Comparative Analysis of the Ultrasonographic and Laryngoscopic Features of Glottic Laryngeal Carcinoma

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Methods This retrospective study included 151 patients with pathologically confirmed glottic laryngeal carcinoma. Ultrasonographic findings were categorized based on two-dimensional grayscale and CDFI findings. The concordance between ultrasound-based classifications and morphological types observed under white-light and NBI endoscopy was analyzed. The influencing factors of different vascular patterns were also investigated. Results The morphological classifications identified by two-dimensional ultrasound—i.e., mass, moth-eaten, popcorn-like, and thickened types—were significantly correlated with endoscopic morphological types. Blood flow patterns observed on CDFI—i.e., star-like, tree-branch, and firework-like—were strongly correlated with intrapapillary capillary loop (IPCL) classifications under NBI. Tumor length and the resistive index (RI) were significantly associated with blood flow patterns (p < 0.05), and multivariate logistic regression analysis revealed that the RI was an independent predictor of blood flow patterns. Conclusion Two-dimensional ultrasound can be used to obtain quantitative vascular parameters and to noninvasively assess both the morphology and vascular characteristics of glottic laryngeal carcinoma. These sonographic findings exhibit high concordance with endoscopic evaluations, thus providing support for the use of ultrasound as a valuable adjunct in the pretreatment assessment of glottic carcinoma. Glottic laryngeal carcinoma ultrasound color Doppler flow imaging vascular morphology narrow-band imaging IPCL classification Figures Figure 1 Figure 2 Figure 3 Introduction Laryngeal cancer is a malignant tumor that originates in the larynx. Although this cancer was previously considered to have a relatively low incidence, recent epidemiological data indicate a 290% increase in its incidence over the past five years. [ 1 ] Owing to its high degree of malignancy and insidious onset, laryngeal cancer has become the only type of head and neck malignancy with a declining survival rate over the past five decades. [ 2 ] Total laryngectomy, which is the standard surgical treatment for advanced laryngeal cancer, severely disrupts the normal anatomical and physiological structure at the junction of the airway and upper digestive tract. However, this procedure imposes significant economic and psychological burdens on patients. Moreover, according to recent studies, the survival rate for advanced laryngeal cancer remains as low as 50%. [ 3 ] In contrast, patients with early-stage glottic laryngeal cancer (T1–T2) may undergo minimally invasive laryngeal procedures such as low-temperature plasma radiofrequency ablation or laser excision. These treatment modalities can preserve laryngeal function to the greatest extent possible, thereby improving patients' quality of life. Therefore, early diagnosis and timely intervention significantly enhance patient outcomes and overall benefit. [ 4 ] Currently, laryngoscopic examination is considered the most important method for the early diagnosis of laryngeal cancer. [ 5 – 7 ] However, white-light laryngoscopy provides limited information because of its relatively low image quality, and narrow-band imaging (NBI) endoscopy is restricted to assessing the surface morphology and vascular patterns of lesions without the ability to evaluate the depth of tumor invasion. [ 8 – 9 ] As a result, accurate T staging cannot be achieved using laryngoscopy alone. Therefore, the preoperative assessment of laryngeal cancer should not rely solely on laryngoscopy and must be complemented by imaging examinations. [ 10 ] Ultrasound examination is a convenient, noninvasive imaging method that enables dynamic, comprehensive visualization of both the surface and deep infiltration of lesions. However, owing to the complex anatomy of the larynx, ultrasound was previously considered insufficient for accurately identifying laryngeal lesions. Thus, research on the application of ultrasound in the diagnosis of laryngeal cancer has been relatively limited. However, in recent years, international research teams have reported that ultrasound achieves an accuracy of 80–90% in the diagnosis and staging of laryngeal cancer. [ 11 – 12 ] These findings indicate that ultrasound examination may play a significant role in improving the prognosis of laryngeal cancer. Glottic laryngeal carcinoma is the most common subtype of laryngeal cancer. To date, no researchers have systematically summarized or differentiated the ultrasonographic features of various morphological subtypes of glottic laryngeal carcinoma. To address this gap in the research and improve the preoperative evaluation of glottic laryngeal carcinoma, this study aimed to refine the ultrasound-based classification system and investigate the correlation between ultrasound-based morphological patterns—including two-dimensional grayscale imaging and color Doppler flow imaging (CDFI)—and endoscopic findings under both white light and narrow-band imaging (NBI). By doing so, we seek to evaluate the diagnostic value of ultrasound in characterizing tumor morphology and vascularity, and to assess its potential as a complementary tool to conventional laryngoscopic examination. Materials and Methods Patients Patients diagnosed with glottic laryngeal carcinoma were retrospectively enrolled from the Second Affiliated Hospital of Xi’an Jiaotong University between 2019 and 2024. All patients underwent both ultrasound and laryngoscopic examinations in the outpatient setting, and the diagnosis was confirmed by pathological examination (Table 1 ). Table 1 Patient characteristics Variables Number of Cases (n) Sex Male 139 Female 12 Age(years) 45–60 61 61–85 90 Symptoms Hoarseness 116 Dysphagia 35 Pathological T Stage pT1a 41 pT1b 31 pT2 22 pT3 39 pT4 18 Lymph Node Metastasis Region I 6 II 15 III 79 IV 10 The exclusion criteria were as follows: missing pathological diagnosis; missing ultrasound or laryngoscopy data; coexisting head and neck malignancies; calcification of the thyroid cartilage prevents complete visualization of the lesion; a history of head and neck surgery or chemoradiotherapy; or severe mental disorders or cognitive impairments affecting communication. A total of 151 patients were included in the study. Among them, 139 were male (92%), with a mean age of 62 years, and 12 were female (8%), with a mean age of 57 years. Informed consent was obtained from all patients and their families. This study was approved by the hospital’s ethics committee (Approval numbers: 2021052; 2023503). Electronic Laryngoscopy All laryngoscopic examinations were performed by senior attending or higher-level endoscopy specialists using an OLYMPUS CLV-S190. The endoscope was inserted through the nasopharynx into the laryngeal cavity. The lesion morphology was first observed under white light mode. On the basis of the observed morphology, glottic carcinoma can be classified into four types: nodular, cauliflower-like, ulcerative, and infiltrative. NBI Endoscopy and Classification The endoscopic mode was switched from white light to narrow-band imaging (NBI) in order to observe the intraepithelial papillary capillary loops (IPCLs) on the lesion surface. The lesions were classified based on the Ni [ 13 ] classification: type I: fine, oblique, arborizing vessels with no visible IPCLs, commonly observed in vocal cord polyps; type II: enlarged oblique and arborizing vessels, with IPCLs still not visible; commonly associated with inflammation; type III: IPCLs covered by white mucosa, often seen in squamous hyperplasia; type IV: IPCLs identifiable as small dots, typically observed in mild to moderate dysplasia; type Va: IPCLs appearing as solid or hollow brownish dots with irregular shapes, common in severe dysplasia or carcinoma in situ; type Vb: IPCLs appearing as irregular, tortuous lines, indicative of invasive carcinoma; type Vc: IPCLs presented as brown dots or tortuous lines distributed irregularly across the tumor surface, also associated with invasive carcinoma. Ultrasound Examination All ultrasound examinations were performed by senior attending or higher-level sonographers using the HI VISION Ascendus system, with linear-array transducers consistently used, and probe frequencies ranging from 8 to 10 MHz. Patients were placed in the supine position with full neck exposure. Scanning was performed continuously from the lower margin of the hyoid bone to the lower edge of the cricoid cartilage in a top-to-bottom direction. The examination included assessment of vocal cord mobility, lesion location, morphology, and vascular characteristics. All relevant data were carefully recorded. In cases involving bilateral vocal cord lesions, the side with more severe involvement was used for analysis. Statistical Analysis Measurement data conforming to a normal distribution are expressed as the mean ± standard deviation (x̄ ± s). One-way analysis of variance (ANOVA) was used for univariate analysis of continuous variables. Categorical variables were analyzed using the chi-square test or Fisher’s exact test. 1. Ultrasonographic Morphological and Vascular Classification of Laryngeal Carcinoma 1.1 Morphological Classification On the basis of the ultrasonographic features of the laryngeal carcinoma lesions, we classified the tumor morphologies into four types: mass type, moth-eaten type, popcorn-like type, and thickened type (Fig. 1 ). Among the 151 patients, the mass type was the predominant ultrasonographic morphology, accounting for 59.6% (n = 90), followed by the moth-eaten type at 27.8% (n = 42), the popcorn-like type at 9.3% (n = 14), and the thickened type at 3.3% (n = 5). The mean long diameter measured by ultrasound was 13.17 ± 0.83 mm for the mass type, 11.69 ± 0.80 mm for the moth-eaten type, and 13.85 ± 1.16 mm for the popcorn-like type. There was no significant difference observed among the tumor types (P = 0.468). Similarly, the mean short diameter was 7.90 ± 0.68 mm, 6.31 ± 0.62 mm, and 7.62 ± 0.89 mm for the mass, moth-eaten, and popcorn-like types, respectively. There were no significant differences in the short diameters between the tumor types (P = 0.336). 