Vocal Fold Leukoplakia: Which of the Classifications of White Light and Narrow Band Imaging Most Accurately Predicts Laryngeal Cancer Transformation? Proposition for a Diagnostic Algorithm
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Patients
2.2. Endoscopic Examination Procedure
2.3. White Light Imaging (WLI)
2.4. Narrow Band Imaging (NBI)
2.4.1. Assessment of the Immediate Surrounding of Leukoplakia Plaque According to Ni 2011 Classification
2.4.2. Assessment of the Microvascular Features of Leukoplakia According to 2015 ELS Guidelines
2.4.3. Assessment of Vocal Fold Leukoplakia According to the NBI Endoscopic Classification by Ni et al. 2019
2.5. Histopathological Assessment
2.6. Statistical Analysis
3. Results
4. Discussion
4.1. WLI Classifications
4.2. NBI Classifications
4.3. Combination of WLI and NBI Classifications
4.4. The Limitations and Strengths of the Study
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Conflicts of Interest
Abbreviations
NBI | narrow band imaging |
WLI | white light imaging |
VF | vocal fold |
VFL | vocal fold leukoplakia |
HP | histopathology |
ELS | European Laryngological Society |
IPCLs | Intraepithelial papillary capillary loops |
CT | conservative treatment |
TOLMS | Transoral Laser Microsurgery |
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Laryngeal Light Endoscopy | Classification | Benign Leukoplakia | Malignant Leukoplakia |
---|---|---|---|
White Light Endoscopy | two-tier classification | thin white plaque of a uniform color and a flat surface | thick white plaque, a rough surface, and congestive vocal fold mucosa |
three-tier classification acc. to Chen 2019 |
|
| |
Narrow Band Imaging | Ni 2011 classification: cut-off point 4 | 1+2
| 4+5 4. IPCLs recognized as small dots 5a. IPCLs appear as solid or hollow, with a brownish, speckled pattern and various shapes 5b. IPCLs appear as irregular, tortuous, line-like shapes 5c. IPCLs appear as brownish speckles or tortuous, line-like shapes with irregular distribution, scattered on the tumour surface. |
Ni 2011 classification: cut-off point 5 | 1+2+4 | 5 | |
ELS classification |
|
| |
Ni 2019 classification: cut-off point 4 | 1+2+3
| 4+5+6
| |
Ni 2019 classification: cut-off point 5 | 1+2+3+4 | 5+6 |
Endoscopic Light Imaging. | Clinical Classification | Proposed Cut-Off Point | AUC (95% CI) | Youden’s Index | Accuracy % | Sensitivity % | Specificity % | PPV % | NPV % |
---|---|---|---|---|---|---|---|---|---|
WLI | two-tier classification | 2 | 0.734 (0.675; 0.793) | 0.47 | 72.0 | 78.9 | 67.9 | 58.9 | 84.7 |
three-tier classification acc. to Chen 2019 | 2 | 0.806 (0.751; 0.861) | 0.46 | 70.9 | 81.7 | 64.7 | 57.4 | 85.8 | |
3 | 0.806 (0.751; 0.861) | 0.53 | 80.4 | 60.6 | 92.0 | 81.5 | 80.0 | ||
NBI | ELS classification | 2 | 0.787 (0.729; 0.844) | 0.57 | 80.1 | 73.4 | 84.0 | 72.7 | 84.4 |
Ni 2011 classification | 4 | 0.856 (0.809; 0.902) | 0.56 | 77.4 | 81.7 | 74.9 | 65.4 | 87.5 | |
5 | 0.856 (0.809; 0.902) | 0.59 | 83.1 | 65.1 | 93.6 | 85.5 | 82.2 | ||
Ni 2019 classification | 4 | 0.869 (0.826; 0.912) | 0.61 | 80.7 | 79.8 | 81.3 | 71.3 | 87.4 | |
5 | 0.869 (0.826; 0.912) | 0.62 | 84.1 | 68.8 | 93.0 | 85.2 | 83.7 |
Laryngeal Endoscopy | Clinical Classification | Cut-Off Point | Low-Risk VFL Cases | High-Risk VFL Cases | Cohens Kappa (κ) Coefficient Value | Bowker’s Test for Symmetry (p Value) |
---|---|---|---|---|---|---|
White Light Imaging | two-tier classification | 2 | 150 | 146 | 0.44 | <0.001 |
three-tier classification acc. to Chen 2019 | 2 | 141 | 155 | 0.43 | <0.001 | |
3 | 215 | 81 | 0.56 | <0.001 | ||
Narrow Band Imaging | ELS classification | 2 | 186 | 110 | 0.57 | 0.896 |
Ni 2011 classification | 4 | 181 | 115 | 0.63 | <0.001 | |
5 | 211 | 85 | 0.62 | 0.404 | ||
Ni 2019 classification | 4 | 176 | 120 | 0.58 | 0.152 | |
5 | 208 | 88 | 0.68 | <0.001 | ||
Total VFL cases in HP | 187 | 109 |
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Pietruszewska, W.; Morawska, J.; Rosiak, O.; Leduchowska, A.; Klimza, H.; Wierzbicka, M. Vocal Fold Leukoplakia: Which of the Classifications of White Light and Narrow Band Imaging Most Accurately Predicts Laryngeal Cancer Transformation? Proposition for a Diagnostic Algorithm. Cancers 2021, 13, 3273. https://doi.org/10.3390/cancers13133273
Pietruszewska W, Morawska J, Rosiak O, Leduchowska A, Klimza H, Wierzbicka M. Vocal Fold Leukoplakia: Which of the Classifications of White Light and Narrow Band Imaging Most Accurately Predicts Laryngeal Cancer Transformation? Proposition for a Diagnostic Algorithm. Cancers. 2021; 13(13):3273. https://doi.org/10.3390/cancers13133273
Chicago/Turabian StylePietruszewska, Wioletta, Joanna Morawska, Oskar Rosiak, Agata Leduchowska, Hanna Klimza, and Małgorzata Wierzbicka. 2021. "Vocal Fold Leukoplakia: Which of the Classifications of White Light and Narrow Band Imaging Most Accurately Predicts Laryngeal Cancer Transformation? Proposition for a Diagnostic Algorithm" Cancers 13, no. 13: 3273. https://doi.org/10.3390/cancers13133273
APA StylePietruszewska, W., Morawska, J., Rosiak, O., Leduchowska, A., Klimza, H., & Wierzbicka, M. (2021). Vocal Fold Leukoplakia: Which of the Classifications of White Light and Narrow Band Imaging Most Accurately Predicts Laryngeal Cancer Transformation? Proposition for a Diagnostic Algorithm. Cancers, 13(13), 3273. https://doi.org/10.3390/cancers13133273