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Mamidi IS, Dunham ME, Adkins LK, McWhorter AJ, Fang Z, Banh BT. Laryngeal Cancer Screening During Flexible Video Laryngoscopy Using Large Computer Vision Models. Ann Otol Rhinol Laryngol 2024:34894241253376. [PMID: 38755974 DOI: 10.1177/00034894241253376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
OBJECTIVE Develop an artificial intelligence assisted computer vision model to screen for laryngeal cancer during flexible laryngoscopy. METHODS Using laryngeal images and flexible laryngoscopy video recordings, we developed computer vision models to classify video frames for usability and cancer screening. A separate model segments any identified lesions on the frames. We used these computer vision models to construct a video stream annotation system. This system classifies findings from flexible laryngoscopy as "potentially malignant" or "probably benign" and segments any detected lesions. Additionally, the model provides a confidence level for each classification. RESULTS The overall accuracy of the flexible laryngoscopy cancer screening model was 92%. For cancer screening, it achieved a sensitivity of 97.7% and a specificity of 76.9%. The segmentation model attained an average precision at a 0.50 intersection-over-union of 0.595. The confidence level for positive screening results can assist clinicians in counseling patients regarding the findings. CONCLUSION Our model is highly sensitive and adequately specific for laryngeal cancer screening. Segmentation helps endoscopists identify and describe potential lesions. Further optimization is required to enable the model's deployment in clinical settings for real-time annotation during flexible laryngoscopy.
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Affiliation(s)
- Ishwarya S Mamidi
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Michael E Dunham
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Lacey K Adkins
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Andrew J McWhorter
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Zhide Fang
- Biostatistics Program, School of Public Health, Louisiana State University Health Sciences Center, New Orleans LA, USA
| | - Britney T Banh
- Our Lady of the Lake Voice Center, Our Lady of the Lake Regional Medical Center, Baton Rouge, LA, USA
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Staníková L, Kántor P, Fedorová K, Zeleník K, Komínek P. Clinical significance of type IV vascularization of laryngeal lesions according to the Ni classification. Front Oncol 2024; 14:1222827. [PMID: 38333687 PMCID: PMC10851150 DOI: 10.3389/fonc.2024.1222827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 01/09/2024] [Indexed: 02/10/2024] Open
Abstract
Background Scattered, small, dot-like intraepithelial papillary capillary loops (IPCLs) represent type IV epithelial vascularization according to "Ni classification" and are considered to be nonmalignant. According to the European Laryngological Society classification, these loops are malignant vascular changes. This contradiction has high clinical importance; therefore, clarification of the clinical significance of type IV vascularization according to the Ni classification is needed. Methods The study was performed between June 2015 and December 2022. All recruited patients (n = 434) were symptomatic, with macroscopic laryngeal lesions (n = 674). Patients were investigated using the enhanced endoscopic methods of narrow band imaging (NBI) and the Storz Professional Image Enhancement System (IMAGE1 S). The microvascular patterns in the lesions were categorized according to Ni classification from 2011 and all lesions were examined histologically. Results A total of 674 lesions (434 patients) were investigated using flexible NBI endoscopy and IMAGE1 S endoscopy. Type IV vascularization was recognized in 293/674 (43.5%) lesions. Among these 293 lesions, 178 (60.7%) were benign (chronic laryngitis, hyperplasia, hyperkeratosis, polyps, cysts, granulomas, Reinkeho oedema and recurrent respiratory papillomatosis); 9 (3.1%) were squamous cell carcinoma; 61 (20.8%) were mildly dysplastic, 29 (9.9%) were moderately dysplastic, 14 (4.8%) were severe dysplastic and 2 (0.7%) were carcinoma in situ. The ability to recognize histologically benign lesions in group of nonmalignant vascular pattern according to Ni (vascularization type I-IV) and distinguish them from precancers and malignancies was with accuracy 75.5%, sensitivity 54.4%, specificity 94.4%, positive predictive value 89.6% and negative predictive value 69.9%. Conclusion Laryngeal lesions with type IV vascularization as defined by Ni present various histological findings, including precancerous and malignant lesions. Patients with type IV vascularization must be followed carefully and, in case of progression mucosal lesion microlaryngoscopy and excision are indicated.
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Affiliation(s)
- Lucia Staníková
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Ostrava, Ostrava, Czechia
- Department of Craniofacial Surgery, Faculty of Medicine, University of Ostrava, Ostrava, Czechia
| | - Peter Kántor
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Ostrava, Ostrava, Czechia
- Department of Craniofacial Surgery, Faculty of Medicine, University of Ostrava, Ostrava, Czechia
| | - Katarína Fedorová
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Ostrava, Ostrava, Czechia
| | - Karol Zeleník
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Ostrava, Ostrava, Czechia
- Department of Craniofacial Surgery, Faculty of Medicine, University of Ostrava, Ostrava, Czechia
| | - Pavel Komínek
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Ostrava, Ostrava, Czechia
- Department of Craniofacial Surgery, Faculty of Medicine, University of Ostrava, Ostrava, Czechia
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Xu ZH, Fan DG, Huang JQ, Wang JW, Wang Y, Li YZ. Computer-Aided Diagnosis of Laryngeal Cancer Based on Deep Learning with Laryngoscopic Images. Diagnostics (Basel) 2023; 13:3669. [PMID: 38132254 PMCID: PMC10743023 DOI: 10.3390/diagnostics13243669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023] Open
Abstract
Laryngeal cancer poses a significant global health burden, with late-stage diagnoses contributing to reduced survival rates. This study explores the application of deep convolutional neural networks (DCNNs), specifically the Densenet201 architecture, in the computer-aided diagnosis of laryngeal cancer using laryngoscopic images. Our dataset comprised images from two medical centers, including benign and malignant cases, and was divided into training, internal validation, and external validation groups. We compared the performance of Densenet201 with other commonly used DCNN models and clinical assessments by experienced clinicians. Densenet201 exhibited outstanding performance, with an accuracy of 98.5% in the training cohort, 92.0% in the internal validation cohort, and 86.3% in the external validation cohort. The area under the curve (AUC) values consistently exceeded 92%, signifying robust discriminatory ability. Remarkably, Densenet201 achieved high sensitivity (98.9%) and specificity (98.2%) in the training cohort, ensuring accurate detection of both positive and negative cases. In contrast, other DCNN models displayed varying degrees of performance degradation in the external validation cohort, indicating the superiority of Densenet201. Moreover, Densenet201's performance was comparable to that of an experienced clinician (Clinician A) and outperformed another clinician (Clinician B), particularly in the external validation cohort. Statistical analysis, including the DeLong test, confirmed the significance of these performance differences. Our study demonstrates that Densenet201 is a highly accurate and reliable tool for the computer-aided diagnosis of laryngeal cancer based on laryngoscopic images. The findings underscore the potential of deep learning as a complementary tool for clinicians and the importance of incorporating advanced technology in improving diagnostic accuracy and patient care in laryngeal cancer diagnosis. Future work will involve expanding the dataset and further optimizing the deep learning model.
