Survey
After exclusion of three lesions with undetectable vascularization
patterns, online survey included 74 high-definition digital images of 37
lesions, and the questions below:
What is the pattern of vascularization in each picture?
Which light mode reveals vasculatures better?
The survey was distributed to a group of otolaryngologists who had none
or limited experience in using image enhancement systems to define
laryngeal vascular changes according to the ELS classification. We
preferred a heterogeneous sampling method, also known as the maximum
variation sampling method, as the purposive sampling technique as it
captures a wide range of experience relating to the examination of the
laryngeal lesions. The participants were selected from the whole
population of otolaryngology residents and fellows in Turkey; the group
comprised 12 residents in the minimum second year of their training
program, 8 junior fellows within 10 years after termination of the
training program, and 10 seniors with more than 10 years of work
experience in general otolaryngology. The survey was sent to the
participants via social media groups, with brief information about the
ELS classification. In every case, the participants identified the
predominant type of vascular pattern on the pictures and then selected
the clearest picture in the pair.
Participants classified the vasculatures as pertaining to longitudinal
or perpendicular patterns, being unaware of the authors’ evaluations and
final pathological diagnoses. The evaluation of the images by the
participants was compared to the evaluation of the authors to determine
the congruence of the answers. The evaluation of the participants was
correlated with their previous work experience in calendar years.
Statistical analysis was performed using the Statistical Package for the
Social Sciences version 25 software program (SPSS Inc., USA). A p value
< 0.05 was considered statistically significant. The
χ2 (chi square) statistic and a contingency table were
used to evaluate the relevance between the vascularization patterns and
the pathological diagnosis.
The congruence between the two groups of evaluators (the authors and the
participants) was tested with using cross-tabulation,
χ2 and Cohen’s Kappa estimates were determined.
Intra-class correlation coefficient (ICC) analysis was performed to
evaluate the inter-rater reliability between the participants. Each
participant in the group evaluated every single photo separately;
two-way random ICC was used. Bivariate Pearson correlation analysis was
used to determine the correlation between participants’ evaluation and
participants’ work experience.
The study included 40 patients with laryngeal lesions. The average age
was 55.1 years (min 24 - max 76 years). In the group, 10% of the
patients were female and 90% were male.
Full survey responses were received from 30 otolaryngologists, with a
mean age of 35.73 years (min 26-max 60) and a minimum of 2 and maximum
of 35 years’ work experience (mean: 10,56).