A morphological classification for vocal fold leukoplakia

Abstract Introduction: There is still no general method for discriminating between benign and malignant leukoplakia and identifying vocal fold leukoplakia. Objective: To evaluate the reliability of a morphological classification and the correlation between morphological types and pathological grades of vocal fold leukoplakia. Methods: A total of 375 patients with vocal fold leukoplakia between 2009 and 2015 were retrospectively reviewed. Two observers divided the vocal fold leukoplakia into flat and smooth, elevated and smooth, and rough type on the basis of morphological appearance. The inter-observer reliability was evaluated and the results of classification from both observers were compared with final pathological grades. Clinical characteristics between low risk and high risk group were also analyzed. Results: The percentage inter-observer agreement of the morphological classification was 78.7% (κ = 0.615, p < 0.001). In the results from both observers, the morphological types were significantly correlated with the pathological grades (p1 < 0.001, p2 < 0.001, Kruskal-Wallis test; r1 = 0.646, p1 < 0.001, r2 = 0.539, p2 < 0.001, Spearman Correlation Analysis). Multivariate analysis showed patient's age (p = 0.018), the size of lesion (p < 0.001), and morphological type (p < 0.001) were significantly different between low risk group and high risk group. Combined receiver operating characteristic curve analysis of significant parameters revealed an area under the receiver operating characteristic curve of 0.863 (95% CI 0.823-0.903, p < 0.001). Conclusions: The proposed morphological classification of vocal fold leukoplakia was consistent between observers and morphological types correlated with pathological grades. Patient's age, the size of lesion, and morphological type might enable risk stratification and provide treatment guidelines for vocal fold leukoplakia.

摘要：目前尚无通用方法可区分白斑的良恶性，亦无法准确识别声带白斑（vocal fold leukoplakia）。研究目的：评估声带白斑形态学分类的可靠性，以及其形态类型与病理分级之间的相关性。研究方法：回顾性分析2009年至2015年间收治的375例声带白斑患者的临床资料。由2名观察者依据形态学表现将声带白斑分为平坦光滑型、隆起光滑型及粗糙型三种类型。评估观察者间一致性，并将两名观察者的分类结果与最终病理分级进行比对；同时分析低危组与高危组患者的临床特征差异。研究结果：本次形态学分类的观察者间一致率为78.7%（κ=0.615，P<0.001）。两名观察者的分类结果均显示，形态学类型与病理分级存在显著相关性（观察者1：克鲁斯卡尔-沃利斯检验（Kruskal-Wallis test）：P₁<0.001，斯皮尔曼相关性分析：r₁=0.646，P₁<0.001；观察者2：克鲁斯卡尔-沃利斯检验（Kruskal-Wallis test）：P₂<0.001，斯皮尔曼相关性分析：r₂=0.539，P₂<0.001）。多因素分析结果显示，低危组与高危组患者在年龄（P=0.018）、病灶大小（P<0.001）及形态学类型（P<0.001）方面差异均具有统计学意义。对上述具有统计学意义的参数进行联合受试者工作特征曲线（receiver operating characteristic curve，ROC曲线）分析，结果显示受试者工作特征曲线下面积为0.863（95%置信区间（95% CI）为0.823~0.903，P<0.001）。研究结论：本研究提出的声带白斑形态学分类具有良好的观察者间一致性，且形态学类型与病理分级显著相关。患者年龄、病灶大小及形态学类型可用于声带白斑的风险分层，并可为其临床治疗提供指导依据。