Wang Q, Huang Y Y Y, Li L R, Zhou J S, Li Y, Shen L, Fan G K
Department of Otorhinolaryngology,the Second Affiliated Hospital Zhejiang University School of Medicne, Hangzhou 310000, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2022 Jul 7;57(7):868-873. doi: 10.3760/cma.j.cn115330-20211021-00678.
To evaluate the clinical value of high-definition intelligent endoscopy (iSCAN) combined with stroboscopy in identifying vocal cord leukoplakia. Seventy-nine patients with vocal cord leukoplakia who underwent CO laser laryngeal microsurgery and diagnosed by histopathology were recruited between October 2020 to August 2021. The morphological features, microvascular morphology and mucosal waves were observed by stroboscope; SPSS 20.0 software was used for statistical analysis. There were 79 patients with a total of 119 lesions (56 on left and 63 on right).Pathological examination showed that 51 sides of the vocal cords were malignant lesions (severe dysplasia, carcinoma in situ and invasive carcinoma), and 68 sides were benign lesions.Under stroboscopy, 69 sides of mucosal wave were normal or slightly decreased, and 50 sides were severely decreased or disappeared.The decrease degree of mucosal wave was positively correlated with malignant lesions (=0.687, <0.001).Under iSCAN endoscopy, there was a positive correlation between the morphological changes of microvessels at the lesion site (vertical) and the malignant lesion (=0.687, <0.001).Univariate analysis showed that lesion size, thickness, uneven color, granular elevation, peripheral erythema and asymmetry were positively correlated with malignant lesions (=0.530, 0.401, 0.538, 0.315, 0.497, 0.281, <0.05).Logistic regression analysis showed that the risk of pathological malignancy with large lesions was 5.437 times higher than those of small lesions, the vertical vascular changes under iSCAN were 8.711 times higher than that of normal vascular morphology, and the severe reduction or disappearance of mucosal waves was 9.12 times higher than that of normal or mild reduction of mucosal waves. ISCAN can be combined with staphyloscopy to comprehensively observe and evaluate the changes of vocal cord morphology, submucosal microvessels and mucosal wave of vocal cord in patients with vocal cord leukoplosis, thus improving the ability to distinguish benign and malignant lesions.
评估高清智能内镜（iSCAN）联合频闪喉镜在识别声带白斑中的临床价值。选取2020年10月至2021年8月期间79例行CO2激光喉显微手术并经组织病理学确诊的声带白斑患者。用频闪喉镜观察其形态特征、微血管形态及黏膜波；采用SPSS 20.0软件进行统计分析。79例患者共有119个病变（左侧56个，右侧63个）。病理检查显示，声带51侧为恶性病变（重度不典型增生、原位癌及浸润癌），68侧为良性病变。频闪喉镜下，69侧黏膜波正常或轻度降低，50侧重度降低或消失。黏膜波降低程度与恶性病变呈正相关（r = 0.687，P < 0.001）。iSCAN内镜下，病变部位（垂直方向）微血管形态变化与恶性病变呈正相关（r = 0.687，P < 0.001）。单因素分析显示，病变大小、厚度、颜色不均、颗粒样隆起、周边红斑及不对称性与恶性病变呈正相关（r = 0.530、0.401、0.538、0.315、0.497、0.281，P < 0.05）。Logistic回归分析显示，病变大者病理恶性风险是病变小者的5.437倍，iSCAN下垂直血管改变者是正常血管形态者的8.711倍，黏膜波重度降低或消失者是正常或轻度降低者的9.12倍。iSCAN可联合频闪喉镜全面观察和评估声带白斑患者声带形态、黏膜下微血管及黏膜波变化，从而提高鉴别良恶性病变的能力。
