Proposed Classification System for the 445 nm Blue Light Laser for Treatment of Laryngeal Lesions

Only preliminary investigations on the use of the 445 nm wavelength blue light laser (BLL) for various laryngeal pathologies have been described. Currently, no standard exists for reporting treatment technique and tissue effect with this modality. Here, we aim to establish and validate a classification system to describe laser-induced tissue effects.

Retrospective video-based study for classification development and reliability validation.

Video recordings from procedures performed with the BLL by multiple academic laryngologists were retrospectively reviewed. A preliminary six-point classification (BLL 1-6) was developed based on expert consensus. Thirteen additional procedural clips were independently rated utilizing the classification schema to assess perceived tissue effect and measure inter- and intra-rate reliability.

The final five-point classification system (BLL 1-5) included angiolysis, blanching, tissue vaporization, ablation with mechanical tissue removal, and cutting. The consensus of the combined reviewers in rating all cases was 89% (58 of 65). Complete consensus was not achieved in 11% (7/65) of cases. Of those incorrect, 57% (4/7) were of clips illustrating the BLL-2 classification. Intra-rater reliability among the reviewers was 100%.

The tissue effect of the 445 nm blue light laser can reliably be standardized with this proposed classification system. This rating system can be used to facilitate future systematic study of outcomes and effective communication between laryngologists and trainees.