Autofluorescent Endoscopy as a New Modality in Diagnostics of Laryngeal Premalignant and Malignant Lesions

Objective: In this prospective study, we compared the diagnostic potential of Pentax's System of Autofluorescent Endoscopy (SAFE 1000) with standard microlaryngoscopy in the diagnosis of laryngeal precancerous and malignant lesions. Methods: We compared the sensitivity and specificity of microlaryngoscopy and SAFE 1000 in a total of 128 patients with various laryngeal pathologies. Fiberoptic endoscopic examinations of the larynx in white light and autofluorescent mode were performed, followed by microlaryngoscopy with obtaining biopsy from suspected areas, performed by another endoscopist. During the microlaryngoscopy, the endoscopist evaluated images provided by SAFE and compared them with the findings of microlaryngoscopy and, if necessary, took biopsies from areas with autofluorescent irregularities. Histopathological examination of biopsy samples was used as a "gold standard" for definitive diagnosis and for comparison of studied methods. Results: Overall sensitivity of SAFE was higher than the sensitivity of microlaryngoscopy (89.06% vs. 83.59%, P=.016). Specificity of detection of defect in autofluorescent signal in cases with laryngeal premalignancies and malignant tumors by SAFE 1000 endoscopy was 81.71%. The results suggest that SAFE has a significantly higher sensitivity than standard MLS in detection and description of precancerous and malignant lesions of the larynx. The specificity of SAFE 1000 was relatively insufficient, suggesting the necessity for histopathological analysis. Conclusion: SAFE 1000 could be a powerful tool in recognizing and describing premalignant and malignant lesions of the larynx in addition to standard microlaryngoscopy. Authors recommend the simultaneous use of SAFE 1000 and microlaryngoscopy in the diagnostics of laryngeal lesions, in order to obtain the most accurate diagnostic results. Keywords: Larynx, premalignant lesions, carcinoma, endoscopy, autofluorescence