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

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.

Laryngeal Lesion Classification Based on Vascular Patterns in Contact Endoscopy and Narrow Band Imaging: Manual Versus Automatic Approach

“…The otolaryngologists were blinded to the histologic diagnosis. They used the ELS guideline to independently visually evaluate the CE-NBI images of Subset I based on PVC appearance in the CE-NBI images, as explained in [ 12 ].…”

“…In the manual classification, the otolaryngologists assessed the set of CE-NBI images in the Subset I and classified each patient’s image set as benign or malignant. Following [ 12 ], the PVC-positive patients with the malignant histological diagnosis were considered as true positive cases. With this assumption, a confusion matrix was created and the average value of sensitivity and specificity of all otolaryngologists, specialists and residents, was calculated using the following parameters: True Positive: PVC-positive patients with malignant lesions.…”

“…For the purpose of detecting and evaluating superficial vascular changes, several enhanced endoscopic techniques such as Narrow Band Imaging (NBI) have been combined with CE to ease the detection of vascular changes [ 10 ]. The use of enhanced CE showed promising results in the assessment of vascular patterns followed by indicative of various laryngeal pathologies [ 4 , 11 , 12 ].…”

“…There are similarities between vascular patterns of benign and malignant laryngeal lesions. The PVC with wide-angled turning points, as observed in laryngeal Papillomatosis can be difficult to distinguish from PVC with narrow-angled turning points, as observed in pre-malignant and malignant histopathologies [ 5 , 12 , 13 , 14 ]. Hence, the interpretation of vascular patterns in enhanced CE images requires an extensive learning curve from the clinicians to reduce the risk of subjective evaluation that can cause potential problems in differentiation between benign and malignant laryngeal lesions [ 4 , 10 , 12 , 15 , 16 ].…”

Laryngeal Mid-Cord Erythroleukoplakias: How to Modulate the Transoral CO2 Laser Excisional Biopsy

“…As already demonstrated by Stanikova et al, NBI and SPIES appear to provide comparable outcomes with excellent diagnostic agreement between them [11]. Furthermore, coupling biologic endoscopy with contact endoscopes is a promising and inter-rater-reliable technique to further improve the diagnostic accuracy of intraoperative endoscopic evaluation [20,21].…”