BACKGROUND.: Narrow band imaging (NBI) is a new imaging technique for the depiction of tumor-specific neoangiogenesis. The purpose of the present study was to assess the value of NBI in the early diagnosis of laryngeal cancer. METHODS.: This prospective study includes 205 consecutive patients with a laryngeal lesion scheduled for microlaryngoscopy. NBI was immediately performed after white light endoscopy (WLE), whereas excisional biopsy was carried out for histologic verification of diagnosis. RESULTS.: In identifying laryngeal cancer and its precursor lesions, NBI with WLE showed a significantly higher sensitivity (97% vs 79%) and accuracy (97% vs 90%) than WLE alone, but the specificity (96% vs 95%) was essentially equal in both methods. CONCLUSION.: NBI qualifies for rapid detection and delineation of suspicious lesions. Additionally, this noninvasive method is also beneficial in a variety of benign lesions. © 2015 Wiley Periodicals, Inc. Head Neck 38: 15–20, 2016