1 INTRODUCTION
Vocal cord leukoplakia is a descriptive clinical diagnosis with
different pathological manifestations, including inflammatory changes or
squamous hyperplasia, dysplasia of different grades, carcinoma in
situ , or even carcinogenesis.1 Vocal cord leukoplakia
is a key precancerous lesion observed in laryngeal carcinoma. Welleret al. 2 performed a meta-analysis on the risk
for the transformation of laryngeal dysplasia into a malignant laryngeal
tumor and found that the malignant transformation rate of laryngeal
mild/moderate dysplasia was 10.6%, and that of severe
dysplasia/carcinoma in situ was 30.4%. Therefore, exploring the
relationship between the appearance of vocal cord leukoplakia and the
degree of dysplasia is the key to determining treatment strategies,
prognosis and follow-up approaches. Making this distinction would help
to avoid the excessive treatment of benign lesions and the misdiagnosis
and mistreatment of lesions with high malignant potential.
Vocal cord leukoplakia often causes hoarseness, patients usually visit a
doctor early in the course of the disease. Some studies have shown that
narrow band imaging (NBI) laryngoscopy and strobolaryngoscopy are
helpful for the differential diagnosis of benign and malignant vocal
cord leukoplakia.3 Nevertheless, white light imaging
(WLI) laryngoscopy, which allows the observation of morphological
characteristics of the vocal cord surface, remains the most common
examination used for vocal cord leukoplakia diagnosis. Although some
studies exist on the scoring4 and
classification5 of vocal cord leukoplakia by WLI,
these studies have limitations and do not include all the morphological
characteristics related to malignant transformation. Therefore, there
are still deficiencies in the differential diagnosis of benign and
malignant vocal cord leukoplakia. This study was designed to
comprehensively summarize the morphological characteristics associated
with malignant leukoplakia and propose a new, simple, and effective
leukoplakia finding score (LFS) for the diagnosis of vocal cord
leukoplakia to improve the accuracy of the preliminary judgment by WLI
laryngoscopy before treatment.