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Pavlidis P, Tseriotis VS, Matthias C, Katsikari I, Chatzinikolaou A, Gouveris H. Contact Endoscopic Surface Vascular and Epithelial Morphology in Leukoplakia and Carcinoma of the Vocal Cords: Vascular and morphological changes of vocal folds in leukoplakia and cancer. Indian J Otolaryngol Head Neck Surg 2024; 76:462-468. [PMID: 38440476 PMCID: PMC10908749 DOI: 10.1007/s12070-023-04183-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 08/23/2023] [Indexed: 03/06/2024] Open
Abstract
Purpose Leukoplakia is a macroscopic morphological term for thick white or grey mucosal patches that can represent various histologic diagnostic entities ranging from hyperplasia to malignancy. Aim was the study morphology of the superficial mucosa and microvascular network of the vocal cords in patients with suspected glottic squamous cell carcinoma (SCC) using contact endoscopy (CE). Material and Methods Seventy-nine patients (21 female, 58 male), with a mean age of 57.5 years ± 7.12 (range, 32-73 years), were prospectively enrolled and evaluated. Of these patients, 58 had leukoplakia (Group A/41 males and 17 females, with a mean age of 53.7 years ± 6.65), and 21 (Group B/ 17males and 4 females/ with a mean age of 60.5 years ± 6.04) had malignant lesions (pT1, n = 6; p T2, n = 8; pT3, n = 8; Group B), as proven by the results of the histological examination. Further, 79 non-smokers (control group-group C) were studied. CE imaging findings were classified into five types (I to V) based on the features of the mucosal intra-epithelial capillary loops. CE findings were correlated to the histologic findings. A separate analysis involving smoking status was done. Results The CE-based intraepithelial papillary capillary loop classification score was strongly correlated with the histological findings. Age was strongly associated with both malignancy and bilateral involvement. Smoking habits didn't significantly differ between patients with unilateral and bilateral SCC. Conclusions CE imaging of the vocal cord mucosal capillaries may be useful for the early detection of glottic SCC and pre-cancerous lesions.
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Affiliation(s)
- Pavlos Pavlidis
- Department of Otorhinolaryngology / Head and Neck Surgery, University Medical Center Mainz, Badralexi 3, Veria, 59132 Mainz, Germany
- Laboratory of Clinical Pharmacology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Christopher Matthias
- Department of Otorhinolaryngology / Head and Neck Surgery, University Medical Center Mainz, Badralexi 3, Veria, 59132 Mainz, Germany
| | | | | | - Haralampos Gouveris
- Department of Otorhinolaryngology / Head and Neck Surgery, University Medical Center Mainz, Badralexi 3, Veria, 59132 Mainz, Germany
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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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Syba J, Trnkova K, Dostalova L, Votava M, Lukesova E, Novak S, Kana M, Tesarova M, Zabrodsky M, Plzak J, Lukes P. Comparison of narrow-band imaging with autofluorescence imaging for endoscopic detection of squamous cell carcinoma of the tonsil. Eur Arch Otorhinolaryngol 2023; 280:5073-5080. [PMID: 37464156 PMCID: PMC10562293 DOI: 10.1007/s00405-023-08111-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 07/03/2023] [Indexed: 07/20/2023]
Abstract
PURPOSE Early detection of mucosal neoplastic lesions is crucial for a patient's prognosis. This has led to the development of effective optical endoscopic diagnostic methods such as narrow band imaging (NBI) and autofluorescence (AFI). Independent of each other, both of these methods were proven useful in the detection of mucosal neoplasias. There are limited reported data comparing both methods for oropharyngeal cancer diagnostics. The aim of the study was to compare NBI and AFI endoscopic visualization of signs in identifying tonsillar squamous cell carcinoma (SCC) and assessing its extent and to determine whether the score was related to the evaluator's experience. METHODS Patients with tonsillar SCC underwent endoscopic pharyngeal examination using NBI and AFI. Fiftyseven video sequences of examinations of lesions proven to be SCC were evaluated by three reviewers. The accuracy of determination of lesion extent and visualization of its endoscopic signs of malignancy were evaluated. RESULTS Endoscopic visualization of tumour spread was significantly better using AFI than NBI (p = 0.0003). No significant difference was found between NBI and AFI in the visualization of endoscopic malignancy determining signs (p = 0.1405). No significant difference was found among the three reviewers in the visualization of tumour spread and for identifying malignancy-determining signs in NBI endoscopy or AFI endoscopy. CONCLUSIONS The results show that AFI obtained better results for assessing the extent of tonsillar cancers than NBI. Both methods were proven to be equal in the visualization of endoscopic malignancy-determining signs. Both are useful even for less experienced evaluators.