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Affiliation(s)
- Zhi-Hui Xu
- Department of Otolaryngology, The Second Affiliated Hospital, Fujian Medical University, 950 Donghai Street, Fengze District, Quanzhou 362000, China; (Z.-H.X.)
| | - Da-Ge Fan
- Department of Pathology, The Second Affiliated Hospital, Fujian Medical University, 950 Donghai Street, Fengze District, Quanzhou 362000, China;
| | - Jian-Qiang Huang
- Department of Otolaryngology, The Second Affiliated Hospital, Fujian Medical University, 950 Donghai Street, Fengze District, Quanzhou 362000, China; (Z.-H.X.)
| | - Jia-Wei Wang
- Department of Emergency, The Second Affiliated Hospital, Fujian Medical University, 950 Donghai Street, Fengze District, Quanzhou 362000, China;
| | - Yi Wang
- CT/MRI Department, The Second Affiliated Hospital, Fujian Medical University, 950 Donghai Street, Fengze District, Quanzhou 362000, China
| | - Yuan-Zhe Li
- CT/MRI Department, The Second Affiliated Hospital, Fujian Medical University, 950 Donghai Street, Fengze District, Quanzhou 362000, China
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Arthur C, Huangfu H, Li M, Dong Z, Asamoah E, Shaibu Z, Zhang D, Ja L, Obwoya RT, Zhang C, Han R, Yan X, Zhang S, Dakura C, Dormocara A, Yu W. The Effectiveness of White Light Endoscopy Combined With Narrow Band Imaging Technique Using Ni Classification in Detecting Early Laryngeal Carcinoma in 114 Patients: Our Clinical Experience. J Voice 2023:S0892-1997(23)00280-1. [PMID: 37891128 DOI: 10.1016/j.jvoice.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/06/2023] [Accepted: 09/07/2023] [Indexed: 10/29/2023]
Abstract
INTRODUCTION By displaying tumor-specific neoangiogenesis, narrow band imaging (NBI), a novel imaging approach, enhances the diagnosis of head and neck cancers and makes it more accurate OBJECTIVE: To determine the effect of NBI in combination with white light endoscopy (WLE) for diagnosis of preneoplastic or neoplastic laryngeal cancers according to Ni classification and to conclude if higher Ni classification and tumor stage are related. METHODS We enrolled 114 patients with various laryngeal cancer between December 2018 and June 2021. Patients were examined with WLE and NBI. Squamous cell carcinoma (SCC) accounted for 46 cases, benign lesions 30 cases, and nondysplastic, low-grade, and severe dysplasias for 38 cases. Based on characteristics of the intraepithelial papillary capillary loop (IPCL), endoscopic NBI results were divided into five categories (I, II, III, IV, and V). Type I-IV are regarded to be benign, while type V is considered to be cancerous. An incisional biopsy was conducted to assess histopathology, and the histopathology was compared to the NBI results. We assessed the negative predictive value (NPV), positive predictive value (PPV), specificity, and sensitivity for WLE alone and WLE combined with NBI. Analyses were conducted using SPSS software version 26. RESULTS The WLE combined with NBI showed excellent sensitivity (96%) compared to WLE (86.4%). Specificity was higher in the WLE combined with NBI (96.4%) than WLE alone (91.7%). WLE combined with NBI saw a NPV of 89% as compared with WLE with 88%. WLE and WLE in combination with NBI, recorded a PPV of 90% and 98%, respectively. CONCLUSION The accuracy of detecting laryngeal cancer increases when WLE and NBI are combined. Combined NBI with WLE remains highly sensitive to early glottis cancer. Accuracy of preoperative NBI was high. In the diagnosis of laryngeal cancer, a higher Ni classification closely correlates with the late stages of the glottis tumor.
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Affiliation(s)
- Clement Arthur
- Department of Otolaryngology-Head & Neck Surgery, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China; Shanxi Key Laboratory of Otorhinolaryngology Head and Neck Cancer, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China; Shanxi Province Clinical Medical Research Center for Precision Medicine of Head and Neck Cancer, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Hui Huangfu
- Department of Otolaryngology-Head & Neck Surgery, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China; Shanxi Key Laboratory of Otorhinolaryngology Head and Neck Cancer, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China; Shanxi Province Clinical Medical Research Center for Precision Medicine of Head and Neck Cancer, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China.
| | - MengLu Li
- Department of Otolaryngology-Head & Neck Surgery, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China; Shanxi Key Laboratory of Otorhinolaryngology Head and Neck Cancer, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China; Shanxi Province Clinical Medical Research Center for Precision Medicine of Head and Neck Cancer, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Zhen Dong
- Department of Otolaryngology-Head & Neck Surgery, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China; Shanxi Key Laboratory of Otorhinolaryngology Head and Neck Cancer, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China; Shanxi Province Clinical Medical Research Center for Precision Medicine of Head and Neck Cancer, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Emmanuel Asamoah
- Department of Health Sciences, University of York, York City, United Kingdom
| | - Zakari Shaibu
- School of Medicine, Jiangsu University, Zhenjiang, Jiangsu, China
| | - Di Zhang
- Basic Medical Department, Shanxi Medical University, Jinzhong, Shanxi, China
| | - Lina Ja
- Department of Otolaryngology-Head & Neck Surgery, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China; Shanxi Key Laboratory of Otorhinolaryngology Head and Neck Cancer, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China; Shanxi Province Clinical Medical Research Center for Precision Medicine of Head and Neck Cancer, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Rubangakene T Obwoya
- College of Electrical and Control engineering, Shaanxi University of Science and Technology, Xian City, Shaanxi Province, China
| | - Chunming Zhang
- Department of Otolaryngology-Head & Neck Surgery, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China; Shanxi Key Laboratory of Otorhinolaryngology Head and Neck Cancer, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China; Shanxi Province Clinical Medical Research Center for Precision Medicine of Head and Neck Cancer, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Rui Han
- Department of Otolaryngology-Head & Neck Surgery, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China; Shanxi Key Laboratory of Otorhinolaryngology Head and Neck Cancer, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China; Shanxi Province Clinical Medical Research Center for Precision Medicine of Head and Neck Cancer, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Xiuwen Yan
- Department of Cardiothoracic Surgery, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Sen Zhang
- Department of Otolaryngology-Head & Neck Surgery, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China; Shanxi Key Laboratory of Otorhinolaryngology Head and Neck Cancer, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China; Shanxi Province Clinical Medical Research Center for Precision Medicine of Head and Neck Cancer, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Christina Dakura
- Department of Science and Mathematics, Oti Senior High Technical School, Dambai City, Oti Region, Ghana
| | - Amos Dormocara
- College of Pharmaceutical Sciences, Pharmaceutics controlled released and drug delivery, Soochow University, Suzhou, Jiangsu, China
| | - Wenjie Yu
- Department of Otolaryngology-Head & Neck Surgery, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China; Shanxi Key Laboratory of Otorhinolaryngology Head and Neck Cancer, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China; Shanxi Province Clinical Medical Research Center for Precision Medicine of Head and Neck Cancer, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
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Ye E, Huang J, Wang J, Zhao Y, Niu D, Liu J, Huang X, Yue S, Hou X, Wu J. Trend and projection of larynx cancer incidence and mortality in China from 1990 to 2044: A Bayesian age-period-cohort modeling study. Cancer Med 2023; 12:16517-16530. [PMID: 37306154 PMCID: PMC10469639 DOI: 10.1002/cam4.6239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 05/23/2023] [Accepted: 06/02/2023] [Indexed: 06/13/2023] Open
Abstract
BACKGROUND Larynx cancer is one of the most common cancers in head and neck, and imposes heavy burden on individual and societies. A comprehensive understanding of the burden of larynx cancer is necessary to improve prevention and control strategies. However, the secular trend of larynx cancer incidence and mortality in China remains unclear. METHODS The incidence and deaths rates of larynx cancer from 1990 to 2019 were collected from the Global Burden of Disease Study 2019 database. The temporal trend of larynx cancer was analyzed using a joinpoint regression model. The age-period-cohort model was used to explore the age, period, and cohort effects on larynx cancer and predict future trends up to 2044. RESULTS From 1990 to 2019, the age-standardized incidence rate of larynx cancer in China increased by 1.3% (95% CI 1.1 to 1.5) in males, but decreased by 0.5% (95% CI -0.1 to 0) in females. The age-standardized mortality rate of larynx cancer in China decreased by 0.9% (95% CI -1.1 to -0.6) and 2.2% (95% CI -2.8 to -1.7) in males and females, respectively. Among the four risk factors, smoking and alcohol use contributed to a heavier burden compared to occupational exposure to asbestos and sulfuric acid with respect to mortality. Age effects showed that the incidence and deaths of larynx cancer were concentrated in people older than 50 years old. Period effects exerted the most significant effect on larynx cancer incidence for males. In terms of cohort effects, people born in the earlier cohorts presented a higher risk of larynx cancer compared with the later cohorts. From 2020 to 2044, the age-standardized incidence rates of larynx cancer continued to increase in males, whereas the age-standardized mortality rates continued to decrease in both males and females. CONCLUSION The burden of larynx cancer in China has a significant gender difference. The age-standardized incidence rates will continue to increase in males up to 2044. The disease pattern and risk factors of larynx cancer should be comprehensively studied to promote the development of timely intervention measures and relieve the burden effectively.