1.2 Classification of Tumor Vascularization Patterns in Laryngeal Cancer Based on Ultrasonographic CDFI According to the blood supply characteristics of laryngeal cancer lesions observed via color Doppler flow imaging (CDFI), the vascular patterns were classified into three types: star-like, tree-branch, and firework-like (Fig. 2 ). Among the 151 patients, the most common vascular pattern observed on CDFI was the firework-like type (42.4%, n = 64), followed by the tree-branch type (40.4%, n = 61) and the star-like type (16.6%, n = 25). In one patient, no detectable blood flow signal was observed on the sonogram. White-light laryngoscopy revealed 132 nodular type lesions, 14 cauliflower-like type lesions, and 5 infiltrative type lesions among the 151 patients. In comparison, ultrasound examination revealed 90 mass type lesions, 42 moth-eaten type lesions, 14 popcorn-like type lesions, and 5 thickened type lesions. Analysis of the correlation between ultrasonographic morphology and laryngoscopic appearance revealed that all 90 mass type lesions on ultrasound corresponded to the nodular type on laryngoscopy. Similarly, all 42 moth-eaten lesions on ultrasound also corresponded to the nodular type on laryngoscopy. The 14 popcorn-like lesions on ultrasound corresponded exclusively to the cauliflower-like type on laryngoscopy, whereas all five thickened lesions on ultrasound corresponded to the infiltrative type on laryngoscopy. With respect to vascular features, NBI endoscopy was used to categorize the 151 lesions as follows: 11 IPCL type IV lesions, 25 type Va lesions, 66 type Vb lesions, and 49 type Vc lesions. On contrast-enhanced Doppler flow imaging (CDFI), ultrasonography revealed 25 star-like lesions, 61 tree-branched lesions, and 64 firework-like vascular lesions. One lesion showed no detectable blood flow signal. Correlation analysis revealed that star-like vascular patterns were associated with 3 cases of IPCL type IV lesions, 5 type Va lesions, 4 type Vb lesions, and 13 type Vc lesions. The tree-branch vascular patterns corresponded to 5 IPCL type IV lesions, 6 type Va lesions, 45 type Vb lesions, and 5 type Vc lesions. Firework-like vascular patterns were associated with 2 IPCL type IV lesions, 14 type Va lesions, 17 type Vb lesions, and 31 type Vc lesions. Notably, one IPCL type IV lesion exhibited no detectable blood flow signal under CDFI (Fig. 3 ). 3. Univariate Analysis of Differences in Ultrasonographic Vascular Pattern Types The longitudinal diameter and RI of glottic laryngeal carcinoma lesions were significantly different between the different ultrasonographic vascular pattern types (P < 0.05) (Table 2 , Table 5 ). In contrast, no statistically significant differences were observed in T stage, lymph node metastasis, or transverse diameter among the different vascular pattern types (P > 0.05) (Table 3 , Table 4 ). Table 2 Comparison of Tumor Diameter among Different Ultrasonographic Vascular Patterns Diameter Star-like Tree-branch Firework-like F P Transverse 5.400 ± 0.972 8.627 ± 1.143 8.013 ± 0.636 1.357 0.262 Longitudinal 13.776 ± 1.731 19.369 ± 0.910 19.7109 ± 0.905 6.292 0.002 Table 3 Comparison of Lymph Node Metastasis among Different Ultrasonographic Vascular Patterns Metastasis Status Star-like Tree-branch Firework-like Total χ2 P No Metastasis 20 49 48 117 0.587 0.746 Metastasis 5 12 16 33 Total 25 61 64 150 Table 4 Distribution of Ultrasonographic Vascular Patterns across T Stages T stage Star-like Tree-branch Firework-like Total χ2 P T1a (anterior commissure invasion) 3 5 8 16 2.126 0.977 T1a (no anterior commissure invasion) 4 12 9 25 T1b(anterior commissure invasion) 2 6 9 17 T1b (no anterior commissure invasion) 3 6 5 14 T2 5 10 7 22 T3 6 14 18 38 T4 2 8 8 18 Total 25 61 64 150 Table 5 Comparison of the Resistive Index (RI) among Different Ultrasonic Vascular Patterns Vascular Pattern Total RI F P Star-like 25 0.584 ± 0.004 30.725 <0.001 Tree-branch 61 0.559 ± 0.002 Firework-like 64 0.542 ± 0.003 4. Multinomial Logistic Regression Analysis of Ultrasound Blood Flow Patterns Multivariate unordered logistic regression analysis identified the RI as an independent influencing factor of vascular morphology (Table 6 ). Table 6 Multinomial Logistic Regression Analysis of Factors Influencing Ultrasound Blood Flow Pattern Types Comparison Variable β SE Wald χ² P 95% CI Star-like vs Tree-branch Intercept 1.109 1.066 1.083 0.298 RI -0.392 0.458 9.248 0.002 0.101ཞ 0.610 Length 0.038 0.052 0.526 0.468 0.938ཞ1.149 Star-like vs Firework-like Intercept 2.045 1.101 3.450 0.063 RI -2.485 0.497 25.034 < 0.001 0.031ཞ0.221 Length -0.018 0.055 0.111 0.739 0.882ཞ1.093 Firework-like vs Tree-branch Intercept -0.936 0.596 2.463 0.117 RI 1.092 0.276 15.619 < 0.001 1.734ཞ5.126 Length 0.056 0.030 3.472 0.062 0.997ཞ1.121 Discussion Laryngeal carcinoma is characterized by high malignancy and poor prognosis. Traditional open surgical approaches significantly impair both the physical and psychological well-being of patients. [ 14 ] Whether minimally invasive procedures—which are known for their definitive therapeutic outcomes—can be implemented effectively depends heavily on the accuracy of the preoperative assessment. [ 15 ] However, conventional laryngoscopy fails to evaluate the extent of tumor invasion, thus highlighting the need for a diagnostic modality that combines flexibility with high resolution to better support clinical decision-making. Historically, the application of ultrasound in the diagnosis of laryngeal carcinoma has been limited, primarily due to poor image quality resulting from calcification of the thyroid cartilage and gas artifacts within the laryngeal cavity. [ 16 ] However, our study demonstrated that these limitations can be effectively mitigated. Multiplanar scanning helps to avoid acoustic shadows caused by cartilage calcification, and interestingly, gas reflections within the laryngeal cavity can assist in outlining lesion morphology by providing strong echogenic contrast. These findings suggest that ultrasound is capable of accurately evaluating and diagnosing laryngeal carcinoma. Nevertheless, specific sonographic morphologies and vascular patterns of laryngeal carcinoma, as well as their correlations with laryngoscopic findings, have not been previously reported. Our study addresses this gap by systematically classifying sonographic patterns and exploring their clinical implications. This is the first study to categorize glottic laryngeal carcinomas on ultrasound into four morphological types: mass, moth-eaten, popcorn-like, and thickened types. Compared with direct laryngoscopy, white-light laryngoscopy revealed a high degree of concordance between the sonographic morphology and the gross appearance of the lesions. Specifically, the mass and moth-eaten types on ultrasound corresponded closely to nodular lesions; the popcorn-like type aligned with a cauliflower-like appearance; and the thickened type matched the infiltrative pattern observed under laryngoscopy. These results indicate that ultrasound not only clearly visualizes the tumor lesions of laryngeal carcinoma but also enables accurate morphological classification. Furthermore, ultrasound overcomes certain anatomical limitations inherent to laryngoscopy and provides valuable clues regarding submucosal infiltration. In normal vocal cords, the vascular network is typically not visualized via CDFI. However, when tumor infiltration induces abnormal IPCLs, various blood flow patterns become detectable by ultrasound. Previous studies have primarily employed the Adler grading system to evaluate vascularity in lesions. This method is useful, but it only emphasizes the quantity of blood flow and fails to capture the characteristic vascular morphologies seen in laryngeal carcinoma. To better describe tumor vascularity in a more intuitive and morphologic manner, we introduced a novel classification of blood flow patterns under ultrasound: star-like, tree-branch, and firework-like types. Compared with the IPCL classification under NBI, we found a relatively high degree of consistency. The star-like pattern, characterized by sparsely distributed punctate signals, predominantly corresponded to the IPCL type Vc (52%). The tree-branch pattern, featuring dilated, tortuous, and irregularly branching vessels, was primarily associated with type Vb lesions (68%). The firework-like pattern, comprising a mixture of coarse, disordered vessels and punctate flow signals, most frequently corresponded to type Vc lesions (63%). These findings suggest that sonographic blood flow morphology classification may serve as a reliable complement to IPCL grading, offering a more detailed representation of tumor vascular characteristics. The growth of malignant tumors is closely associated with angiogenesis. Without the induction of neovascularization, the tumor diameter typically does not exceed 1–2 mm. [ 17 ] In this study, we found a significant difference in the longitudinal diameter of tumors among different blood flow