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Evaluation of a new grading system of laryngeal squamous intraepithelial lesions - a proposed unified classification
Gale, Nina ...
Aims To verify the applicability, reproducibility and predictive value of a proposed unified classification (amended Ljubljana classification) of laryngeal squamous intraepithelial lesions (SILs). ...Methods Six internationally recognised experts and three pathologists from Ljubljana contributed to this study by evaluating a set of laryngeal SILs using the new system: low-gradeSIL, high-grade SIL and carcinoma in situ (CIS). Results The overall agreement among reviewers was good. Overall unweighted and weighted %-statistics and 95% confidence intervals were 0.75 (0.65 - 0.84) and 0.80 (0.71 - 0.87), respectively. The results were stratified between the international reviewers and the Ljubljana pathologists. The former had a good overall agreement, while the latter had very good agreement. Kaplan-Meier survival curves showed a significant difference (p<0.0001) between patients with low- and high-grade SILs; 19/1204 patients with low-grade SILs and 30/240 patients with high-grade SILs progressed to malignancy in 2 to 15 years and in 2 to 26 years, respectively. Conclusions The proposed modification to the LC classification provides clear morphological criteria to define the prognostic groups. The criteria facilitate better inter-observer agreement than previous systems and the retrospective follow-up study demonstrates a highly significant difference in the risk of malignant progression between low and high grade SILs.
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