Background/Objectives: Narrow Band Imaging (NBI) endoscopy is a relatively novel optical biological endoscopic method that enables improved visualization of microvascular patterns and thus, earlier detection of vocal cord cancer. The purpose of this instructional course is to present the diagnostic value of NBI and compare the most commonly used classifications of microvascular patterns.

Methods: The literature was reviewed and our own clinical experience in the use of NBI and enhanced contact endoscopy using NBI were incorporated with an emphasis on Ni's classification and the classification of the European Laryngology Society (ELS) and Puxeddu’s classification.

Results: NBI allows for the precise visualization of mucosal and submucosal vessels and the detection of pathological microvascular patterns associated with malignant transformation. Ni's classification offers a detailed, but complex classification that requires a high level of training. The ELS classification is simpler, based on the dichotomous division of vascular changes into longitudinal and perpendicular ones, allowing for the effective and straightforward differentiation between benign and malignant changes as well as rapid learning. Puxeddu’s classification is intended for use with contact endoscopes coupled to NBI device and high-resolution monitors. Although complex, it provides highly informative clinical data.

Conclusions: NBI is a non-invasive, swift, reliable endoscopic method for the early detection of vocal cord cancer. For optimal results, both profound understanding of microvascular patterns and two-step endoscopic diagnostic procedure are of paramount importance.