morphologies. Specifically, lesions with a star-like vascular pattern presented significantly shorter longitudinal diameters than those with tree-branch and firework-like patterns. This may be attributed to the lower vascular density and simpler vascular architecture in the star-like type, which likely provides only limited perfusion, supporting the slow proliferation of localized tumor cells. In contrast, the tree-branch and firework-like patterns suggest increased vascular density and structural complexity. These disorganized vascular networks are presumed to provide enhanced metabolic support for tumor progression, thereby promoting more rapid growth and increased invasiveness. [ 18 ] This finding offers direct imaging-based evidence to support the angiogenesis-dependent growth model in laryngeal carcinoma. Furthermore, this study revealed that the differences in the RI among various blood flow patterns were statistically significant. Multivariate unordered logistic regression analysis identified the RI as an independent influencing factor of vascular morphology. Specifically, the RI decreased with increasing vascular richness. This phenomenon may be attributed to the structural abnormalities of the tumor-induced neovasculature—such as immature or absent vascular smooth muscle—which are unable to maintain a high RI. Additionally, the elevated oxygen demand of tumor cells and the increased formation of arteriovenous shunts may contribute to this decline. Hypoxic microenvironments can further enhance vascular permeability, collectively leading to a reduction in the RI. [ 19 ] Owing to the marked heterogeneity of laryngeal carcinoma. [ 20 ] the tumor location and invasion pattern significantly influence treatment strategies. In early-stage glottic carcinoma, balancing treatment efficacy with recurrence control is critical. Among these factors, involvement of the anterior commissure is widely regarded as a key predictor of recurrence in early glottic cancer patients. [ 21 ] To enhance the clinical relevance of this study, we further refined the T1 stage into four subgroups: T1a (without anterior commissure involvement), T1a (with anterior commissure involvement), T1b (without anterior commissure involvement), and T1b (with anterior commissure involvement). Feng Yan et al. [ 22 – 23 ] reported that the microvessel density in laryngeal carcinoma patients was significantly greater in the T3 and T4 stages than in the T1 and T2 stages. However, in our study, no significant differences in the distribution of ultrasound blood flow patterns were observed across T stages, which may require validation in future studies with larger sample sizes. This study has several limitations. The proportion of T4-stage patients was low. Given the relatively low incidence of laryngeal carcinoma and the real-world nature of clinical staging in this study, data merging or subgroup exclusion was not feasible. Therefore, this topic is worthy of further investigation in future studies with expanded cohorts. Conclusion Two-dimensional ultrasound can be used to obtain quantitative vascular parameters and to noninvasively assess both the morphology and vascular characteristics of glottic laryngeal carcinoma. Notably, the sonographic findings demonstrate a high degree of concordance with those obtained via endoscopic evaluation, indicating that key morphological features typically visualized through invasive laryngoscopy can also be reliably captured through ultrasound. Furthermore, ultrasound offers significant advantages as a noninvasive, real-time, and repeatable imaging modality, allowing for longitudinal monitoring of tumor progression or treatment response without subjecting patients to repeated invasive procedures. This makes ultrasound particularly valuable not only in the initial pretreatment evaluation, but also in post-treatment surveillance and efficacy follow-up, enabling clinicians to detect early signs of recurrence or residual disease in a safe and patient-friendly manner. These findings support the broader clinical integration of ultrasound as a complementary tool to laryngoscopy in the comprehensive management of glottic carcinoma. Declarations Ethics approval and consent to participate ： This study was approved by the Ethics Committee of Second Affiliated Hospital of Xi’an Jiaotong University (Ethics Approval No: 2021052; 2023503). Written informed consent was obtained. The study complied with the Declaration of Helsinki. Consent for publication ： Not Applicable. Availability of data and materials ： Data generated or analyzed during the study are available from the corresponding author by request. Acknowledgments: We deeply appreciate the ultrasonographers who contributed to the research process, and we are grateful to the surgeons who helped and the pathologists who assisted in the diagnosis. Conflict of Interest Statement : Xin-xin Lu No relevant relationships. Lei Sun No relevant relationships. Fang-xi zhao No relevant relationships. Yue-he Zhao No relevant relationships.Xiao-peng Li No relevant relationships. Hua Wang No relevant relationships. Funding ： This study has received funding by the Key Research and Development Program of Shaanxi Province, China (2020GXLH-Y-002) Authors' contributions ： The conception and design of the study, or acquisition of data, or analysis and interpretation of data: Xin-xin Lu, Hua Wang, Lei Sun. Drafting the article or revising it critically for important intellectual content: Xin-xin Lu, Lei Sun. Final approval of the version to be submitted Hua Wang, Lei Sun, Fang-xi Zhao, Yue-he Zhao, Xiao-peng Li . References Gong H, Wu LP, Wu Q, et al. Disease burden of laryngeal cancer in China from 1990 to 2019. Zhongguo Yixue Qianyan Zazhi (Dianzi Ban). 2021; 13(12):53-9. Quintana DMVO, Dedivitis RA, Kowalski LP. Perineural invasion and laryngeal squamous cell carcinoma: a systematic review. Braz J Otorhinolaryngol. 2025;91(1):101519. Kuroki M, Shibata H, Kobayashi K, et al. Postoperative pathological findings and prognosis of early laryngeal and pharyngeal cancer treated with transoral surgery. Auris Nasus Larynx. 2024;51(6):976-983. Ju J, Wang JS, Hou SY, et al. A retrospective study on the prognosis of endoscopic surgery for 385 early glottic cancer patients. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2024;59(10):1020–1028. Arthur C, Huangfu H, Li M, et al. The Effectiveness of White Light Endoscopy Combined With Narrow Band Imaging Technique Using Ni Classification in Detecting Early Laryngeal Carcinoma in 114 Patients: Our Clinical Experience. J Voice. Published online October 25, 2023. Aliye IA, Nour AS. Laryngeal Cancer Imaging Patterns and Agreement with Laryngoscopy Findings at Tikur Anbessa Specialized Hospital: A Retrospective Study. Ethiop J Health Sci. 2023;33(1):91-96. Sahu PK, Paramasivam PK, Dutta A, Gupta DK, Marlapudi SK. Role of narrow band imaging in detecting recurrence in patients of squamous cell carcinoma larynx and hypopharynx who underwent radiotherapy/chemo-radiotherapy. Med J Armed Forces India. 2024;80(5):566-571. Wang D, Li N, Guo R, et al. Clinical Value of Narrow Band Imaging Endoscopy in the Early Diagnosis and Staging Assessment of Laryngeal and Hypopharyngeal Cancer. J Voice. Published online August 14, 2024. Gurău P, Tîrbu V, Sencu E, Vetricean S. Flexible endoscopic approach to verrucous carcinoma of the larynx. Clin Otolaryngol. 2021;46(6):1379-1382. Kuno H, Onaya H, Fujii S, Ojiri H, Otani K, Satake M. Primary staging of laryngeal and hypopharyngeal cancer: CT, MR imaging and dual-energy CT. Eur J Radiol. 2014;83(1):e23-e35. Xia CX, Zhu Q, Zhao HX, Yan F, Li SL, Zhang SM. Usefulness of ultrasonography in assessment of laryngeal carcinoma. Br J Radiol. 2013;86(1030):20130343. Rzepakowska A, Osuch-Wójcikiewicz E, Bruzgielewicz A, Niemczyk K. How useful is ultrasound in the assessment of local advancement of laryngeal cancer?. Otolaryngol Pol. 2015;69(2):21-26. Ni XG, He S, Xu ZG, et al. Endoscopic diagnosis of laryngeal cancer and precancerous lesions by narrow band imaging. J Laryngol Otol. 2011;125(3):288-296. Ding Y, Tian Y, Duan R, et al. Identification of predictors and construction of a prediction model for the quality of life in laryngeal carcinoma patients in China using revised core nursing outcomes. BMC Nurs. 2024;23(1):875. Lovati E, Genovese E, Presutti L, et al. Oncological and functional outcomes after type III cordectomy for early glottic cancer (Tis, T1a): a retrospective study based on our 10-year experience. J Clin Med 2024;13(23):7164. YUAN YP, HUANG WJ, YE JY, et al. [Imaging Features of Laryngeal Carcinoma on Ultrasound and Influence Factors Analysis in Image Quality]. Zhongguo Chaosheng Yixue Zazhi. 2023; 39(2):138-41. Jakóbisiak M, Lasek W, Gołab J, et al. Natural mechanisms protecting against cancer. Immunol Lett 2003;90(2-3):103–122. \[published correction appears in Immunol Lett 2004;91(2-3):255.] Zhang FG, Viswanathan S, Zhang C, et al. Association of tumor growth rate with overall survival and recurrence among patients with laryngeal squamous cell carcinoma. Head Neck. 2025;47(1):23-33. Colombo A, Provenzano M, Rivoli L, et al. Utility of Blood Flow/Resistance Index Ratio (Qx) as a Marker of Stenosis and Future Thrombotic Events in Native Arteriovenous Fistulas. Front Surg. 2021;7:604347. Ling Z, Hu G, Wang Z, et al. Prognostic analysis of surgical treatment for T3 glottic laryngeal cancer based on different tumor extension patterns. Eur Arch Otorhinolaryngol. 2024;281(3):1379-1389. Eker C, Surmelioglu O, Dagkiran M, et al. Transoral laser microsurgery for T1 glottic cancer with anterior commissure: Identifying clinical and radiological variables that predict oncological outcome. Eur Arch Otorhinolaryngol. 