Abstract
PurposeIn 2016, the European Laryngological Society (ELS) proposed a classification for vascular changes occurring in glottic lesions as visible by narrow band imaging (NBI), based on the dichotomic distinction between longitudinal vessels (not suspicious) and perpendicular ones (suspicious). The aim of our study was to validate this classification assessing the interobserver agreement and diagnostic test performance in detecting the final histopathology.MethodsA retrospective study was carried out by reviewing clinical charts, preoperative videos, and final pathologic diagnosis of patients submitted to transoral microsurgery for laryngeal lesions in two Italian referral centers. In each institution, two physicians, independently re-assessed each case applying the ELS classification.ResultsThe cohort was composed of 707 patients. The pathologic report showed benign lesions in 208 (29.5%) cases, papillomatosis in 34 (4.8%), squamous intraepithelial neoplasia (SIN) up to carcinoma in situ in 200 (28.2%), and squamous cell carcinoma (SCC) in 265 (37.5%). The interobserver agreement was extremely high in both institutions (k = 0.954, p < 0.001 and k = 0.880, p < 0.001). Considering the diagnostic performance for identification of at least SIN or SCC, the sensitivity was 0.804 and 0.902, the specificity 0.793 and 0.581, the positive predictive value 0.882 and 0.564, and the negative predictive value 0.678 and 0.908, respectively.ConclusionThe ELS classification for NBI vascular changes of glottic lesions is a highly reliable tool whose systematic use allows a better diagnostic evaluation of suspicious laryngeal lesions, reliably distinguishing benign ones from those with a diagnosis of papillomatosis, SIN or SCC, thus paving the way towards confirmation of the optical biopsy concept.
Highlights
Detection and diagnosis of laryngeal squamous cell carcinoma (SCC) are crucially involved in reducing mortality, and to optimize therapeutic approaches aimed at achieving the best organ and functional preservation [1, 2]
The present study aims to assess the performance of the European Laryngological Society (ELS) classification of vascular changes in a broad multicenter cohort, testing its interobserver agreement as primary endpoint, and analyzing its accuracy in predicting the final pathological results in an optical biopsy setting, i.e. by evaluating the diagnostic accuracy of narrow band imaging (NBI) by comparing it with the final histopathologic diagnosis obtained after complete removal of the glottic lesion
All patients enrolled were affected by laryngeal lesions; a pre-treatment videoendoscopic evaluation with both white light (WL) and NBI was performed in the office as well as in the operatory theater, and the records were saved in his/her medical chart; the laryngeal lesion was treated by a transoral microsurgical approach by either cold instrumentation and carbon dioxide (CO2) laser; postoperative histopathologic assessment was obtained to classify the resected tissue as benign, dysplastic or malignant
Summary
Detection and diagnosis of laryngeal squamous cell carcinoma (SCC) are crucially involved in reducing mortality, and to optimize therapeutic approaches aimed at achieving the best organ and functional preservation [1, 2]. Laryngeal SCC examination is usually performed by flexible (video)endoscopy under white light (WL) and relies on the analysis of superficial characteristics (size, color, location, single or multifocal appearance) and visible morphological features (smoothness, irregularity, keratinization, ulceration, submucosal growth), per se non-pathognomonic and possibly overlapping each other in malignant and benign pathologies, especially when diagnosed at early stages. This implies the frequent need to obtain an incisional biopsy before deciding on the therapeutic approach, with an increase in costs, anesthetic risks, and potential undue damage to the vocal cords. Longitudinal vessels characterize benign lesions, while perpendicular ones (i.e. dot-like intrapapillary capillary loops [IPCL], enlarged and worm-like vessels) are considered signs of benign neoplasms (such as papillomatosis), squamous intraepithelial neoplasia (SIN), or frankly malignant lesions
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