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Affiliation(s)
- Enlin Ye
- Clinical Research Service CenterAffiliated Hospital of Guangdong Medical UniversityZhanjiangChina
- Guangdong Engineering Research Center of Collaborative Innovation Technology of Clinical Medical Big Data Cloud Service in Medical Consortium of West Guangdong ProvinceAffiliated Hospital of Guangdong Medical UniversityZhanjiangChina
| | - Jiasheng Huang
- Clinical Research Service CenterAffiliated Hospital of Guangdong Medical UniversityZhanjiangChina
- Guangdong Engineering Research Center of Collaborative Innovation Technology of Clinical Medical Big Data Cloud Service in Medical Consortium of West Guangdong ProvinceAffiliated Hospital of Guangdong Medical UniversityZhanjiangChina
| | - Jia Wang
- Clinical Research Service CenterAffiliated Hospital of Guangdong Medical UniversityZhanjiangChina
| | - Yumei Zhao
- Clinical Research Service CenterAffiliated Hospital of Guangdong Medical UniversityZhanjiangChina
| | - Dongdong Niu
- Clinical Research Service CenterAffiliated Hospital of Guangdong Medical UniversityZhanjiangChina
| | - Jie Liu
- Clinical Research Service CenterAffiliated Hospital of Guangdong Medical UniversityZhanjiangChina
| | - Xueying Huang
- Clinical Research Service CenterAffiliated Hospital of Guangdong Medical UniversityZhanjiangChina
| | - Suru Yue
- Clinical Research Service CenterAffiliated Hospital of Guangdong Medical UniversityZhanjiangChina
| | - Xuefei Hou
- Clinical Research Service CenterAffiliated Hospital of Guangdong Medical UniversityZhanjiangChina
| | - Jiayuan Wu
- Clinical Research Service CenterAffiliated Hospital of Guangdong Medical UniversityZhanjiangChina
- Guangdong Engineering Research Center of Collaborative Innovation Technology of Clinical Medical Big Data Cloud Service in Medical Consortium of West Guangdong ProvinceAffiliated Hospital of Guangdong Medical UniversityZhanjiangChina
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Surgical Treatment for Advanced Oropharyngeal Cancer: A Narrative Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020304. [PMID: 36837506 PMCID: PMC9961866 DOI: 10.3390/medicina59020304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/30/2022] [Accepted: 01/30/2023] [Indexed: 02/10/2023]
Abstract
Background and Objectives: to describe current scientific knowledge regarding the treatment options in advanced oropharyngeal cancer. The standard care for advanced oropharyngeal cancer (OPSCC) has been chemoradiotherapy, although surgical approaches followed by adjuvant treatment have been proposed. The best therapy for each patient should be decided by an interdisciplinary tumour-board. Different strategies should be considered for the specific patient's treatment: surgery, chemotherapy and radiation therapy or combinations of them. The treatment choice is influenced by tumour variability and prognostic factors, but it also depends on cancer extension, extranodal extension, nervous invasion, human papilloma virus (HPV) presence, making the decisional algorithm not always clear. HPV-related OPSCC is strongly associated with a favourable overall survival (OS) and disease-free survival rate (DSS); by contrast, HPV-negative OPSCC often flags a worse prognosis. Consequently, the American Joint Committee on Cancer (AJCC) differentiates OPSCC treatment and prognosis based on HPV status. Methods: we carried out a review of current scientific literature to analyze the different indications and limitations of surgical treatment options in OPSCC stage III and IV. Conclusion: robotic surgery or open approaches with reconstructive flaps can be considered in advanced stages, resulting in the de-intensification of subsequent systemic therapy and fewer related side effects. Furthermore, in the event of the primary failure of systemic therapy or disease recurrence, the surgical approach constitutes an additional therapeutic option which lengthens patient survival functions.
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Kwon I, Wang SG, Shin SC, Cheon YI, Lee BJ, Lee JC, Lim DW, Jo C, Cho Y, Shin BJ. Diagnosis of Early Glottic Cancer Using Laryngeal Image and Voice Based on Ensemble Learning of Convolutional Neural Network Classifiers. J Voice 2022:S0892-1997(22)00209-0. [PMID: 36075802 DOI: 10.1016/j.jvoice.2022.07.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/05/2022] [Accepted: 07/06/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVES The purpose of study is to improve the classification accuracy by comparing the results obtained by applying decision tree ensemble learning, which is one of the methods to increase the classification accuracy for a relatively small dataset, with the results obtained by the convolutional neural network (CNN) algorithm for the diagnosis of glottal cancer. METHODS Pusan National University Hospital (PNUH) dataset were used to establish classifiers and Pusan National University Yangsan Hospital (PNUYH) dataset were used to verify the classifier's performance in the generated model. For the diagnosis of glottic cancer, deep learning-based CNN models were established and classified using laryngeal image and voice data. Classification accuracy was obtained by performing decision tree ensemble learning using probability through CNN classification algorithm. In this process, the classification and regression tree (CART) method was used. Then, we compared the classification accuracy of decision tree ensemble learning with CNN individual classifiers by fusing the laryngeal image with the voice decision tree classifier. RESULTS We obtained classification accuracy of 81.03 % and 99.18 % in the established laryngeal image and voice classification models using PNUH training dataset, respectively. However, the classification accuracy of CNN classifiers decreased to 73.88 % in voice and 68.92 % in laryngeal image when using an external dataset of PNUYH. To solve this problem, decision tree ensemble learning of laryngeal image and voice was used, and the classification accuracy was improved by integrating data of laryngeal image and voice of the same person. The classification accuracy was 87.88 % and 89.06 % for the individualized laryngeal image and voice decision tree model respectively, and the fusion of the laryngeal image and voice decision tree results represented a classification accuracy of 95.31 %. CONCLUSION The results of our study suggest that decision tree ensemble learning aimed at training multiple classifiers is useful to obtain an increased classification accuracy despite a small dataset. Although a large data amount is essential for AI analysis, when an integrated approach is taken by combining various input data high diagnostic classification accuracy can be expected.
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Affiliation(s)
- Ickhwan Kwon
- Department of Applied IT and Engineering, Pusan National University, Miryang, Gyeongsangnam-do, South Korea
| | - Soo-Geun Wang
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Pusan National University and Medical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Sung-Chan Shin
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Pusan National University and Medical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Yong-Il Cheon
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Pusan National University and Medical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Byung-Joo Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Pusan National University and Medical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Jin-Choon Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Pusan National University Yangsan Hospital, Yangsan, Gyeongsangnam-do, South Korea
| | - Dong-Won Lim
- Department of Otorhinolaryngology-Head and Neck Surgery, Pusan National University Hospital, Busan, South Korea
| | - Cheolwoo Jo
- School of Electrical, Electronics & Control Engineering, Changwon National University, Changwon, South Korea
| | - Youngseuk Cho
- Department of Statistics, College of Natural Sciences, Pusan National University, Busan, South Korea
| | - Bum-Joo Shin
- Department of Applied IT and Engineering, Pusan National University, Miryang, Gyeongsangnam-do, South Korea.
