Laryngoscopic characteristics in vocal leukoplakia: inter-rater reliability and correlation with histology grading

Abstract

Objectives/hypothesis: Vocal cord leukoplakia is a clinical diagnosis that comprises a spectrum of benignities, premalignancies, and malignancies. Accurate recordings of the visual characteristics of the affected area are important for communication between physicians and are helpful in further management. The objective of this study was to determine the laryngoscopic characteristics among patients with vocal cord leukoplakia and the reliability of examinations between different raters.

Study design: Retrospective chart review conducted in a tertiary referral center in Taiwan.

Methods: From January 2010 to April 2013, 107 consecutive patients with vocal leukoplakia who had accepted excisional biopsy were recruited and classified into two groups according to histologic findings. The patients without clear preoperative flexible laryngoscope images stored in the picture archiving and communication system were excluded. There were 68 patients who met the inclusion criteria, and the preoperative laryngoscope images were reviewed by two laryngologists. The inter-rater reliabilities of the recordings were assessed. Correlation between the variables and histologic classification was also performed.

Results: The inter-rater reliability of the assessment was significant in the recordings of color, texture, size, hyperemia, thickness, and symmetry (κ = 0.267 to 0.573, P < .05) but not in vocal cord edema. The laryngoscopic findings including color, texture, size, and hyperemia were associated with the grade of dysplasia (P < .05).

Conclusions: The specific proposed laryngoscopic characteristics are consistent in the recordings between raters and can be potentially used for stratifying patients' risk.

Level of evidence: 4.

Keywords: Vocal leukoplakia; laryngoscopy; predictor.