2024;281(5):2597-2608. Feng Y, Wang B, Liang G, Wen S, Sun R. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2015;29(23):2071-2075. Inoue H, Kaga M, Ikeda H, et al. Magnification endoscopy in esophageal squamous cell carcinoma: a review of the intrapapillary capillary loop classification. Ann Gastroenterol. 2015;28(1):41-48. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7339757","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":522147665,"identity":"779696e3-5df1-4adf-934c-1ced733d7a53","order_by":0,"name":"Xin xin Lu","email":"","orcid":"","institution":"The Second Affiliated Hospital of Xi'an Jiaotong University","correspondingAuthor":false,"prefix":"","firstName":"Xin","middleName":"xin","lastName":"Lu","suffix":""},{"id":522147666,"identity":"f6fea27f-05fe-43e2-b0f0-f50984308096","order_by":1,"name":"Lei Sun","email":"","orcid":"","institution":"The Second Affiliated Hospital of Xi'an 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University","correspondingAuthor":false,"prefix":"","firstName":"Xiao-peng","middleName":"","lastName":"Li","suffix":""},{"id":522147670,"identity":"09267f18-a333-4636-a2b1-cb7c333975a7","order_by":5,"name":"Hua Wang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8UlEQVRIiWNgGAWjYJACZiC2sz/ewGAA5h4gUksyw5kDDAYHSNHC2HAjAaqakBaD42cPvy5ss2NmnPnGoPhjG4Mc340Exs8F+LScyUuzntmWzMcsnZZgcLCNwVjyRgKz9Aw8WswO5JgZ87YxM7NJJx8AaUnccCOBjZkHn5bzb0Ba6hl7JA82gLTUE9ZyI8f4MW/bYcYZEsxgWxIMCGmxv/HGjJnn3PFkAx6gX86ckzCceeZhszQ+LZL9Ocafecqq7QzYz5gZVJTZyPMdTz74GZ8WIGCTgDGAsQ9iMzbg1wCMyQ8wxgNCSkfBKBgFo2BkAgA2g0xwosE8SgAAAABJRU5ErkJggg==","orcid":"","institution":"The Second Affiliated Hospital of Xi'an Jiaotong University","correspondingAuthor":true,"prefix":"","firstName":"Hua","middleName":"","lastName":"Wang","suffix":""}],"badges":[],"createdAt":"2025-08-10 15:38:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7339757/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7339757/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":92682457,"identity":"62eccf03-ea91-41fd-890b-83100940175f","added_by":"auto","created_at":"2025-10-03 01:15:50","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":1463802,"visible":true,"origin":"","legend":"","description":"","filename":"BMC.docx","url":"https://assets-eu.researchsquare.com/files/rs-7339757/v1/c6877ead4adf065c253aec3a.docx"},{"id":92679498,"identity":"6e807eb5-90d5-4ea6-aa49-8ac2490cb72a","added_by":"auto","created_at":"2025-10-03 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01:07:50","extension":"xml","order_by":9,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":86620,"visible":true,"origin":"","legend":"","description":"","filename":"2ba1651684174c79ad10ee2563a8d7051structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7339757/v1/8af3df27683997c09260ec56.xml"},{"id":92679511,"identity":"7950ab7b-2b9c-4b6e-b165-f6a93167cdf9","added_by":"auto","created_at":"2025-10-03 00:59:50","extension":"html","order_by":10,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":92935,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7339757/v1/255984b62cedc8e0b40c16ec.html"},{"id":92680995,"identity":"4b0a46a5-504d-4d35-9cb8-a5c943f30f0d","added_by":"auto","created_at":"2025-10-03 01:07:50","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":743023,"visible":true,"origin":"","legend":"\u003cp\u003eUltrasonographic morphological classification of glottic laryngeal carcinoma.\u003c/p\u003e\n\u003cp\u003e(A–C) Thickened type: (A) Transverse ultrasound imaging showed asymmetric thickening of the affected vocal cord with a relatively smooth mucosal surface and no obvious protruding mass. (B) The correspondingappearance under white-light laryngoscopy was classified as the infiltrative type. (C) Schematic diagram of the thickened-type ultrasonographic appearance. (D–F) Mass type: (D) Ultrasonography revealed a well-defined hypoechoic mass protruding into the laryngeal ventricle with smooth and regular margins. (E) White-light laryngoscopy showed a nodular-type lesion. (F) Schematic diagram of the ultrasonographic appearanceof the mass type. (G–I) Moth-eaten type: (G) Ultrasound imaging demonstrated a hypoechoic lesion protruding into the laryngeal ventricle with an irregular mucosal surface and an incomplete hyperechoic mucosal line. (H) Laryngoscopic appearance under white light was classified as nodular type. (I) Schematic diagram of the ultrasonographic appearance of the moth-eatentype. (J–L) Popcorn-like type: (J) The lesion surface appears rough and irregular under ultrasonography, with alternating hyperechoic gas artifacts and hypoechoic soft tissue at the lesion margins. (K) White-light laryngoscopy revealed an exophytic cauliflower-like mass. (L) Schematic diagram of the popcorn-like-type ultrasonographic appearance.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7339757/v1/5ab30eee6786b65373ee8fce.png"},{"id":92679499,"identity":"4fc15ee0-16b0-49a2-94a2-ca15695b710d","added_by":"auto","created_at":"2025-10-03 00:59:50","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":94030,"visible":true,"origin":"","legend":"\u003cp\u003eClassification of vascular patterns of glottic laryngeal cancer under CDFI.\u003c/p\u003e\n\u003cp\u003e(A) Star-like type: CDFI revealed scattered dot-like or rod-like blood flow signals, resembling starlight. (B) Schematic illustration of the star-like type. (C) Tree-branch type: This type is characterized by one or two thick primary vessels with multiple branching small vessels extending axially, forming a tree-like pattern. (D) Schematic illustration of the branching type. (E) Firework-like type: characterizedby three or more main vessels and numerous small vessels with disorganized orientation. Both punctate and patchy blood flow signals are present, radiating outward in a firework-like pattern. (F) Schematic illustration of the firework-like type.\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7339757/v1/0d489a9fab10cc8779bfd37e.png"},{"id":92679503,"identity":"1ddfb852-2f15-4898-a1af-bfb50f15b770","added_by":"auto","created_at":"2025-10-03 00:59:50","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":142886,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of Ultrasonographic Morphological and Endoscopic Classification Patterns in Glottic Laryngeal Carcinoma.\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-7339757/v1/09146534d0809a1fe16609b6.png"},{"id":99681931,"identity":"d08277fc-ac3b-4ea6-bd43-b64133a900a0","added_by":"auto","created_at":"2026-01-07 08:56:29","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1817516,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7339757/v1/528aea26-4f73-4f90-98f3-3466c78749b0.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Comparative Analysis of the Ultrasonographic and Laryngoscopic Features of Glottic Laryngeal Carcinoma","fulltext":[{"header":"Introduction","content":"\u003cp\u003eLaryngeal cancer is a malignant tumor that originates in the larynx. Although this cancer was previously considered to have a relatively low incidence, recent epidemiological data indicate a 290% increase in its incidence over the past five years.\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e Owing to its high degree of malignancy and insidious onset, laryngeal cancer has become the only type of head and neck malignancy with a declining survival rate over the past five decades.\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e Total laryngectomy, which is the standard surgical treatment for advanced laryngeal cancer, severely disrupts the normal anatomical and physiological structure at the junction of the airway and upper digestive tract. However, this procedure imposes significant economic and psychological burdens on patients. Moreover, according to recent studies, the survival rate for advanced laryngeal cancer remains as low as 50%. \u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e In contrast, patients with early-stage glottic laryngeal cancer (T1\u0026ndash;T2) may undergo minimally invasive laryngeal procedures such as low-temperature plasma radiofrequency ablation or laser excision. These treatment modalities can preserve laryngeal function to the greatest extent possible, thereby improving patients' quality of life. Therefore, early diagnosis and timely intervention significantly enhance patient outcomes and overall benefit.\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eCurrently, laryngoscopic examination is considered the most important method for the early diagnosis of laryngeal cancer.\u003csup\u003e[\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e However, white-light laryngoscopy provides limited information because of its relatively low image quality, and narrow-band imaging (NBI) endoscopy is restricted to assessing the surface morphology and vascular patterns of lesions without the ability to evaluate the depth of tumor invasion.\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003eAs a result, accurate T staging cannot be achieved using laryngoscopy alone. Therefore, the preoperative assessment of laryngeal cancer should not rely solely on laryngoscopy and must be complemented by imaging examinations.\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eUltrasound examination is a convenient, noninvasive imaging method that enables dynamic, comprehensive visualization of both the surface and deep infiltration of lesions. However, owing to the complex anatomy of the larynx, ultrasound was previously considered insufficient for accurately identifying laryngeal lesions. Thus, research on the application of ultrasound in the diagnosis of laryngeal cancer has been relatively limited. However, in recent years, international research teams have reported that ultrasound achieves an accuracy of 80\u0026ndash;90% in the diagnosis and staging of laryngeal cancer.