Morphology, Vibratory Function, and Vascular Pattern for Predicting Malignancy in Vocal Fold Leukoplakia

J Voice. 2020 Sep;34(5):812.e9-812.e15. doi: 10.1016/j.jvoice.2019.04.001. Epub 2019 Apr 19.


Background: The study evaluates clinical features of vocal fold (VF) leukoplakia in predicting its benign or malignant nature.

Materials: 57 patients with 84 lesions were evaluated before undergoing laryngeal microsurgery. The texture, color, thickness and size of the leukoplakia, along with an assessment of the surrounding mucosa vascularization using narrow-band imaging (NBI), and VF vibratory function were analyzed. Receiver-operating characteristic curves were constructed to determine the predictive value of each feature and area under the curve (AUC) was calculated.

Results: Histopathological examination revealed high-grade dysplasia or invasive cancer in 13 of VF leukoplakia. Seventy-one lesions were nondysplastic or low-grade dysplasia. Nonhomogenous color, irregular texture, and prominent thickness predicted malignancy with statistical significance (P < 0.05). AUC was 0.793, 0.793, and 0.679, respectively. Absence of a mucosal wave on laryngovideostroboscopy was significant for the detection of malignancy (P < 0.001) with an AUC of 0.927. The NBI diagnosis of horizontal vessel loops was significant with the highest AUC of 0.993.

Conclusions: The comprehensive clinical evaluation of VF leukoplakia with laryngovideostroboscopy and NBI creates the opportunity to differentiate between low- and high-risk malignancy lesions. The perpendicular vascular pattern and the limited or absent mucosal wave appear to be the most powerful indicators of malignancy.

Keywords: Dysplasia; Glottis cancer; Laryngovideostroboscopy; Leukoplakia; Narrow-band imaging.

MeSH terms

  • Humans
  • Hyperplasia / pathology
  • Laryngeal Neoplasms* / diagnostic imaging
  • Laryngeal Neoplasms* / pathology
  • Laryngeal Neoplasms* / surgery
  • Leukoplakia / diagnostic imaging
  • Leukoplakia / pathology
  • Narrow Band Imaging
  • Vocal Cords* / diagnostic imaging
  • Vocal Cords* / pathology
  • Vocal Cords* / surgery