{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T15:41:01Z","timestamp":1783698061790,"version":"3.55.0"},"reference-count":63,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,1,25]],"date-time":"2024-01-25T00:00:00Z","timestamp":1706140800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Scattered, small, dot-like intraepithelial papillary capillary loops (IPCLs) represent type IV epithelial vascularization according to \u201cNi classification\u201d and are considered to be nonmalignant. According to the European Laryngological Society classification, these loops are malignant vascular changes. This contradiction has high clinical importance; therefore, clarification of the clinical significance of type IV vascularization according to the Ni classification is needed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The study was performed between June 2015 and December 2022. All recruited patients (n = 434) were symptomatic, with macroscopic laryngeal lesions (n = 674). Patients were investigated using the enhanced endoscopic methods of narrow band imaging (NBI) and the Storz Professional Image Enhancement System (IMAGE1 S). The microvascular patterns in the lesions were categorized according to Ni classification from 2011 and all lesions were examined histologically.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 674 lesions (434 patients) were investigated using flexible NBI endoscopy and IMAGE1 S endoscopy. Type IV vascularization was recognized in 293\/674 (43.5%) lesions. Among these 293 lesions, 178 (60.7%) were benign (chronic laryngitis, hyperplasia, hyperkeratosis, polyps, cysts, granulomas, Reinkeho oedema and recurrent respiratory papillomatosis); 9 (3.1%) were squamous cell carcinoma; 61 (20.8%) were mildly dysplastic, 29 (9.9%) were moderately dysplastic, 14 (4.8%) were severe dysplastic and 2 (0.7%) were carcinoma in situ. The ability to recognize histologically benign lesions in group of nonmalignant vascular pattern according to Ni (vascularization type I-IV) and distinguish them from precancers and malignancies was with accuracy 75.5%, sensitivity 54.4%, specificity 94.4%, positive predictive value 89.6% and negative predictive value 69.9%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Laryngeal lesions with type IV vascularization as defined by Ni present various histological findings, including precancerous and malignant lesions. Patients with type IV vascularization must be followed carefully and, in case of progression mucosal lesion microlaryngoscopy and excision are indicated.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fonc.2024.1222827","type":"journal-article","created":{"date-parts":[[2024,1,25]],"date-time":"2024-01-25T10:22:13Z","timestamp":1706178133000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Clinical significance of type IV vascularization of laryngeal lesions according to the Ni classification"],"prefix":"10.3389","volume":"14","author":[{"given":"Lucia","family":"Stan\u00edkov\u00e1","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"K\u00e1ntor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katar\u00edna","family":"Fedorov\u00e1","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karol","family":"Zelen\u00edk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pavel","family":"Kom\u00ednek","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,1,25]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/j.otc.2008.01.016","article-title":"Laryngeal cancer: diagnosis and preoperative work-up","volume":"41","author":"Chu","year":"2008","journal-title":"Otolaryngol Clin North Am"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1002\/hed.26186","article-title":"Use of narrowband imaging for the diagnosis and screening of laryngeal cancer: A systematic review and meta-analysis","volume":"42","author":"Kim","year":"2020","journal-title":"Head Neck"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1097\/MOO.0b013e32835908ac","article-title":"Narrow band imaging in endoscopic evaluation of the larynx","volume":"20","author":"Piazza","year":"2012","journal-title":"Curr Opin Otolaryngol Head Neck Surg"},{"key":"B4","article-title":"Narrow Band Imaging (NBI) - endoskopick\u00e1 metoda pro diagnostiku karcinom\u016f hlavy a krku [Narrow Band Imaging (NBI) - Endoscopic Method for Head and Neck Squamous Cell Carcinoma Diagnostics]","volume":"62","author":"Luke\u0161","year":"2013","journal-title":"Otorinolaryngol Foniatr"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1017\/S0022215110002033","article-title":"Endoscopic diagnosis of laryngeal cancer and precancerous lesions by narrow band imaging","volume":"125","author":"Ni","year":"2011","journal-title":"J Laryngol Otol"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1002\/lary.25124","article-title":"Enhanced contact endoscopy for the detection of neoangiogenesis in tumors of the larynx and hypopharynx","volume":"125","author":"Puxeddu","year":"2015","journal-title":"Laryngoscope"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1007\/s00405-015-3851-y","article-title":"Proposal for a descriptive guideline of vascular changes in lesions of the vocal folds by the committee on endoscopic laryngeal imaging of the European Laryngological Society","volume":"73","author":"Arens","year":"2016","journal-title":"Eur Arch Otorhinolaryngol"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1002\/lary.27346","article-title":"Diagnosis of vocal cord leukoplakia: the role of a novel narrow band imaging endoscopic classification","volume":"129","author":"Ni","year":"2019","journal-title":"Laryngoscope"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1002\/hed.23582","article-title":"Effectiveness of narrow band imaging in the detection of premalignant and Malignant lesions of the larynx: validation of a new endoscopic clinical classification","volume":"37","author":"Bertino","year":"2015","journal-title":"Head Neck"},{"key":"B10","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1002\/hed.23838","article-title":"Value of narrow band imaging in the early diagnosis of laryngeal cancer","volume":"38","author":"Kraft","year":"2016","journal-title":"Head Neck"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1002\/lary.26721","article-title":"Can the Ni classification of vessels predict neoplasia? 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