Relationship between laryngoscopic and histopathological characteristics of vocal folds leukoplakia and/or erythroplakia

Background Vocal fold leukoplakia (VFL) and erythroplakia are precancerous laryngeal lesions with variable malignant potential. While laryngoscopy aids in diagnosis, its correlation with histopathology remains unclear. Identifying predictive laryngoscopic characteristics may enhance early risk stratification and management. This study aims to evaluate the relationship between laryngoscopic appearance and histopathological dysplasia grading in VFL and erythroplakia to guide clinical decision-making. Methods This cross-sectional study was conducted on 100 patients with persistent hoarseness who underwent laryngoscopic examination and histopathological assessment at Benha University Hospital. Laryngoscopic findings, including lesion morphology, laterality, and vocal mobility, were analyzed and compared to histopathological dysplasia grades. Results Laryngoscopic morphology significantly correlated with histopathology ( r = 0.536, P < 0.001). Flat smooth lesions were mostly non-dysplastic (77.1%), while elevated smooth lesions had mild (46.5%) to moderate (41.9%) dysplasia. Rough lesions had the highest dysplasia severity, with 36.4% showing severe dysplasia. Mobile vocal cords were more common in the low-risk group (84.6% vs. 65.7%, P = 0.03), and rough morphology was prevalent in the high-risk group (34.3% vs. 15.4%, P = 0.004). Multivariate analysis identified severe dysphonia (OR = 20.107, P = 0.001) and rough morphology (OR = 6.754, P = 0.025) as significant predictors of high grade dysplasia. Conclusion Laryngoscopic findings correlate significantly with histopathological dysplasia grades, aiding in risk stratification. Rough and elevated smooth lesions warrant closer monitoring and potential intervention to prevent malignant transformation.