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.