Relationship Between Vascularization Patterns and Histopathology
Histopathology revealed benign lesions in 27.5%, malignant lesions in 40%, and dysplastic changes in 32.5% of the cases. The patients lacking detectable vasculatures (%7.5) included one who presented with a mass of granulation tissue covered with exudative material, while the other two presented with leukoplakia on a low-grade dysplastic lesion (Figure-1). In the surveyed cases, 29.7% were benign, 2.7% were dysplastic, and 43.2% were malignant.
Of the 37 lesions, 9 were classified as longitudinal and 28 as perpendicular by the authors. The distribution of the pathological lesions across the vascular patterns is shown in Table 1. The pathological diagnoses of the lesions associated with longitudinal vascular pattern were as follows: 8/9 were benign, as five polyps (Figure-2), and three Reinke’s edema, and 1/9 was a low-grade dysplasia. The pathological diagnoses of the lesions associated with perpendicular vascular pattern were as follows: 16/28 were malignant, 9/28 were with high-grade dysplasia (Figure-3) and 3/28 were benign. The distribution of vascular patterns in benign, dysplastic and malignant conditions is shown in Table 2. In the benign cases, the longitudinal pattern was present in 72.7% and the perpendicular pattern was present in 27.3 % of the lesions. In dysplastic and malignant lesions, the longitudinal pattern was observed in 3.8% (Figure-4), whereas 96.2% presented with perpendicular vascular pattern. The benign lesions with perpendicular vascular patterns (Figure-4), included a granular cell tumor and another two that were granulation tissue after laser cordectomy; the granulation here was not associated with fibrin accumulation. In dysplastic and malignant lesions, a low-grade dysplasia was evident with the longitudinal vascular pattern. The relationship between the vascularization pattern and the histopathological diagnosis was statistically significant.
The sensitivity (SE) and specificity (SP) of Image1 S endoscopy were 96% (95% CI 80-99) and 72% (95% CI 39-93) respectively, for the differentiation of malignant and dysplastic lesions from benign lesions. The positive predictive value was 89% (95% CI 75-95) and the negative predictive value was 88% (95% CI 53-98) with the accuracy rate 89% (95% CI 74-96) (Table-2).