〔Abstract〕 Objective To investigate the clinical value of endoscopic narrow-band imaging in the diagnosis of early laryngeal cancer and precancerous lesions. Methods From January 2019 to December 2020 , 96 patients with suspected malignant lesions of the throat detected by electronic nasopharyngolaryngoscope in the department of ENT of Meizhou People's Hospital were selected as object of study. All patients were performed white light endoscopy and endoscopic narrow-band imaging and pathological biopsy. The number of benign lesions, suspicious lesions and malignant lesions of the two test modes were recorded. The pathological results was used as gold standard to evaluate the diagnostic efficacy of the two test modes. Results The Pathological biopsies results of 96 patients showed that the rate of malignant lesion of patients was 30.21% (29/96), and the rate of non-malignant lesion was 69.79% (67/96). The diagnosis rate of malignant lesion of white light mode group was 22.92% (22/96), and the diagnosis rate of nonmalignant lesion of white light mode group was 77.08% (74/96). The diagnosis rate of malignant lesion of endoscopic narrow-band imaging mode group was 28.13% (27/96), and the diagnosis rate of non-malignant lesion of endoscopic narrow-band imaging mode group was 71.87% (69/96). The diagnostic sensitivity, specificity and accuracy in the endoscopic narrow-band imaging mode group were higher than those in the white light mode group, and the differences were statistically significant (P < 0.05). Conclusions Endoscopic narrow-band imaging has a high diagnosis efficiency in the diagnosis of early laryngeal cancer and precancerous lesions, which is conducive to the early detection of lesions and provides guidance for subsequent treatment.