INTRODUCTION
Endoscopic examination of the larynx typically focuses on the surface of the mucosa. However, finer details of the mucosal and submucosal vascular structures are possible due to the recent integration of image enhancement systems using optical tools and digital technology into conventional endoscopic systems. Inspection of mucosal pathologies by these endoscopic enhancement systems has revealed vascular characteristics of the inflammatory and the tumorigenic processes and especially the neo-angiogenesis related to carcinogenesis.
One of these enhancement systems is narrow-band imaging (NBI), which uses optically filtered light to produce high contrast images of the vasculature for endoscopic diagnosis of malignant and precancerous lesions (1). A corresponding study by the European Laryngological Society (ELS), using NBI, defined the vascularization patterns associated with laryngeal pathologies in a descriptive guideline (2). Recently, a novel image enhancement system, Image1 S, has been successfully used in different branches of medicine with the same aim; to make endoscopic images clearer and vascular network identifiable (3, 4). This system is based on software that uses the spectral light separations to produce images with different contrast characteristics. The spectral separation is obtained from the camera console and is enhanced by color processing algorithms.
In the present study, we attempted to evaluate the practical usefulness of the Image1 S system for the detecting the vascular patterns associated with benign, premalignant, and malignant lesions. Here, we included a group of otolaryngologists with different levels of proficiency as observers to discriminate between the vascular patterns defined by the ELS and determined the level of accuracy and consistency among the observers.