Diagnosis of vocal cord leukoplakia: The role of a novel narrow band imaging endoscopic classification
Diagnosis of vocal cord leukoplakia: The role of a novel narrow band imaging endoscopic classification
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DOI：
10.1002/lary.27346
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发表时间：
2019-02-01
期刊：
影响因子：
2.6
通讯作者：
Wang, Gui-Qi
中科院分区：
文献类型：
--
作者：
Ni, Xiao-Guang;Zhu, Ji-Qing;Wang, Gui-Qi
目的介绍一种新的窄带成像(NBI)声带白斑内窥镜分类方法。研究设计案例系列。方法选择2010年1月至2018年2月收治的声带白斑患者120例。使用NBI内窥镜系统检查声带。所有病变均在NBI胃镜下观察，并根据上皮内乳头状毛细血管环(IPCL)的详细形态进行评价。浅层IPCL分成6种类型(I-VI型)。探讨NBI分类对良、恶性白斑的鉴别诊断能力。结果120例声带白斑中，良性病变(包括炎症、上皮细胞增殖、角化过度、角化不良、轻度不典型增生和中度不典型增生)占81%(97/120)，恶性病变(包括重度不典型增生、原位癌和浸润性癌)占19%(23/120)。鼻内窥镜对声带白斑的鉴别诊断准确率达90.8%(109/120)，明显高于白光显像法的70.0%(84/120)(X~2=16.536，P=0.000)。NBI诊断恶性声带白斑的敏感性为82.6%，特异性为92.8%，阳性预测值为73.1%，阴性预测值为95.7%。鼻内窥镜诊断与病理诊断有较好的一致性(kappa=0.718，P=0.000)。结论NBI新的声带白斑内窥镜分类方法可提高声带白斑良恶性鉴别诊断的准确率。
Objectives The purpose of this study was to introduce a new narrow band imaging (NBI) endoscopic classification for the diagnosis of vocal cord leukoplakia. Study Design Case series. Methods From January 2010 to February 2018, a total of 120 cases of vocal cord leukoplakia were enrolled in this study. The NBI endoscopic system was used to examine the vocal cords. Each lesion was observed by NBI endoscopy and evaluated according to the detailed morphologic findings of intraepithelial papillary capillary loop (IPCL). The superficial IPCL patterns were classified into six types (types I-VI). The differential diagnosis abilities of NBI classification for benign and malignant leukoplakia were investigated. Results Out of the 120 cases of vocal cord leukoplakia, 81% (97 of 120) related to benign lesions (including inflammation, epithelial proliferation, hyperkeratosis, dyskeratosis, mild dysplasia, and moderate dysplasia); the remaining 19% (23 of 120) consisted of malignant lesions (including severe dysplasia, carcinoma in situ, and invasive carcinoma). The accuracy of differential diagnosis for vocal cord leukoplakia using NBI endoscopy was up to 90.8% (109 of 120), significantly higher than that of white light imaging (70.0%, 84 of 120) (chi(2) = 16.536, P = 0.000). The sensitivity, specificity, and positive and negative predictive values of the diagnosis for malignant vocal cord leukoplakia under the NBI endoscope were 82.6%, 92.8%, 73.1%, and 95.7%, respectively. There is relatively good consistency between the NBI endoscopic diagnosis and pathological diagnosis (kappa = 0.718, P = 0.000). Conclusion The new NBI endoscopic classification of vocal cord leukoplakia can improve the accuracy of distinguishing benign and malignant leukoplakia.