ORIGINAL ARTICLE Classification of vocal fold leukoplakia by clinical scoring Tuan-Jen Fang, MD, FICS, 1,2 * Wan-Ni Lin, MD, 1,2 Li-Yu Lee, MD, 2,3 Chi-Kuang Young, MD, 5 Li-Ang Lee, MD, 1,2 Kai-Ping Chang, MD, PhD, 1,2 Chun-Ta Liao, MD, 1,2 Hseuh-Yu Li, MD, 1,2 Tzu-Chen Yen, MD, PhD, 2,4 1 Department of Otolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan, 2 School of Medicine, Chang Gung University, Taoyuan, Taiwan, 3 Department of Pathology, Chang Gung Memorial Hospital, Linkou, Taiwan, 4 Department of Nuclear Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan, 5 Department of Otolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan. Accepted 25 November 2015 Published online 5 February 2016 in Wiley Online Library (wileyonlinelibrary.com). DOI 10.1002/hed.24368 ABSTRACT: Background. Vocal cord leukoplakia comprises a variety of lesions. The purpose of this study was to stratify vocal leukoplakias before surgery. Methods. Patients with an initial diagnosis of vocal leukoplakia who underwent surgical excision at a tertiary referral center in Taiwan were recruited for this study. Their clinical records, including age, sex, preop- erative laryngoscopic images in the office setting, and final pathology reports were collected and analyzed. Results. Patient age (p 5 .010), nonhomogenous lesion texture (p 5 .001), and existence of hyperemia (p 5 .014) were identified as independent fac- tors predicting malignancy. A predictive formula was established accordingly. The model showed an excellent discrimination role by receiver operating characteristic curve analysis (area under the curve 5 0.86; p < .001). Conclusion. This study confirmed the value of a scoring system based on laryngoscopic characteristics and patient age for predicting the histo- logic results in vocal leukoplakia. It is helpful for classifying vocal leuko- plakia and pretreatment planning. VC 2016 Wiley Periodicals, Inc. Head Neck 38: E1998–E2003, 2016 KEY WORDS: laryngoscopy, scoring, vocal leukoplakia, larynx, dysphonia INTRODUCTION Leukoplakia refers to whitish patches associated with a spectrum of histological diagnoses ranging from benign to malignant lesions. 1–4 Patients with vocal leukoplakia, sim- ilar to other vocal fold mucosal lesions, usually suffer from hoarseness and expect to regain their voice after adequate therapy. There is still no consensus on the ideal treatment of vocal fold premalignant lesions. Stripping of mucosa, CO2 laser excision, or ablation, or even radiation has been suggested as an option. From a study reviewing 56 cases by Schweinfurth et al, 5 most of the cases of vocal fold leukoplakia reduction in histologic aggressive- ness occur after serial universe microflap excision but there were still few that progressed. Thus, vocal leukopla- kia should be managed individually based on its benign or malignant possibilities of the lesion. 6–8 In suspected benign lesions, observation or superficial excision to pre- serve as much subepithelial tissue as possible is preferred, whereas deeper excision is adequate in cases with malig- nant potential. Although clinical classification and staging procedures exist for leukoplakia in other sites, 4,9 to our knowledge, there has been no report in English about the classifica- tion of the vocal fold leukoplakia before surgery, and the management thus varies among surgeons. The appearance of vocal leukoplakia varies among indi- viduals and is closely related to histologic findings. 10,11 Advances in high-quality digital imaging systems and dis- tal chip fiber-optic laryngoscopy have made it possible to distinguish between benign and malignant vocal cord mucosal disorders (Figure 1). As reported previously, 10 laryngoscopic characteristics can be determined using a laryngoscopic imaging recording system, with adequate interobserver reliability. The purpose of the present study was to establish a scoring system by combining clinical demographic and laryngoscopic characteristics in order to improve the management of vocal leukoplakia. MATERIALS AND METHODS This retrospective study was approved by the institutional review board of Chang Gung Memorial Hospital before con- ducting the study. Patients diagnosed with vocal leukoplakia between January 2010 and April 2014 were enrolled. Clini- cal records, including information on age, sex, smoking habit, medical history, preoperative laryngoscopic images in the office setting, and final pathology reports were collected. *Corresponding author: T.-J. Fang, Department of Otolaryngology, Head and neck Surgery, Chang Gung Memorial Hospital, 5 Fu-Shin Street, Kweishan, Taoyuan 333, Taiwan. E-mail: fang3109@cgmh.org.tw This work was presented at the 2015 International Congress of Korean Society of Otorhinolaryngology Head and Neck Surgery Seoul, Korea, April 24–26, 2015. Contract grant sponsor: This research was supported by a Chang Gung Medical Foundation Grant (CMRPG 3B1413). The funder had no role in the study design, data collection or analysis, decision to publish, or preparation of the manuscript. E1998 HEAD & NECK—DOI 10.1002/HED APRIL 2016