\u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e These findings indicate that ultrasound examination may play a significant role in improving the prognosis of laryngeal cancer. Glottic laryngeal carcinoma is the most common subtype of laryngeal cancer. To date, no researchers have systematically summarized or differentiated the ultrasonographic features of various morphological subtypes of glottic laryngeal carcinoma. To address this gap in the research and improve the preoperative evaluation of glottic laryngeal carcinoma, this study aimed to refine the ultrasound-based classification system and investigate the correlation between ultrasound-based morphological patterns\u0026mdash;including two-dimensional grayscale imaging and color Doppler flow imaging (CDFI)\u0026mdash;and endoscopic findings under both white light and narrow-band imaging (NBI). By doing so, we seek to evaluate the diagnostic value of ultrasound in characterizing tumor morphology and vascularity, and to assess its potential as a complementary tool to conventional laryngoscopic examination.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003ePatients\u003c/p\u003e\u003cp\u003ePatients diagnosed with glottic laryngeal carcinoma were retrospectively enrolled from the Second Affiliated Hospital of Xi\u0026rsquo;an Jiaotong University between 2019 and 2024. All patients underwent both ultrasound and laryngoscopic examinations in the outpatient setting, and the diagnosis was confirmed by pathological examination (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePatient characteristics\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNumber of Cases (n)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e139\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge(years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e45\u0026ndash;60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e61\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e61\u0026ndash;85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e90\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSymptoms\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHoarseness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e116\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDysphagia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e35\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePathological T Stage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003epT1a\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e41\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003epT1b\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e31\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003epT2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e22\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003epT3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e39\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003epT4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLymph Node Metastasis Region\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eII\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIII\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e79\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIV\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe exclusion criteria were as follows: missing pathological diagnosis; missing ultrasound or laryngoscopy data; coexisting head and neck malignancies; calcification of the thyroid cartilage prevents complete visualization of the lesion; a history of head and neck surgery or chemoradiotherapy; or severe mental disorders or cognitive impairments affecting communication.\u003c/p\u003e\u003cp\u003eA total of 151 patients were included in the study. Among them, 139 were male (92%), with a mean age of 62 years, and 12 were female (8%), with a mean age of 57 years. Informed consent was obtained from all patients and their families. This study was approved by the hospital\u0026rsquo;s ethics committee (Approval numbers: 2021052; 2023503).\u003c/p\u003e\u003cp\u003eElectronic Laryngoscopy\u003c/p\u003e\u003cp\u003eAll laryngoscopic examinations were performed by senior attending or higher-level endoscopy specialists using an OLYMPUS CLV-S190. The endoscope was inserted through the nasopharynx into the laryngeal cavity. The lesion morphology was first observed under white light mode. On the basis of the observed morphology, glottic carcinoma can be classified into four types: nodular, cauliflower-like, ulcerative, and infiltrative.\u003c/p\u003e\u003cp\u003eNBI Endoscopy and Classification\u003c/p\u003e\u003cp\u003eThe endoscopic mode was switched from white light to narrow-band imaging (NBI) in order to observe the intraepithelial papillary capillary loops (IPCLs) on the lesion surface. The lesions were classified based on the Ni \u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003eclassification: type I: fine, oblique, arborizing vessels with no visible IPCLs, commonly observed in vocal cord polyps; type II: enlarged oblique and arborizing vessels, with IPCLs still not visible; commonly associated with inflammation; type III: IPCLs covered by white mucosa, often seen in squamous hyperplasia; type IV: IPCLs identifiable as small dots, typically observed in mild to moderate dysplasia; type Va: IPCLs appearing as solid or hollow brownish dots with irregular shapes, common in severe dysplasia or carcinoma in situ; type Vb: IPCLs appearing as irregular, tortuous lines, indicative of invasive carcinoma; type Vc: IPCLs presented as brown dots or tortuous lines distributed irregularly across the tumor surface, also associated with invasive carcinoma.\u003c/p\u003e\u003cp\u003eUltrasound Examination\u003c/p\u003e\u003cp\u003eAll ultrasound examinations were performed by senior attending or higher-level sonographers using the HI VISION Ascendus system, with linear-array transducers consistently used, and probe frequencies ranging from 8 to 10 MHz. Patients were placed in the supine position with full neck exposure. Scanning was performed continuously from the lower margin of the hyoid bone to the lower edge of the cricoid cartilage in a top-to-bottom direction. The examination included assessment of vocal cord mobility, lesion location, morphology, and vascular characteristics. All relevant data were carefully recorded. In cases involving bilateral vocal cord lesions, the side with more severe involvement was used for analysis.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eMeasurement data conforming to a normal distribution are expressed as the mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (x̄ \u0026plusmn; s). One-way analysis of variance (ANOVA) was used for univariate analysis of continuous variables. Categorical variables were analyzed using the chi-square test or Fisher\u0026rsquo;s exact test.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003e1. Ultrasonographic Morphological and Vascular Classification of Laryngeal Carcinoma\u003c/h3\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003e1.1 Morphological Classification\u003c/h2\u003e\u003cp\u003eOn the basis of the ultrasonographic features of the laryngeal carcinoma lesions, we classified the tumor morphologies into four types: mass type, moth-eaten type, popcorn-like type, and thickened type (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eAmong the 151 patients, the mass type was the predominant ultrasonographic morphology, accounting for 59.6% (n\u0026thinsp;=\u0026thinsp;90), followed by the moth-eaten type at 27.8% (n\u0026thinsp;=\u0026thinsp;42), the popcorn-like type at 9.3% (n\u0026thinsp;=\u0026thinsp;14), and the thickened type at 3.3% (n\u0026thinsp;=\u0026thinsp;5).\u003c/p\u003e\u003cp\u003eThe mean long diameter measured by ultrasound was 13.17\u0026thinsp;\u0026plusmn;\u0026thinsp;0.83 mm for the mass type, 11.69\u0026thinsp;\u0026plusmn;\u0026thinsp;0.80 mm for the moth-eaten type, and 13.85\u0026thinsp;\u0026plusmn;\u0026thinsp;1.16 mm for the popcorn-like type. There was no significant difference observed among the tumor types (P\u0026thinsp;=\u0026thinsp;0.468).\u003c/p\u003e\u003cp\u003eSimilarly, the mean short diameter was 7.90\u0026thinsp;\u0026plusmn;\u0026thinsp;0.68 mm, 6.31\u0026thinsp;\u0026plusmn;\u0026thinsp;0.62 mm, and 7.62\u0026thinsp;\u0026plusmn;\u0026thinsp;0.89 mm for the mass, moth-eaten, and popcorn-like types, respectively. There were no significant differences in the short diameters between the tumor types (P\u0026thinsp;=\u0026thinsp;0.336).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003e1.2 Classification of Tumor Vascularization Patterns in Laryngeal Cancer Based on Ultrasonographic CDFI\u003c/h2\u003e\u003cp\u003eAccording to the blood supply characteristics of laryngeal cancer lesions observed via color Doppler flow imaging (CDFI), the vascular patterns were classified into three types: star-like, tree-branch, and firework-like (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eAmong the 151 patients, the most common vascular pattern observed on CDFI was the firework-like type (42.4%, n\u0026thinsp;=\u0026thinsp;64), followed by the tree-branch type (40.4%, n\u0026thinsp;=\u0026thinsp;61) and the star-like type (16.6%, n\u0026thinsp;=\u0026thinsp;25). In one patient, no detectable blood flow signal was observed on the sonogram.