Endoscopic features of oral and pharyngolaryngeal papillomas and their role in distinguishing squamous cell carcinoma

Abstract

BACKGROUND

Oral and pharyngolaryngeal papillomas are occasionally detected during esophagogastroduodenoscopy. However, their endoscopic features have not been sufficiently investigated.

AIM

To distinguish oral and pharyngolaryngeal papillomas from elevated squamous carcinomas, this study examined their endoscopic features.

METHODS

Forty-seven patients with oral or pharyngeal papilloma participated in this study. The endoscopic characteristics of papillomas were identified by focusing on narrowband and blue laser imaging representations.

RESULTS

Papillomas were classified into three patterns based on their endoscopic features: Salmon roe-like polyps, polyps without capillary transparency, and pinecone-like polyps, with salmon roe-like polyps most prevalent (48.9%). We subsequently analyzed features differentiating papillomas and squamous cell carcinomas in the same region and found that squamous cell carcinomas exhibited at least one of the following three features: Uneven or absent lobulated structure, irregular morphology of capillaries, and coexistence of flat lesions. In contrast, papillomas displayed a uniform lobulated structure, homogeneous or non-visible capillaries, and an absence of flat components. When any of these characteristics were present, two endoscopic specialists evaluated the lesions for the diagnosis of squamous cell carcinoma, with sensitivities of 100% and 97.6% and specificities of 68.9% and 93.3%.

CONCLUSION

Understanding distinct endoscopic patterns of oropharyngeal papillomas and squamous cell carcinomas provides valuable guidance to endoscopists performing esophagogastroduodenoscopy.

Keywords: Esophagogastroduodenoscopy; Human papillomavirus; Laryngeal polyp; Papilloma; Pharyngeal polyp

Core Tip: This retrospective study highlighted the endoscopic features of oral and pharyngolaryngeal papillomas and identified three distinct morphological patterns: Salmon roe-like, polyps without capillary transparency, and pinecone-like. By contrasting these features with those of squamous cell carcinomas, namely, uneven lobulated structures, irregular capillaries, and flat lesion components, this study provides practical guidance for distinguishing these lesions during esophagogastroduodenoscopy. Our findings may reduce unnecessary biopsies and improve diagnostic accuracy, offering endoscopists valuable insights into oropharyngeal region evaluations. To our knowledge, this is the first detailed analysis of the endoscopic patterns of papillomas in these regions.