Evaluation of Vascular Changes and Histological Examination
All patients were examined intraoperatively with 0 and/or 30-degree rigid endoscopes (Karl Storz®, Germany). The vascularization patterns of the lesions were visualized using white light mode and the Spectra light modes A and/or B (Image1 S ™, Karl Storz, Germany). Spectra A mode was utilized to filter out red in the tissue, while intensifying the remaining colors, thereby enhancing the contrast of capillaries in the mucosa and submucosa. Spectra B mode was used to achieve a higher contrast by increasing the green and blue spectra (5). Side-by-side monitor views of white light and one of the spectral modes were obtained during endoscopic examination of each patient for survey analysis.
Laryngeal suspension and endoscopic examinations with white light and spectral modes were performed at the operating theater by three senior otolaryngologists (authors BK, ÇB, KG).
The evaluation was based on qualitative observations of the images. The qualitative data were collected by the authors through direct observation and from the participants through an electronic survey. The qualitative data were analyzed comparing and contrasting the endoscopic images and interpreting the vascular patterns as longitudinal or perpendicular in accordance with the ELS classification.
The judgment on the differentiation of the vascular patterns was made unaware of the pathological diagnosis. No consensus was reached on three cases; these were excluded from the survey.
Under endoscopic control, an incisional biopsy or an excisional biopsy was taken for histopathological examination. Pathologists specialized in head and neck lesions examined specimens, blinded to the vascular characteristics of the endoscopic images. The histopathological results were categorized into three groups as benign, malignant, and dysplastic changes. Polyps, cysts, inflammation, and Reinke’s edema were classified as benign. Malignant pathology was defined as invasive squamous cell carcinoma. Dysplastic changes were classified according to the World Health Organization (WHO) grading system as low grade and high grade dysplasia (6).
The relationship between the vascular patterns and the pathological diagnosis was analyzed.