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Zhao Q, He Y, Wu Y, Huang D, Wang Y, Sun C, Ju J, Wang J, Mahr JJL. Vocal cord lesions classification based on deep convolutional neural network and transfer learning. Med Phys 2021; 49:432-442. [PMID: 34813114 DOI: 10.1002/mp.15371] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 09/12/2021] [Accepted: 09/29/2021] [Indexed: 01/01/2023] Open
Abstract
PURPOSE Laryngoscopy, the most common diagnostic method for vocal cord lesions (VCLs), is based mainly on the visual subjective inspection of otolaryngologists. This study aimed to establish a highly objective computer-aided VCLs diagnosis system based on deep convolutional neural network (DCNN) and transfer learning. METHODS To classify VCLs, our method combined the DCNN backbone with transfer learning on a system specifically finetuned for a laryngoscopy image dataset. Laryngoscopy image database was collected to train the proposed system. The diagnostic performance was compared with other DCNN-based models. Analysis of F1 score and receiver operating characteristic curves were conducted to evaluate the performance of the system. RESULTS Beyond the existing VCLs diagnosis method, the proposed system achieved an overall accuracy of 80.23%, an F1 score of 0.7836, and an area under the curve (AUC) of 0.9557 for four fine-grained classes of VCLs, namely, normal, polyp, keratinization, and carcinoma. It also demonstrated robust classification capacity for detecting urgent (keratinization, carcinoma) and non-urgent (normal, polyp), with an overall accuracy of 0.939, a sensitivity of 0.887, a specificity of 0.993, and an AUC of 0.9828. The proposed method also outperformed clinicians in the classification of normal, polyps, and carcinoma at an extremely low time cost. CONCLUSION The VCLs diagnosis system succeeded in using DCNN to distinguish the most common VCLs and normal cases, holding a practical potential for improving the overall diagnostic efficacy in VCLs examinations. The proposed VCLs diagnosis system could be appropriately integrated into the conventional workflow of VCLs laryngoscopy as a highly objective auxiliary method.
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Affiliation(s)
- Qian Zhao
- Key Laboratory of Photoelectronic Imaging Technology and System, Ministry of Education, School of Optics and Photonics, Beijing Institute of Technology, Beijing, China
| | - Yuqing He
- Key Laboratory of Photoelectronic Imaging Technology and System, Ministry of Education, School of Optics and Photonics, Beijing Institute of Technology, Beijing, China
| | - Yanda Wu
- Key Laboratory of Photoelectronic Imaging Technology and System, Ministry of Education, School of Optics and Photonics, Beijing Institute of Technology, Beijing, China
| | - Dongyan Huang
- National Clinical Research Center for Otolaryngologic Diseases, College of Otolaryngology-Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China
| | - Yang Wang
- National Clinical Research Center for Otolaryngologic Diseases, College of Otolaryngology-Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China
| | - Cai Sun
- National Clinical Research Center for Otolaryngologic Diseases, College of Otolaryngology-Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China
| | - Jun Ju
- National Clinical Research Center for Otolaryngologic Diseases, College of Otolaryngology-Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China
| | - Jiasen Wang
- National Clinical Research Center for Otolaryngologic Diseases, College of Otolaryngology-Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China
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Abstract
OPINION STATEMENT Dysplasia and early laryngeal cancer lie on a spectrum of cellular changes. These start with early changes to the cells including epithelial hyperplasia and expand to dysplasia, squamous cell carcinoma in situ and finally developing in to invasive cancer. Dysplasia can range from low to high grade, with each being treated in a different manner. Treatment options are typically determined by where the dysplasia/invasive cancer lie on this spectrum along with the site within the larynx. Hyperkeratosis, mild dysplasia and moderate dysplasia typically involve primary endoscopic excision. Severe dysplasia and squamous cell carcinoma in situ involve primary endoscopic resection with the addition of possible laser resection and/or ablation. At this stage, surgery will be followed by close surveillance. Finally, early laryngeal cancer such as T1 and T2 lesions is typically more involved. Treatment depends on the site and degree of involvement of the structures, along with spread to surrounding structures. Typical treatment options of more involved early laryngeal cancer can range from radiation therapy, endoscopic transoral laser resection, endoscopic transoral robotic resection to open resection. Often times, my choice of treatment will be aimed at voice preservation but patient preference will also play a role in the decision making between treatment modalities. Chemotherapy and immunotherapy are typically not used in early stage laryngeal cancer.
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10
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Missale F, Taboni S, Carobbio ALC, Mazzola F, Berretti G, Iandelli A, Fragale M, Mora F, Paderno A, Del Bon F, Parrinello G, Deganello A, Piazza C, Peretti G. Validation of the European Laryngological Society classification of glottic vascular changes as seen by narrow band imaging in the optical biopsy setting. Eur Arch Otorhinolaryngol 2021; 278:2397-2409. [PMID: 33710441 PMCID: PMC8165057 DOI: 10.1007/s00405-021-06723-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 02/23/2021] [Indexed: 12/12/2022]
Abstract
Purpose In 2016, the European Laryngological Society (ELS) proposed a classification for vascular changes occurring in glottic lesions as visible by narrow band imaging (NBI), based on the dichotomic distinction between longitudinal vessels (not suspicious) and perpendicular ones (suspicious). The aim of our study was to validate this classification assessing the interobserver agreement and diagnostic test performance in detecting the final histopathology. Methods A retrospective study was carried out by reviewing clinical charts, preoperative videos, and final pathologic diagnosis of patients submitted to transoral microsurgery for laryngeal lesions in two Italian referral centers. In each institution, two physicians, independently re-assessed each case applying the ELS classification. Results The cohort was composed of 707 patients. The pathologic report showed benign lesions in 208 (29.5%) cases, papillomatosis in 34 (4.8%), squamous intraepithelial neoplasia (SIN) up to carcinoma in situ in 200 (28.2%), and squamous cell carcinoma (SCC) in 265 (37.5%). The interobserver agreement was extremely high in both institutions (k = 0.954, p < 0.001 and k = 0.880, p < 0.001). Considering the diagnostic performance for identification of at least SIN or SCC, the sensitivity was 0.804 and 0.902, the specificity 0.793 and 0.581, the positive predictive value 0.882 and 0.564, and the negative predictive value 0.678 and 0.908, respectively. Conclusion The ELS classification for NBI vascular changes of glottic lesions is a highly reliable tool whose systematic use allows a better diagnostic evaluation of suspicious laryngeal lesions, reliably distinguishing benign ones from those with a diagnosis of papillomatosis, SIN or SCC, thus paving the way towards confirmation of the optical biopsy concept.
