In the United States, an estimated 16,000 people are diagnosed with laryngeal cancer each year, with most patients being 55 or older, and Black men being the most vulnerable demographic. The five-year survival rate is about 50% [1]. Developing methods for real-time malignant cell detection can help ensure accurate tumor margins, prevent recurrence, and conserve physiological structures. 

Confocal Laser Endomicroscopy (CLE) allows real-time tissue microarchitecture assessment using a mini probe, providing cellular-level details without compromising tissue integrity. Widely used across various specialties, CLE has found an additional role in head and neck cancer surgery. However, CLE often relies on subjective interpretation, causing variability in reporting. To improve accuracy and precision, a scoring system based on histopathological criteria, considered the gold standard in cancer diagnosis, can help create objective data for CLE image and video evaluation.

This study proposes a modified LPCIS CLE scoring system based on the histopathological characteristics of dysplastic epithelium. The new system builds on a previous six-criteria scoring system for the larynx and pharynx, expanding it to eight criteria that reflect cellular changes typical of cancer in histopathological evaluations. This method allows observers to assign numerical values to images, similar to how pathologists examine tissue specimens.

Using a “weighted” system with reference to the 14 Hallmarks of Cancer, a scoring criteria system/criterion was developed, with scores higher than 3 indicating an increased probability of being dysplastic. This approach enhances diagnostic accuracy and supports better clinical decision-making in managing laryngeal cancer, providing the potential for the introduction of CLE as a clinical standard during intra-operative tissue assessment in real time for during head and neck tumor resection surgeries.