\u003c/p\u003e\u003cp\u003eWhite-light laryngoscopy revealed 132 nodular type lesions, 14 cauliflower-like type lesions, and 5 infiltrative type lesions among the 151 patients. In comparison, ultrasound examination revealed 90 mass type lesions, 42 moth-eaten type lesions, 14 popcorn-like type lesions, and 5 thickened type lesions. Analysis of the correlation between ultrasonographic morphology and laryngoscopic appearance revealed that all 90 mass type lesions on ultrasound corresponded to the nodular type on laryngoscopy. Similarly, all 42 moth-eaten lesions on ultrasound also corresponded to the nodular type on laryngoscopy. The 14 popcorn-like lesions on ultrasound corresponded exclusively to the cauliflower-like type on laryngoscopy, whereas all five thickened lesions on ultrasound corresponded to the infiltrative type on laryngoscopy.\u003c/p\u003e\u003cp\u003eWith respect to vascular features, NBI endoscopy was used to categorize the 151 lesions as follows: 11 IPCL type IV lesions, 25 type Va lesions, 66 type Vb lesions, and 49 type Vc lesions. On contrast-enhanced Doppler flow imaging (CDFI), ultrasonography revealed 25 star-like lesions, 61 tree-branched lesions, and 64 firework-like vascular lesions. One lesion showed no detectable blood flow signal. Correlation analysis revealed that star-like vascular patterns were associated with 3 cases of IPCL type IV lesions, 5 type Va lesions, 4 type Vb lesions, and 13 type Vc lesions. The tree-branch vascular patterns corresponded to 5 IPCL type IV lesions, 6 type Va lesions, 45 type Vb lesions, and 5 type Vc lesions. Firework-like vascular patterns were associated with 2 IPCL type IV lesions, 14 type Va lesions, 17 type Vb lesions, and 31 type Vc lesions. Notably, one IPCL type IV lesion exhibited no detectable blood flow signal under CDFI (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003e3. Univariate Analysis of Differences in Ultrasonographic Vascular Pattern Types\u003c/h3\u003e\n\u003cp\u003eThe longitudinal diameter and RI of glottic laryngeal carcinoma lesions were significantly different between the different ultrasonographic vascular pattern types (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). In contrast, no statistically significant differences were observed in T stage, lymph node metastasis, or transverse diameter among the different vascular pattern types (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of Tumor Diameter among Different Ultrasonographic Vascular Patterns\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDiameter\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStar-like\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTree-branch\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFirework-like\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTransverse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e5.400\u0026thinsp;\u0026plusmn;\u0026thinsp;0.972\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e8.627\u0026thinsp;\u0026plusmn;\u0026thinsp;1.143\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e8.013\u0026thinsp;\u0026plusmn;\u0026thinsp;0.636\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.357\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.262\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLongitudinal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e13.776\u0026thinsp;\u0026plusmn;\u0026thinsp;1.731\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e19.369\u0026thinsp;\u0026plusmn;\u0026thinsp;0.910\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e19.7109\u0026thinsp;\u0026plusmn;\u0026thinsp;0.905\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e6.292\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of Lymph Node Metastasis among Different Ultrasonographic Vascular Patterns\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMetastasis Status\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStar-like\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTree-branch\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFirework-like\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eχ2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo Metastasis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e117\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.587\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.746\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMetastasis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e150\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDistribution of Ultrasonographic Vascular Patterns across T Stages\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eT stage\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStar-like\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTree-branch\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFirework-like\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eχ2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eT1a (anterior commissure invasion)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e2.126\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.977\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eT1a (no anterior commissure invasion)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eT1b(anterior commissure invasion)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eT1b (no anterior commissure invasion)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eT2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eT3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eT4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e150\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of the Resistive Index (RI) among Different Ultrasonic Vascular Patterns\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVascular Pattern\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStar-like\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e0.584\u0026thinsp;\u0026plusmn;\u0026thinsp;0.004\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e30.725\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTree-branch\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e0.559\u0026thinsp;\u0026plusmn;\u0026thinsp;0.002\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFirework-like\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e0.542\u0026thinsp;\u0026plusmn;\u0026thinsp;0.003\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003e4. Multinomial Logistic Regression Analysis of Ultrasound Blood Flow Patterns\u003c/h3\u003e\n\u003cp\u003eMultivariate unordered logistic regression analysis identified the RI as an independent influencing factor of vascular morphology (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMultinomial Logistic Regression Analysis of Factors Influencing Ultrasound Blood Flow Pattern Types\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eComparison\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eβ\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSE\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eWald χ\u0026sup2;\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e95% CI\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStar-like vs Tree-branch\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIntercept\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.109\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.066\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.083\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.298\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e-0.392\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.458\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e9.248\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.101ཞ 0.610\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLength\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.038\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.052\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.526\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.468\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.938ཞ1.149\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStar-like vs Firework-like\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIntercept\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.045\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.101\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e3.450\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.063\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e-2.485\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.497\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e25.034\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.031ཞ0.221\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLength\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e-0.018\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.055\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.111\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.739\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.882ཞ1.093\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFirework-like vs Tree-branch\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIntercept\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e-0.936\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.596\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e2.463\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.117\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.092\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.276\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e15.619\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e1.734ཞ5.126\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLength\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.056\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.030\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e3.472\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.062\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.997ཞ1.121\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eLaryngeal carcinoma is characterized by high malignancy and poor prognosis. Traditional open surgical approaches significantly impair both the physical and psychological well-being of patients.\u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e Whether minimally invasive procedures—which are known for their definitive therapeutic outcomes—can be implemented effectively depends heavily on the accuracy of the preoperative assessment.\u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e However, conventional laryngoscopy fails to evaluate the extent of tumor invasion, thus highlighting the need for a diagnostic modality that combines flexibility with high resolution to better support clinical decision-making. Historically, the application of ultrasound in the diagnosis of laryngeal carcinoma has been limited, primarily due to poor image quality resulting from calcification of the thyroid cartilage and gas artifacts within the laryngeal cavity.\u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e However, our study demonstrated that these limitations can be effectively mitigated. Multiplanar scanning helps to avoid acoustic shadows caused by cartilage calcification, and interestingly, gas reflections within the laryngeal cavity can assist in outlining lesion morphology by providing strong echogenic contrast. These findings suggest that ultrasound is capable of accurately evaluating and diagnosing laryngeal carcinoma. Nevertheless, specific sonographic morphologies and vascular patterns of laryngeal carcinoma, as well as their correlations with laryngoscopic findings, have not been previously reported. Our study addresses this gap by systematically classifying sonographic patterns and exploring their clinical implications.\u003c/p\u003e\u003cp\u003eThis is the first study to categorize glottic laryngeal carcinomas on ultrasound into four morphological types: mass, moth-eaten, popcorn-like, and thickened types. Compared with direct laryngoscopy, white-light laryngoscopy revealed a high degree of concordance between the sonographic morphology and the gross appearance of the lesions. Specifically, the mass and moth-eaten types on ultrasound corresponded closely to nodular lesions; the popcorn-like type aligned with a cauliflower-like appearance; and the thickened type matched the infiltrative pattern observed under laryngoscopy. These results indicate that ultrasound not only clearly visualizes the tumor lesions of laryngeal carcinoma but also enables accurate morphological classification. Furthermore, ultrasound overcomes certain anatomical limitations inherent to laryngoscopy and provides valuable clues regarding submucosal infiltration.\u003c/p\u003e\u003cp\u003eIn normal vocal cords, the vascular network is typically not visualized via CDFI. However, when tumor infiltration induces abnormal IPCLs, various blood flow patterns become detectable by ultrasound. Previous studies have primarily employed the Adler grading system to evaluate vascularity in lesions. This method is useful, but it only emphasizes the quantity of blood flow and fails to capture the characteristic vascular morphologies seen in laryngeal carcinoma. To better describe tumor vascularity in a more intuitive and morphologic manner, we introduced a novel classification of blood flow patterns under ultrasound: star-like, tree-branch, and firework-like types. Compared with the IPCL classification under NBI, we found a relatively high degree of consistency. The star-like pattern, characterized by sparsely distributed punctate signals, predominantly corresponded to the IPCL type Vc (52%). The tree-branch pattern, featuring dilated, tortuous, and irregularly branching vessels, was primarily associated with type Vb lesions (68%). The firework-like pattern, comprising a mixture of coarse, disordered vessels and punctate flow signals, most frequently corresponded to type Vc lesions (63%). These findings suggest that sonographic blood flow morphology classification may serve as a reliable complement to IPCL grading, offering a more detailed representation of tumor vascular characteristics.\u003c/p\u003e\u003cp\u003eThe growth of malignant tumors is closely associated with angiogenesis. Without the induction of neovascularization, the tumor diameter typically does not exceed 1–2 mm.\u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e In this study, we found a significant difference in the longitudinal diameter of tumors among different blood flow morphologies. Specifically, lesions with a star-like vascular pattern presented significantly shorter longitudinal diameters than those with tree-branch and firework-like patterns. This may be attributed to the lower vascular density and simpler vascular architecture in the star-like type, which likely provides only limited perfusion, supporting the slow proliferation of localized tumor cells. In contrast, the tree-branch and firework-like patterns suggest increased vascular density and structural complexity. These disorganized vascular networks are presumed to provide enhanced metabolic support for tumor progression, thereby promoting more rapid growth and increased invasiveness.\u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e This finding offers direct imaging-based evidence to support the angiogenesis-dependent growth model in laryngeal carcinoma.\u003c/p\u003e\u003cp\u003eFurthermore, this study revealed that the differences in the RI among various blood flow patterns were statistically significant. Multivariate unordered logistic regression analysis identified the RI as an independent influencing factor of vascular morphology. Specifically, the RI decreased with increasing vascular richness. This phenomenon may be attributed to the structural abnormalities of the tumor-induced neovasculature—such as immature or absent vascular smooth muscle—which are unable to maintain a high RI. Additionally, the elevated oxygen demand of tumor cells and the increased formation of arteriovenous shunts may contribute to this decline. Hypoxic microenvironments can further enhance vascular permeability, collectively leading to a reduction in the RI.\u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eOwing to the marked heterogeneity of laryngeal carcinoma.\u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e the tumor location and invasion pattern significantly influence treatment strategies. In early-stage glottic carcinoma, balancing treatment efficacy with recurrence control is critical. Among these factors, involvement of the anterior commissure is widely regarded as a key predictor of recurrence in early glottic cancer patients.\u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e To enhance the clinical relevance of this study, we further refined the T1 stage into four subgroups: T1a (without anterior commissure involvement), T1a (with anterior commissure involvement), T1b (without anterior commissure involvement), and T1b (with anterior commissure involvement). Feng Yan et al.\u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e–\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003ereported that the microvessel density in laryngeal carcinoma patients was significantly greater in the T3 and T4 stages than in the T1 and T2 stages. However, in our study, no significant differences in the distribution of ultrasound blood flow patterns were observed across T stages, which may require validation in future studies with larger sample sizes.\u003c/p\u003e\u003cp\u003eThis study has several limitations. The proportion of T4-stage patients was low. Given the relatively low incidence of laryngeal carcinoma and the real-world nature of clinical staging in this study, data merging or subgroup exclusion was not feasible. Therefore, this topic is worthy of further investigation in future studies with expanded cohorts.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eTwo-dimensional ultrasound can be used to obtain quantitative vascular parameters and to noninvasively assess both the morphology and vascular characteristics of glottic laryngeal carcinoma. Notably, the sonographic findings demonstrate a high degree of concordance with those obtained via endoscopic evaluation, indicating that key morphological features typically visualized through invasive laryngoscopy can also be reliably captured through ultrasound. Furthermore, ultrasound offers significant advantages as a noninvasive, real-time, and repeatable imaging modality, allowing for longitudinal monitoring of tumor progression or treatment response without subjecting patients to repeated invasive procedures. This makes ultrasound particularly valuable not only in the initial pretreatment evaluation, but also in post-treatment surveillance and efficacy follow-up, enabling clinicians to detect early signs of recurrence or residual disease in a safe and patient-friendly manner. These findings support the broader clinical integration of ultrasound as a complementary tool to laryngoscopy in the comprehensive management of glottic carcinoma.