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Affiliation(s)
- J. Syba
- Department of Otorhinolaryngology and Head and Neck Surgery, First Faculty of Medicine, Charles University, University Hospital Motol, Prague, Czech Republic
- Department of Otorhinolaryngology, Third Faculty of Medicine, Charles University, University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - K. Trnkova
- Department of Otorhinolaryngology, Third Faculty of Medicine, Charles University, University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - L. Dostalova
- Department of Otorhinolaryngology and Head and Neck Surgery, First Faculty of Medicine, Charles University, University Hospital Motol, Prague, Czech Republic
| | - M. Votava
- Department of Otorhinolaryngology and Head and Neck Surgery, First Faculty of Medicine, Charles University, University Hospital Motol, Prague, Czech Republic
| | - E. Lukesova
- Department of Otorhinolaryngology and Head and Neck Surgery, First Faculty of Medicine, Charles University, University Hospital Motol, Prague, Czech Republic
| | - S. Novak
- Department of Otorhinolaryngology and Head and Neck Surgery, First Faculty of Medicine, Charles University, University Hospital Motol, Prague, Czech Republic
| | - M. Kana
- Department of Otorhinolaryngology and Head and Neck Surgery, First Faculty of Medicine, Charles University, University Hospital Motol, Prague, Czech Republic
| | - M. Tesarova
- Department of Otorhinolaryngology and Head and Neck Surgery, First Faculty of Medicine, Charles University, University Hospital Motol, Prague, Czech Republic
| | - M. Zabrodsky
- Department of Otorhinolaryngology and Head and Neck Surgery, First Faculty of Medicine, Charles University, University Hospital Motol, Prague, Czech Republic
| | - J. Plzak
- Department of Otorhinolaryngology and Head and Neck Surgery, First Faculty of Medicine, Charles University, University Hospital Motol, Prague, Czech Republic
| | - P. Lukes
- Department of Otorhinolaryngology and Head and Neck Surgery, First Faculty of Medicine, Charles University, University Hospital Motol, Prague, Czech Republic
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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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Filipovsky T, Kalfert D, Lukavcova E, Zavazalova S, Hlozek J, Kovar D, Astl J, Holy R. The importance of preoperative and perioperative Narrow Band Imaging endoscopy in the diagnosis of pre-tumor and tumor lesions of the larynx. J Appl Biomed 2023; 21:107-112. [PMID: 37747310 DOI: 10.32725/jab.2023.015] [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: 08/16/2023] [Accepted: 09/13/2023] [Indexed: 09/26/2023] Open
Abstract
INTRODUCTION Narrow band imaging (NBI) is an endoscopic imaging method intended for the diagnosis of mucosal lesions of the larynx that are not visible in white-light endoscopy, but are typical of pre-tumor and tumor lesions of the larynx. THE PURPOSE OF THE STUDY To compare preoperative/perioperative white light endoscopy and NBI endoscopy with the results of histopathological examinations in pre-tumor and tumor lesions of the larynx. METHODS A prospective study, over a period of five years (5/2018-5/2023), included 87 patients with laryngeal lesions aged 24-80 years. We evaluated preoperative/ perioperative white light and NBI endoscopy, established a working prehistological diagnosis, and compared this with the definitive histopathological results of laryngeal biopsies. RESULTS In relation to the definitive histology score, a statistically significant correlation was found between the evaluation of the finding and the definitive histology for preoperative and perioperative white light endoscopy and NBI endoscopy (p < 0.001). Both methods showed higher precision when used perioperatively. CONCLUSION NBI endoscopy is an optical method that allows us to improve the diagnosis of laryngeal lesions, perform a controlled perioperative biopsy, and refine the surgical scope. The NBI endoscopy is a suitable method for the diagnosis of early cancerous lesions of the larynx. The use of preoperative/perioperative NBI endoscopy allowed us to achieve a high level of agreement correlation (p < 0.001) between the prehistological working diagnosis and the final histopathological result. The NBI method proves its application in the diagnosis of pre-tumor and tumor lesions of the larynx.
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Affiliation(s)
- Tomas Filipovsky
- Military University Hospital Prague, Department of Otorhinolaryngology and Maxillofacial Surgery, Prague, Czech Republic
- Charles University, Third Faculty of Medicine, Prague, Czech Republic
| | - David Kalfert
- Motol University Hospital, Department of Otorhinolaryngology and Head and Neck Surgery, Prague, Czech Republic
- Charles University, First Faculty of Medicine, Prague, Czech Republic
| | - Eva Lukavcova
- Military University Hospital Prague, Department of Otorhinolaryngology and Maxillofacial Surgery, Prague, Czech Republic
| | - Sarka Zavazalova
- Military University Hospital Prague, Department of Otorhinolaryngology and Maxillofacial Surgery, Prague, Czech Republic
- Charles University, Third Faculty of Medicine, Prague, Czech Republic
| | - Jiri Hlozek
- Military University Hospital Prague, Department of Otorhinolaryngology and Maxillofacial Surgery, Prague, Czech Republic
- Charles University, Third Faculty of Medicine, Prague, Czech Republic
| | - Daniel Kovar
- Military University Hospital Prague, Department of Otorhinolaryngology and Maxillofacial Surgery, Prague, Czech Republic
- Charles University, Third Faculty of Medicine, Prague, Czech Republic
| | - Jaromir Astl
- Military University Hospital Prague, Department of Otorhinolaryngology and Maxillofacial Surgery, Prague, Czech Republic
- Charles University, Third Faculty of Medicine, Prague, Czech Republic
| | - Richard Holy
- Military University Hospital Prague, Department of Otorhinolaryngology and Maxillofacial Surgery, Prague, Czech Republic
- Charles University, Third Faculty of Medicine, Prague, Czech Republic
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Bertino G, Pedretti F, Mauramati S, