International Journal of Phonosurgery & Laryngology

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VOLUME 13 , ISSUE 2 ( July-December, 2023 ) > List of Articles

Original Article

Validation of Ni's Grading and European Laryngological Society Grading for Laryngeal Lesions: A Prospective Cross-sectional Study

S Vivek, Jayakumar R Menon, Manju E Issac, Basil Varghese

Keywords : Histopathological examination, Hoarseness, Laryngeal cancer, Laryngoscopy, Narrow band imaging

Citation Information : Vivek S, Menon JR, Issac ME, Varghese B. Validation of Ni's Grading and European Laryngological Society Grading for Laryngeal Lesions: A Prospective Cross-sectional Study. Int J Phonosurg Laryngol 2023; 13 (2):19-23.

DOI: 10.5005/jp-journals-10023-1251

License: CC BY-NC 4.0

Published Online: 01-02-2024

Copyright Statement:  Copyright © 2023; The Author(s).


Aims and background: Laryngeal carcinomas comprise one-third of all head and neck carcinomas. Early detection of these lesions is pertinent for curative and functional preservation. Narrow band imaging (NBI) is a novel biological endoscopic tool enabling in vivo differentiation of nonmalignant from malignant laryngeal lesions. Ni et al. proposed a classification of laryngeal lesions based on intraepithelial papillary capillary loops (IPCL) patterns from type I to V. The European Laryngological Society (ELS) introduced a simpler classification in 2015, categorizing vascular changes as either longitudinal or perpendicular. The present study is aimed at identifying the angiogenetic pattern of different laryngeal lesions and validating the two different grading systems. Materials and methods: Preoperative flexible laryngoscopy coupled NBI evaluation was done for 30 consecutive patients with laryngeal lesions posted for excision biopsy and graded according to both Ni's and ELS grading. The biopsy results of the lesions were correlated with preoperative NBI gradings. Results: Of the 30 patients, 23 (76.7%) were males, and seven (23.3%) were females. The maximum number of patients, 13 (43.3%) belonged to Ni's grade V, whereas 15 patients (50%) each showed longitudinal and perpendicular pattern blood vessels, respectively in ELS grading. A total of 14 patients (46.7%), five patients (16.7%), and 11 patients (36.7%) were revealed to be benign, dysplastic, and malignant, respectively on biopsy. Both Ni's and ELS grading had a statistically significant association with the benign or malignant nature of the lesion. The sensitivity and specificity of Ni's grading were 84.2 and 90.9%, and of ELS grading were 78.9 and 100%, respectively. Both these gradings had similar measures of agreement with histopathological examination (HPE) (measured by Cohen's κ). Conclusion: The NBI is a useful diagnostic tool in evaluating laryngeal pathologies. Clinical significance: The ELS grading system which is convenient and easy to use than Ni's grading can be reliably used for classifying laryngeal lesions.

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