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003eThis study was approved by the Ethics Committee of Second Affiliated Hospital of Xi\u0026rsquo;an Jiaotong University (Ethics Approval No: 2021052; 2023503). Written informed consent was obtained. The study complied with the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003eNot Applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003eData generated or analyzed during the study are available from the corresponding author by request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u0026nbsp;\u003c/strong\u003eWe deeply appreciate the ultrasonographers who contributed to the research process, and we are grateful to the surgeons who helped and the pathologists who assisted in the diagnosis.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest Statement\u003c/strong\u003e: Xin-xin Lu No relevant relationships. Lei Sun No relevant relationships. Fang-xi zhao No relevant relationships. Yue-he Zhao No relevant relationships.Xiao-peng Li No relevant relationships. Hua Wang No relevant relationships.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eThis study has received funding by the Key Research and Development Program of Shaanxi Province, China (2020GXLH-Y-002)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003eThe conception and design of the study, or acquisition of data, or analysis and interpretation of data: Xin-xin Lu, Hua Wang, Lei Sun. Drafting the article or revising it critically for important intellectual content: Xin-xin Lu, Lei Sun. Final approval of the version to be submitted Hua Wang, Lei Sun, Fang-xi Zhao, Yue-he Zhao, Xiao-peng Li .\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eGong H, Wu LP, Wu Q, et al. Disease burden of laryngeal cancer in China from 1990 to 2019. Zhongguo Yixue Qianyan Zazhi (Dianzi Ban). 2021; 13(12):53-9. \u003c/li\u003e\n\u003cli\u003eQuintana DMVO, Dedivitis RA, Kowalski LP. Perineural invasion and laryngeal squamous cell carcinoma: a systematic review. Braz J Otorhinolaryngol. 2025;91(1):101519.\u003c/li\u003e\n\u003cli\u003eKuroki M, Shibata H, Kobayashi K, et al. Postoperative pathological findings and prognosis of early laryngeal and pharyngeal cancer treated with transoral surgery. Auris Nasus Larynx. 2024;51(6):976-983.\u003c/li\u003e\n\u003cli\u003eJu J, Wang JS, Hou SY, et al. A retrospective study on the prognosis of endoscopic surgery for 385 early glottic cancer patients. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2024;59(10):1020\u0026ndash;1028.\u003c/li\u003e\n\u003cli\u003eArthur C, Huangfu H, Li M, et al. The Effectiveness of White Light Endoscopy Combined With Narrow Band Imaging Technique Using Ni Classification in Detecting Early Laryngeal Carcinoma in 114 Patients: Our Clinical Experience. J Voice. Published online October 25, 2023. \u003c/li\u003e\n\u003cli\u003eAliye IA, Nour AS. Laryngeal Cancer Imaging Patterns and Agreement with Laryngoscopy Findings at Tikur Anbessa Specialized Hospital: A Retrospective Study. Ethiop J Health Sci. 2023;33(1):91-96. \u003c/li\u003e\n\u003cli\u003eSahu PK, Paramasivam PK, Dutta A, Gupta DK, Marlapudi SK. Role of narrow band imaging in detecting recurrence in patients of squamous cell carcinoma larynx and hypopharynx who underwent radiotherapy/chemo-radiotherapy. Med J Armed Forces India. 2024;80(5):566-571. \u003c/li\u003e\n\u003cli\u003eWang D, Li N, Guo R, et al. Clinical Value of Narrow Band Imaging Endoscopy in the Early Diagnosis and Staging Assessment of Laryngeal and Hypopharyngeal Cancer. J Voice. Published online August 14, 2024. \u003c/li\u003e\n\u003cli\u003eGurău P, T\u0026icirc;rbu V, Sencu E, Vetricean S. Flexible endoscopic approach to verrucous carcinoma of the larynx. Clin Otolaryngol. 2021;46(6):1379-1382.\u003c/li\u003e\n\u003cli\u003eKuno H, Onaya H, Fujii S, Ojiri H, Otani K, Satake M. Primary staging of laryngeal and hypopharyngeal cancer: CT, MR imaging and dual-energy CT. Eur J Radiol. 2014;83(1):e23-e35. \u003c/li\u003e\n\u003cli\u003eXia CX, Zhu Q, Zhao HX, Yan F, Li SL, Zhang SM. Usefulness of ultrasonography in assessment of laryngeal carcinoma. Br J Radiol. 2013;86(1030):20130343. \u003c/li\u003e\n\u003cli\u003eRzepakowska A, Osuch-W\u0026oacute;jcikiewicz E, Bruzgielewicz A, Niemczyk K. How useful is ultrasound in the assessment of local advancement of laryngeal cancer?. Otolaryngol Pol. 2015;69(2):21-26.\u003c/li\u003e\n\u003cli\u003eNi XG, He S, Xu ZG, et al. Endoscopic diagnosis of laryngeal cancer and precancerous lesions by narrow band imaging. J Laryngol Otol. 2011;125(3):288-296. \u003c/li\u003e\n\u003cli\u003eDing Y, Tian Y, Duan R, et al. Identification of predictors and construction of a prediction model for the quality of life in laryngeal carcinoma patients in China using revised core nursing outcomes. BMC Nurs. 2024;23(1):875. \u003c/li\u003e\n\u003cli\u003eLovati E, Genovese E, Presutti L, et al. Oncological and functional outcomes after type III cordectomy for early glottic cancer (Tis, T1a): a retrospective study based on our 10-year experience. J Clin Med 2024;13(23):7164.\u003c/li\u003e\n\u003cli\u003eYUAN YP, HUANG WJ, YE JY, et al. [Imaging Features of Laryngeal Carcinoma on Ultrasound and Influence Factors Analysis in Image Quality]. Zhongguo Chaosheng Yixue Zazhi. 2023; 39(2):138-41.\u003c/li\u003e\n\u003cli\u003eJak\u0026oacute;bisiak M, Lasek W, Gołab J, et al. Natural mechanisms protecting against cancer. Immunol Lett 2003;90(2-3):103\u0026ndash;122. \\[published correction appears in Immunol Lett 2004;91(2-3):255.]\u003c/li\u003e\n\u003cli\u003eZhang FG, Viswanathan S, Zhang C, et al. Association of tumor growth rate with overall survival and recurrence among patients with laryngeal squamous cell carcinoma. Head Neck. 2025;47(1):23-33. \u003c/li\u003e\n\u003cli\u003eColombo A, Provenzano M, Rivoli L, et al. Utility of Blood Flow/Resistance Index Ratio (Qx) as a Marker of Stenosis and Future Thrombotic Events in Native Arteriovenous Fistulas. Front Surg. 2021;7:604347. \u003c/li\u003e\n\u003cli\u003eLing Z, Hu G, Wang Z, et al. Prognostic analysis of surgical treatment for T3 glottic laryngeal cancer based on different tumor extension patterns. Eur Arch Otorhinolaryngol. 2024;281(3):1379-1389. \u003c/li\u003e\n\u003cli\u003eEker C, Surmelioglu O, Dagkiran M, et al. Transoral laser microsurgery for T1 glottic cancer with anterior commissure: Identifying clinical and radiological variables that predict oncological outcome. Eur Arch Otorhinolaryngol. 2024;281(5):2597-2608. \u003c/li\u003e\n\u003cli\u003eFeng Y, Wang B, Liang G, Wen S, Sun R. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2015;29(23):2071-2075.\u003c/li\u003e\n\u003cli\u003eInoue H, Kaga M, Ikeda H, et al. Magnification endoscopy in esophageal squamous cell carcinoma: a review of the intrapapillary capillary loop classification. Ann Gastroenterol. 2015;28(1):41-48.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Glottic laryngeal carcinoma, ultrasound, color Doppler flow imaging, vascular morphology, narrow-band imaging, IPCL classification","lastPublishedDoi":"10.21203/rs.3.rs-7339757/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7339757/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e\u003cp\u003eTo classify the ultrasonographic features of glottic laryngeal carcinoma and to explore the concordance between two-dimensional ultrasound findings, color Doppler flow imaging (CDFI) characteristics and endoscopic morphological classifications under white light and narrow-band imaging (NBI).\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis retrospective study included 151 patients with pathologically confirmed glottic laryngeal carcinoma. Ultrasonographic findings were categorized based on two-dimensional grayscale and CDFI findings. The concordance between ultrasound-based classifications and morphological types observed under white-light and NBI endoscopy was analyzed. The influencing factors of different vascular patterns were also investigated.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe morphological classifications identified by two-dimensional ultrasound\u0026mdash;i.e., mass, moth-eaten, popcorn-like, and thickened types\u0026mdash;were significantly correlated with endoscopic morphological types. Blood flow patterns observed on CDFI\u0026mdash;i.e., star-like, tree-branch, and firework-like\u0026mdash;were strongly correlated with intrapapillary capillary loop (IPCL) classifications under NBI. Tumor length and the resistive index (RI) were significantly associated with blood flow patterns (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), and multivariate logistic regression analysis revealed that the RI was an independent predictor of blood flow patterns.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eTwo-dimensional ultrasound can be used to obtain quantitative vascular parameters and to noninvasively assess both the morphology and vascular characteristics of glottic laryngeal carcinoma. These sonographic findings exhibit high concordance with endoscopic evaluations, thus providing support for the use of ultrasound as a valuable adjunct in the pretreatment assessment of glottic carcinoma.\u003c/p\u003e","manuscriptTitle":"Comparative Analysis of the Ultrasonographic and Laryngoscopic Features of Glottic Laryngeal Carcinoma","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-03 00:59:45","doi":"10.21203/rs.3.rs-7339757/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f6804860-b62f-472f-9752-efd1290fadc3","owner":[],"postedDate":"October 3rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-07T08:55:32+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-03 00:59:45","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7339757","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7339757","identity":"rs-7339757","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}