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Affiliation(s)
- Francesco Missale
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Stefano Taboni
- Section of Otorhinolaryngology, Head and Neck Surgery, Azienda Ospedaliera di Padova, University of Padua, Padua, Italy.,Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Andrea Luigi Camillo Carobbio
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy. .,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy.
| | - Francesco Mazzola
- Department of Otolaryngology, Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Giulia Berretti
- Unit of Otorhinolaryngology, Head and Neck Surgery, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Andrea Iandelli
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Marco Fragale
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Francesco Mora
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Alberto Paderno
- Unit of Otorhinolaryngology, Head and Neck Surgery, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Francesca Del Bon
- Unit of Otorhinolaryngology, Head and Neck Surgery, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | | | - Alberto Deganello
- Unit of Otorhinolaryngology, Head and Neck Surgery, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Cesare Piazza
- Unit of Otorhinolaryngology, Head and Neck Surgery, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Giorgio Peretti
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
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11
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Fan D, Hou J, Zhang T, Ye Y. Evaluation of narrow band imaging for diagnosis of unilateral nasal lesions. Clin Otolaryngol 2020; 46:388-394. [PMID: 33320431 DOI: 10.1111/coa.13688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 11/06/2020] [Accepted: 11/29/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVES This study aimed to investigate the effect of narrow band imaging (NBI) examination on differentiating diagnosis between benign and malignant neoplasms involving nasal cavity. DESIGN, SETTING, PARTICIPANTS A retrospective study was conducted to analyse cases from January 2018 to December 2019 at a single centre. A total of 188 consecutive patients who were newly diagnosed with lesions in unilateral nasal cavity underwent complete examination with white light endoscopy (WLE) and NBI endoscopy. Biopsy specimens were harvested from the target lesions and sent to the pathologist for definite diagnosis. Participants with a history of congenital malformation, trauma and surgery in nasal cavity were excluded from the study. MAIN OUTCOME MEASURES Endoscopic diagnosis was assessed using sensitivity, specificity, accuracy, positive and negative predictive values (PPV and NPV, respectively). RESULTS In identifying benign and malignant lesions of nasal cavity, NBI had a significant higher sensitivity (92.7% vs 70.7%, P = .020) and NPV (98% vs 92.3%, P = .032) than WLE, but there were no significant differences between NBI and WLE in specificity (98.6% vs 97.3%, P = .684), accuracy (97.3% vs 91.5%, P = .416) and PPV (95% vs 87.9%, P = .400). CONCLUSION NBI as an emerging technique can improve the diagnostic accuracy by distinguishing benign and malignant lesions in nasal cavity and remains a promising and helpful adjunct to the endoscopy techniques.
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Affiliation(s)
- Dachuan Fan
- Department of Otorhinolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Anhui Medical University, Hefei, China.,Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jinxiao Hou
- Department of Hematology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Tianhong Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yijing Ye
- Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
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12
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Saraniti C, Chianetta E, Greco G, Mat Lazim N, Verro B. The Impact of Narrow-band Imaging on the Pre- and Intra- operative Assessments of Neoplastic and Preneoplastic Laryngeal Lesions. A Systematic Review. Int Arch Otorhinolaryngol 2020; 25:e471-e478. [PMID: 34377187 PMCID: PMC8321643 DOI: 10.1055/s-0040-1719119] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 09/27/2020] [Indexed: 01/25/2023] Open
Abstract
Introduction
Narrow-band imaging is an endoscopic diagnostic tool that, focusing on superficial vascular changes, is useful to detect suspicious laryngeal lesions, enabling their complete excision with safe and tailored resection margins.
Objectives
To analyze the applications and benefits of narrow-band imaging in detecting premalignant and malignant laryngeal lesions through a comparison with white-light endoscopy.
Data Synthesis
A literature search was performed in the PubMed, Scopus and Web of Science databases using strict keywords. Then, two authors independently analyzed the articles, read the titles and abstracts, and read completely only the relevant studies according to certain eligibility criteria. In total, 14 articles have been included in the present review; the sensitivity, specificity, positive and negative predictive values, and accuracy of pre- and/or intraoperative narrow-band imaging were analyzed. The analysis showed that narrow-band imaging is better than white-light endoscopy in terms of sensitivity, specificity, positive and negative predictive values, and accuracy regarding the ability to identify cancer and/or precancerous laryngeal lesions. Moreover, the intraoperative performance of narrow-band imaging resulted more effective than the in-office performance.
Conclusion
Narrow-band imaging is an effective diagnostic tool to detect premalignant and malignant laryngeal lesions and to define proper resection margins. Moreover, narrow-band imaging is useful in cases of leukoplakia that may cover a possible malignant lesion and that cannot be easily assessed with white-light endoscopy. Finally, a shared, simple and practical classification of laryngeal lesions, such as that of the European Laryngological Society, is required to identify a shared lesion management strategy.
Key Points
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Affiliation(s)
- Carmelo Saraniti
- Department of Biomedicine, Neurosciences and Advanced Diagnostics, ENT Clinic, Università degli Studi di Palermo, Palermo, Italy
| | - Enzo Chianetta
- Department of Biomedicine, Neurosciences and Advanced Diagnostics, ENT Clinic, Università degli Studi di Palermo, Palermo, Italy
| | - Giuseppe Greco
- Department of Biomedicine, Neurosciences and Advanced Diagnostics, ENT Clinic, Università degli Studi di Palermo, Palermo, Italy
| | - Norhafiza Mat Lazim
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Barbara Verro
- Department of Biomedicine, Neurosciences and Advanced Diagnostics, ENT Clinic, Università degli Studi di Palermo, Palermo, Italy
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13
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Zhang BG, Zhu JQ, Zhang W, Su FX, Wang GQ, Ni XG. Effect of a training course on the diagnosis of vocal fold leukoplakia by narrow-band imaging. J Laryngol Otol 2020; 134:1-6. [PMID: 33092654 DOI: 10.1017/s002221512000211x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To investigate the value of narrow-band imaging training for differentiating between benign and malignant vocal fold leukoplakia. METHOD Thirty cases of vocal fold leukoplakia were selected. RESULTS Narrow-band imaging endoscopy training had a significant positive effect on the specificity of the differential diagnosis of vocal fold leukoplakia. In addition, the consistency of diagnostic typing of vocal fold leukoplakia by narrow-band imaging improved to 'moderate agreement' following the combination of types I and II and the combination of types IV, V and VI in the typing of vocal fold leukoplakia. CONCLUSION The narrow-band imaging training course may improve the ability of laryngologists to diagnose vocal fold leukoplakia. The new endoscopic diagnostic classification by narrow-band imaging needs to be further simplified to facilitate clinical application.
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Affiliation(s)
- B-G Zhang
- Department of Endoscopy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - J-Q Zhu
- Department of Endoscopy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - W Zhang
- Department of Endoscopy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital and Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - F-X Su
- Department of Endoscopy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital and Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - G-Q Wang
- Department of Endoscopy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - X-G Ni
- Department of Endoscopy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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14
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Ahmadzada S, Vasan K, Sritharan N, Singh N, Smith M, Hull I, Riffat F. Utility of narrowband imaging in the diagnosis of laryngeal leukoplakia: Systematic review and m
eta‐analysis. Head Neck 2020; 42:3427-3437. [DOI: 10.1002/hed.26428] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 06/23/2020] [Accepted: 07/28/2020] [Indexed: 12/15/2022] Open
Affiliation(s)
- Sejad Ahmadzada
- Department of Otolaryngology – Head and Neck Surgery Westmead Hospital Westmead New South Wales Australia
- The University of Sydney Sydney Australia
| | | | - Niranjan Sritharan
- Department of Otolaryngology – Head and Neck Surgery Westmead Hospital Westmead New South Wales Australia
- Department of Otolaryngology – Head and Neck Surgery Nepean Hospital Nepean New South Wales Australia
| | - Narinder Singh
- Department of Otolaryngology – Head and Neck Surgery Westmead Hospital Westmead New South Wales Australia
- The University of Sydney Sydney Australia
| | - Mark Smith
- Department of Otolaryngology – Head and Neck Surgery Westmead Hospital Westmead New South Wales Australia
- Department of Otolaryngology – Head and Neck Surgery Nepean Hospital Nepean New South Wales Australia
| | - Isabelle Hull
- Swinburne University of Technology Melbourne Victoria Australia
| | - Faruque Riffat
- Department of Otolaryngology – Head and Neck Surgery Westmead Hospital Westmead New South Wales Australia
- The University of Sydney Sydney Australia
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15
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Ahmadzada S, Tseros E, Sritharan N, Singh N, Smith M, Palme CE, Riffat F. The value of narrowband imaging using the Ni classification in the diagnosis of laryngeal cancer. Laryngoscope Investig Otolaryngol 2020; 5:665-671. [PMID: 32864436 PMCID: PMC7444790 DOI: 10.1002/lio2.414] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 04/15/2020] [Accepted: 05/26/2020] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Narrowband imaging (NBI) is a special endoscopic optical enhancement setting allowing better visualization of mucosal microvasculature compared to white light endoscopy. This study evaluates the validity of NBI using the Ni classification in the detection and differentiation of severe dysplasia (SD) and glottic squamous cell carcinoma (SCC). METHODS Patients with suspicious vocal cord lesions underwent conventional white light endoscopy followed by clinically indicated biopsy. At the same time, NBI images were obtained and graded independently. Lesions were graded from I to V according to the Ni classification and compared to histopathological findings. RESULTS Fifty-two patients were included in this study (40 SCC and 12 SD). The sensitivity and specificity of NBI in diagnosing laryngeal cancer was 95.0% (CI, 83.9%-99.4%) and 83.3% (CI, 51.6%-97.9%), respectively. The negative likelihood ratio was 0.06. Higher Ni grades correlated very strongly with more advanced disease. CONCLUSIONS NBI using the Ni classification is a sensitive diagnostic tool for the detection and differentiation of early neoplastic and preneoplastic glottic lesions. As higher Ni classification correlates strongly with advanced disease, it serves as a useful adjunct to white light endoscopy in the diagnosis of laryngeal cancer.Level of Evidence: Level IV.
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Affiliation(s)
- Sejad Ahmadzada
- Department of Otolaryngology, Head and Neck SurgeryWestmead HospitalWestmeadNew South WalesAustralia
- The University of SydneySydneyAustralia
| | - Evan Tseros
- Department of Otolaryngology, Head and Neck SurgeryWestmead HospitalWestmeadNew South WalesAustralia
| | - Niranjan Sritharan
- Department of Otolaryngology, Head and Neck SurgeryWestmead HospitalWestmeadNew South WalesAustralia
- The University of SydneySydneyAustralia
| | - Narinder Singh
- Department of Otolaryngology, Head and Neck SurgeryWestmead HospitalWestmeadNew South WalesAustralia
- The University of SydneySydneyAustralia
| | - Mark Smith
- Department of Otolaryngology, Head and Neck SurgeryWestmead HospitalWestmeadNew South WalesAustralia
- The University of SydneySydneyAustralia
| | - Carsten E. Palme
- Department of Otolaryngology, Head and Neck SurgeryWestmead HospitalWestmeadNew South WalesAustralia
- The University of SydneySydneyAustralia
| | - Faruque Riffat
- Department of Otolaryngology, Head and Neck SurgeryWestmead HospitalWestmeadNew South WalesAustralia
- The University of SydneySydneyAustralia
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16
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Kim DH, Kim Y, Kim SW, Hwang SH. Use of narrowband imaging for the diagnosis and screening of laryngeal cancer: A systematic review and meta-analysis. Head Neck 2020; 42:2635-2643. [PMID: 32364313 DOI: 10.1002/hed.26186] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 03/01/2020] [Accepted: 04/03/2020] [Indexed: 12/11/2022] Open
Abstract
We evaluated the diagnostic accuracy of narrowband imaging (NBI) in terms of detecting laryngeal cancer compared to that of white light endoscopy (WLE). Two reviewers individually searched the six databases for studies published between the first record date and December 31, 2019. We recorded the numbers of true positives, true negatives, false positives, and false negatives. Quality Assessment of Diagnostic Accuracy Studies ver. 2 software was used to assess the studies. The extent of the inter-rater agreement was also measured. The diagnostic odds ratio (OR) associated with NBI was 87.463 (95% confidence interval [CI]: 46.968, 160.873). The area under the summary receiver operating characteristic curve was 0.954. NBI was more diagnostically accurate than WLE, which was associated with a diagnostic OR of 13.750. NBI affords high diagnostic accuracy, thus supporting a role for NBI in the diagnostic work-up of laryngeal cancer.
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Affiliation(s)
- Do Hyun Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yeonji Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung Won Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Se Hwan Hwang
- Department of Otolaryngology-Head and Neck Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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17
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Davaris N, Lux A, Esmaeili N, Illanes A, Boese A, Friebe M, Arens C. Evaluation of Vascular Patterns Using Contact Endoscopy and Narrow-Band Imaging (CE-NBI) for the Diagnosis of Vocal Fold Malignancy. Cancers (Basel) 2020; 12:cancers12010248. [PMID: 31968528 PMCID: PMC7016896 DOI: 10.3390/cancers12010248] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 01/11/2020] [Accepted: 01/16/2020] [Indexed: 02/06/2023] Open
Abstract
The endoscopic detection of perpendicular vascular changes (PVC) of the vocal folds has been associated with vocal fold cancer, dysplastic lesions, and papillomatosis, according to a classification proposed by the European Laryngological Society (ELS). The combination of contact endoscopy with narrow-band imaging (NBI-CE) allows intraoperatively a highly contrasted, real-time visualization of vascular changes of the vocal folds. Aim of the present study was to determine the association of PVC to specific histological diagnoses, the level of interobserver agreement in the detection of PVC, and their diagnostic effectiveness in diagnosing laryngeal malignancy. The evaluation of our data confirmed the association of PVC to vocal fold cancer, dysplastic lesions, and papillomatosis. The level of agreement between the observers in the identification of PVC was moderate for the less-experienced observers and almost perfect for the experienced observers. The identification of PVC during NBI-CE proved to be a valuable indicator for diagnosing malignant and premalignant lesions.
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Affiliation(s)
- Nikolaos Davaris
- Department of Otorhinolaryngology, Head and Neck Surgery, Magdeburg University Hospital, 39120 Magdeburg, Germany
| | - Anke Lux
- Institute of Biometry and Medical Informatics, Otto-von-Guericke University, 39120 Magdeburg, Germany
| | - Nazila Esmaeili
- Institute of Medical Technology, Otto-von-Guericke University Magdeburg, 39120 Magdeburg, Germany
| | - Alfredo Illanes
- Institute of Medical Technology, Otto-von-Guericke University Magdeburg, 39120 Magdeburg, Germany
| | - Axel Boese
- Institute of Medical Technology, Otto-von-Guericke University Magdeburg, 39120 Magdeburg, Germany
| | - Michael Friebe
- Faculty of Medicine, Otto-von-Guericke-University, 39120 Magdeburg, Germany and IDTM GmbH, 45657 Recklinghausen, Germany
| | - Christoph Arens
- Department of Otorhinolaryngology, Head and Neck Surgery, Magdeburg University Hospital, 39120 Magdeburg, Germany
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Transoral robotic surgery (TORS) for head and neck squamous cell carcinoma: healing by secondary intention, local flap or free flap. EUROPEAN JOURNAL OF PLASTIC SURGERY 2019. [DOI: 10.1007/s00238-019-01586-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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19
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Meccariello G, Montevecchi F, D'Agostino G, Iannella G, Calpona S, Parisi E, Costantini M, Cammaroto G, Gobbi R, Firinu E, Sgarzani R, Nestola D, Bellini C, De Vito A, Amadori E, Vicini C. Trans-oral robotic surgery for the management of oropharyngeal carcinomas: a 9-year institutional experience. ACTA ACUST UNITED AC 2019; 39:75-83. [PMID: 31097824 PMCID: PMC6522856 DOI: 10.14639/0392-100x-2199] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 09/15/2018] [Indexed: 12/11/2022]
Abstract
Trans-oral robotic surgery (TORS) has changed surgical management
of patients with oropharyngeal squamous cell carcinomas (OPSCC). In
this study we present surgical and oncologic outcomes of patients with
oropharyngeal squamous cell carcinomas, treated using TORS, with and
without an adjuvant therapy. Sixty patients with oropharyngeal
squamous cell carcinomas treated with TORS between January 2008 and
December 2017 have been retrospectively evaluated considering
clinicopathologic features, disease characteristics, adjuvant
treatments and oncological outcomes. TORS was performed for OPSCC to
the base of tongue in 41.7%, tonsils in 46.7%, soft palate and
posterior pharyngeal wall in 3.3% and 5%, respectively. Neck
dissection was performed in 43.3% of patients. Management strategies
included surgery alone in 30%, TORS and adjuvant radiotherapy in
33.3%, and TORS plus adjuvant chemotherapy in 36.7%. The 5-year
overall survival of the total group was 77.6%, the 5-year disease-free
survival rate was 85.2%, and the 5-year local recurrence-free survival
rate was 90.6%. Finally, in selected patients TORS appears to yield
similar oncologic outcomes and functional outcomes to traditional
techniques and non-operative treatment with a possible benefit on
long-term quality of life. The future offers exciting opportunities to
combine TORS and radiotherapy in unique ways. However, further
research is urgently needed to clarify the indications for adjuvant
therapy following TORS resections.
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Affiliation(s)
- G Meccariello
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - F Montevecchi
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - G D'Agostino
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - G Iannella
- Department of Organs of Sense, Ear, Nose, and Throat Section, University of Rome "La Sapienza," Italy
| | - S Calpona
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS, Meldola (FC), Italy
| | - E Parisi
- Radiotherapy Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS, Meldola (FC), Italy
| | - M Costantini
- Department of Surgical Pathology, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - G Cammaroto
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy.,Department of Otolaryngology, University of Messina, Italy
| | - R Gobbi
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - E Firinu
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - R Sgarzani
- Department of Emergency, Burn Center, Bufalini Hospital, Azienda USL della Romagna, Cesena, Italy
| | - D Nestola
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - C Bellini
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - A De Vito
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - E Amadori
- Radiology Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS, Meldola (FC), Italy
| | - C Vicini
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
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20
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Mehlum CS, Kjaergaard T, Grøntved ÅM, Lyhne NM, Jørkov APS, Homøe P, Tvedskov JF, Bork KH, Möller S, Jørgensen G, Philipsen BB, Godballe C. Value of pre- and intraoperative diagnostic methods in suspected glottic neoplasia. Eur Arch Otorhinolaryngol 2019; 277:207-215. [PMID: 31654182 DOI: 10.1007/s00405-019-05698-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 10/12/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the individual and combined ability of videostroboscopy (VS), high-speed digital imaging (HSDI), enhanced endoscopy (EE) and saline infusion (SI) to predict neoplasia, defined as glottic precursor lesion (GPL) or T1a glottic cancer, in patients suspected for glottic neoplasia. METHODS A nationwide prospective cohort study of patients treated by cordectomy for suspected GPL or T1a glottic cancer from August 1st 2016 to October 31st 2018 was conducted in the five Danish University Departments of Head and Neck surgery. Sensitivity, specificity, negative and positive predictive values, and area under Receiver Operating Curves (AUC-ROC) were calculated with 95% confidence intervals with respect to the histological diagnosis. Logistic regression with an imputation model for missing data was applied. RESULTS 261 patients aged 34-91 years participated; 79 (30.3%) with non-neoplasia (i.e., inflammation, papilloma, hyperkeratosis) and 182 (69.7%) neoplasia, hereof 95 (36.4%) with GPL and 87 (33.3%) with T1a glottic cancer. Data from 188 VS, 60 HSDI, 100 preoperative EE, 209 intraoperative EE, and 234 SI were analyzed. In the complete case analysis the AUC-ROC of each diagnostic test was low, but increased when the tests were combined and especially if the combination included EE. However, multinomial logistic regression with imputation showed significant association (p < 0.05) only between age, male gender, and perpendicular vasculature in intraoperative EE, and the endpoint neoplasia. CONCLUSIONS Intraoperative EE was the most accurate diagnostic method in detecting neoplasia. The prediction ability of methods applied preoperatively was more limited, but improved when test modalities were combined.
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Affiliation(s)
- Camilla Slot Mehlum
- Department of ORL Head and Neck Surgery and Audiology, Odense University Hospital, J. B. Winsløwsvej 4, 5000, Odense, Denmark.
| | - Thomas Kjaergaard
- Department of Otorhinolaryngology-Head and Neck Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200, Aarhus N, Denmark
| | - Ågot Møller Grøntved
- Department of ORL Head and Neck Surgery and Audiology, Odense University Hospital, J. B. Winsløwsvej 4, 5000, Odense, Denmark
| | - Nina Munk Lyhne
- Department of Head and Neck Surgery, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark
| | | | - Preben Homøe
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Lykkebækvej 1, 4600, Køge, Denmark
| | - Jesper Filtenborg Tvedskov
- Department of Otorhinolaryngology, Head and Neck Surgery, and Audiology, Rigshospitalet, University Hospital of Copenhagen and University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Kristian Hveysel Bork
- Department of Otorhinolaryngology, Head and Neck Surgery, and Audiology, Rigshospitalet, University Hospital of Copenhagen and University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Sören Möller
- OPEN-Open Patient Data Explorative Network and Department of Clinical Research, Odense University Hospital and University of Southern Denmark, J. B. Winsløwsvej 9, 5000, Odense, Denmark
| | - Gita Jørgensen
- Department of ORL Head and Neck Surgery and Audiology, Odense University Hospital, J. B. Winsløwsvej 4, 5000, Odense, Denmark
| | - Bahareh Bakhshaie Philipsen
- Department of ORL Head and Neck Surgery and Audiology, Odense University Hospital, J. B. Winsløwsvej 4, 5000, Odense, Denmark
| | - Christian Godballe
- Department of ORL Head and Neck Surgery and Audiology, Odense University Hospital, J. B. Winsløwsvej 4, 5000, Odense, Denmark
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Xiong H, Lin P, Yu JG, Ye J, Xiao L, Tao Y, Jiang Z, Lin W, Liu M, Xu J, Hu W, Lu Y, Liu H, Li Y, Zheng Y, Yang H. Computer-aided diagnosis of laryngeal cancer via deep learning based on laryngoscopic images. EBioMedicine 2019; 48:92-99. [PMID: 31594753 PMCID: PMC6838439 DOI: 10.1016/j.ebiom.2019.08.075] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 08/20/2019] [Accepted: 08/30/2019] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE To develop a deep convolutional neural network (DCNN) that can automatically detect laryngeal cancer (LCA) in laryngoscopic images. METHODS A DCNN-based diagnostic system was constructed and trained using 13,721 laryngoscopic images of LCA, precancerous laryngeal lesions (PRELCA), benign laryngeal tumors (BLT) and normal tissues (NORM) from 2 tertiary hospitals in China, including 2293 from 206 LCA subjects, 1807 from 203 PRELCA subjects, 6448 from 774 BLT subjects and 3191 from 633 NORM subjects. An independent test set of 1176 laryngoscopic images from other 3 tertiary hospitals in China, including 132 from 44 LCA subjects, 129 from 43 PRELCA subjects, 504 from 168 BLT subjects and 411 from 137 NORM subjects, was applied to the constructed DCNN to evaluate its performance against experienced endoscopists. RESULTS The DCCN achieved a sensitivity of 0.731, a specificity of 0.922, an AUC of 0.922, and the overall accuracy of 0.867 for detecting LCA and PRELCA among all lesions and normal tissues. When compared to human experts in an independent test set, the DCCN' s performance on detection of LCA and PRELCA achieved a sensitivity of 0.720, a specificity of 0.948, an AUC of 0.953, and the overall accuracy of 0.897, which was comparable to that of an experienced human expert with 10-20 years of work experience. Moreover, the overall accuracy of DCNN for detection of LCA was 0.773, which was also comparable to that of an experienced human expert with 10-20 years of work experience and exceeded the experts with less than 10 years of work experience. CONCLUSIONS The DCNN has high sensitivity and specificity for automated detection of LCA and PRELCA from BLT and NORM in laryngoscopic images. This novel and effective approach facilitates earlier diagnosis of early LCA, resulting in improved clinical outcomes and reducing the burden of endoscopists.
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Affiliation(s)
- Hao Xiong
- Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, China; Institute of Hearing and Speech-Language Science, Sun Yat-sen University, China
| | - Peiliang Lin
- Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, China; Institute of Hearing and Speech-Language Science, Sun Yat-sen University, China
| | - Jin-Gang Yu
- School of Automation Science and Engineering, South China University of Technology, China
| | - Jin Ye
- Department of Otolaryngology, the Third Affiliated Hospital, Sun Yat-sen University, China
| | - Lichao Xiao
- School of Automation Science and Engineering, South China University of Technology, China
| | - Yuan Tao
- Department of Otolaryngology, Peking University Shenzhen Hospital, China
| | - Zebin Jiang
- Department of Otolaryngology, Puning People's Hospital, China
| | - Wei Lin
- Department of Otolaryngology, Taizhou First People's Hospital, China
| | - Mingyue Liu
- Department of Otolaryngology, the Third Affiliated Hospital, Sun Yat-sen University, China
| | - Jingjing Xu
- Department of Hearing and Speech-Language Science, Xinhua College, Sun Yat-sen University, China
| | - Wenjie Hu
- Department of Hearing and Speech-Language Science, Xinhua College, Sun Yat-sen University, China
| | - Yuewen Lu
- Department of Hearing and Speech-Language Science, Xinhua College, Sun Yat-sen University, China
| | - Huaifeng Liu
- Department of Hearing and Speech-Language Science, Xinhua College, Sun Yat-sen University, China
| | - Yuanqing Li
- School of Automation Science and Engineering, South China University of Technology, China.
| | - Yiqing Zheng
- Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, China; Institute of Hearing and Speech-Language Science, Sun Yat-sen University, China; Department of Hearing and Speech-Language Science, Xinhua College, Sun Yat-sen University, China.
| | - Haidi Yang
- Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, China; Institute of Hearing and Speech-Language Science, Sun Yat-sen University, China; Department of Hearing and Speech-Language Science, Xinhua College, Sun Yat-sen University, China.
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Flexible transnasal endoscopy with white light or narrow band imaging for the diagnosis of laryngeal malignancy: diagnostic value, observer variability and influence of previous laryngeal surgery. Eur Arch Otorhinolaryngol 2018; 276:459-466. [PMID: 30569190 PMCID: PMC6394425 DOI: 10.1007/s00405-018-5256-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 12/14/2018] [Indexed: 12/15/2022]
Abstract
Purpose Flexible transnasal endoscopy is a common examination technique for the evaluation of laryngeal lesions, while the use of narrow band imaging (NBI) has been reported to enhance the diagnostic value of white light endoscopy (WLE). The purpose of this study is to assess observer variability and diagnostic value of both modalities and investigate the possible influence of previous laryngeal surgery on the detection rates of laryngeal malignancy. Methods The study was based on the retrospective evaluation of 170 WLE and NBI images of laryngeal lesions by three observers in a random order. The histopathological diagnoses serve as the gold standard. Results In identifying laryngeal malignancy, the sensitivity of NBI proved to be higher than that of WLE (93.3% vs. 77.0%). NBI was also superior to WLE in terms of accuracy (96.3% vs. 92%) and diagnostic odds ratio (501.83 vs. 120.65). Both modalities had a specificity of 97.3%. The inter-observer agreement was substantial (kappa = 0.661) for WLE and almost perfect (kappa = 0.849) for NBI. Both WLE and NBI showed a high level of intra-observer agreement. The sensitivity was significantly lower in images with history of previous laryngeal surgery compared to those without. Conclusions Flexible transnasal endoscopy has been proved to be a valuable tool in the diagnosis of laryngeal malignancy. The use of NBI can increase the sensitivity and observer reliability in that context and can also provide a diagnostic gain in cases with previous laryngeal surgery
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Paleri V, Sawant R, Mehanna H, Ainsworth H, Stocken D. Laryngeal dysplasia and narrow band imaging: Secondary analysis of published data supports the role in patient follow-up. Clin Otolaryngol 2018; 43:1439-1442. [PMID: 29972728 DOI: 10.1111/coa.13182] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 12/01/2017] [Accepted: 06/17/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Clinicians have recognised the role of narrow band imaging (NBI) in the management of head and neck cancer in several studies. However, a recent systematic review was unable to pool the data on diagnostic efficacy in this setting owing to the heterogeneity in the published data. METHODS Secondary analysis of data, utilising Bayes' theorem, from meta-analyses and randomised trials. RESULTS In patients with a histological diagnosis of mild dysplasia who show no abnormalities on NBI, the post-test probability of malignancy is estimated to be 2.3%, compared to 10.3% with conventional white light imaging (WLI). For severe dysplasia, similar post-test probabilities after NBI and WLI are estimated to be 8.0% and 29.7%, respectively. Post-test probabilities in this setting indicate the chance of missing malignancy following a negative NBI or WLI in patients who undergo no further intervention. This study also provides a nomogram designed for use in this setting. CONCLUSIONS This study identifies the evidence base for use of NBI in the follow-up for laryngeal dysplasia.
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Affiliation(s)
| | - Rupali Sawant
- Biostatistics Research Group, Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | | | - Holly Ainsworth
- Institute of Head and Neck Studies and Education, University of Birmingham, Birmingham, UK
| | - Deborah Stocken
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
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Mehlum CS, Rosenberg T, Dyrvig AK, Groentved AM, Kjaergaard T, Godballe C. Can the Ni classification of vessels predict neoplasia? A systematic review and meta-analysis. Laryngoscope 2017; 128:168-176. [DOI: 10.1002/lary.26721] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 04/23/2017] [Accepted: 05/05/2017] [Indexed: 12/15/2022]
Affiliation(s)
- Camilla S. Mehlum
- Department of Otorhinolaryngology-Head and Neck Surgery; Odense University Hospital; Odense Denmark
| | - Tine Rosenberg
- Department of Otorhinolaryngology-Head and Neck Surgery; Odense University Hospital; Odense Denmark
| | | | - Aagot Moeller Groentved
- Department of Otorhinolaryngology-Head and Neck Surgery; Odense University Hospital; Odense Denmark
| | - Thomas Kjaergaard
- Department of Otorhinolaryngology-Head and Neck Surgery; Aarhus University Hospital; Aarhus Denmark
| | - Christian Godballe
- Department of Otorhinolaryngology-Head and Neck Surgery; Odense University Hospital; Odense Denmark
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