1 INTRODUCTION
Vocal cord leukoplakia is a descriptive clinical diagnosis with different pathological manifestations, including inflammatory changes or squamous hyperplasia, dysplasia of different grades, carcinoma in situ , or even carcinogenesis.1 Vocal cord leukoplakia is a key precancerous lesion observed in laryngeal carcinoma. Welleret al. 2 performed a meta-analysis on the risk for the transformation of laryngeal dysplasia into a malignant laryngeal tumor and found that the malignant transformation rate of laryngeal mild/moderate dysplasia was 10.6%, and that of severe dysplasia/carcinoma in situ was 30.4%. Therefore, exploring the relationship between the appearance of vocal cord leukoplakia and the degree of dysplasia is the key to determining treatment strategies, prognosis and follow-up approaches. Making this distinction would help to avoid the excessive treatment of benign lesions and the misdiagnosis and mistreatment of lesions with high malignant potential.
Vocal cord leukoplakia often causes hoarseness, patients usually visit a doctor early in the course of the disease. Some studies have shown that narrow band imaging (NBI) laryngoscopy and strobolaryngoscopy are helpful for the differential diagnosis of benign and malignant vocal cord leukoplakia.3 Nevertheless, white light imaging (WLI) laryngoscopy, which allows the observation of morphological characteristics of the vocal cord surface, remains the most common examination used for vocal cord leukoplakia diagnosis. Although some studies exist on the scoring4 and classification5 of vocal cord leukoplakia by WLI, these studies have limitations and do not include all the morphological characteristics related to malignant transformation. Therefore, there are still deficiencies in the differential diagnosis of benign and malignant vocal cord leukoplakia. This study was designed to comprehensively summarize the morphological characteristics associated with malignant leukoplakia and propose a new, simple, and effective leukoplakia finding score (LFS) for the diagnosis of vocal cord leukoplakia to improve the accuracy of the preliminary judgment by WLI laryngoscopy before treatment.