPV, and NPV (90.2%, 89%, 56.9%, and 98.3%, respectively).ConclusionThe schedule that combines white light and Narrow Band Imaging, with a combination of the two classifications, improves the specificity and predictive value, especially of anterior commissure involvement.
Highlights
Discerning the preoperative nature of vocal fold leukoplakia (VFL) with a substantial degree of certainty is fundamental, seeing that the histological diagnosis of Vocal fold leukoplakia (VFL) includes a wide spectrum of pathology and there is no consensus on an appropriate treatment strategy or frequency of surveillance
Vocal fold leukoplakia (VFL) is a clinical term that describes a white patch or plaque resulting from epithelial parakeratosis, but does not specify what is hidden within the lesion
The inclusion criteria were: a diagnosis of vocal fold leukoplakia confirmed by endoscopic evaluation under white light and Narrow Band Imaging (NBI), no prior vocal fold-related medical intervention or procedures
Summary
Discerning the preoperative nature of vocal fold leukoplakia (VFL) with a substantial degree of certainty is fundamental, seeing that the histological diagnosis of VFL includes a wide spectrum of pathology and there is no consensus on an appropriate treatment strategy or frequency of surveillance. The goal of our study was to establish a clear schedule of the diagnostics and decision-making in which the timing and necessity of surgical intervention are crucial to not miss this cancer hidden underneath the white plaque. The histological diagnosis of VFL includes a wide spectrum of pathology, through stages of dysplasia to invasive cancer [1, 2]. There is no consensus on the threshold for surgical intervention, appropriate treatment strategy (wait and see policy, sampling, or excisional surgery), or the frequency of surveillance [3, 4]. In aiming to resolve these discrepancies, diagnostic methods and recommendations such as the schedule for VFL management should be of utmost importance [9]
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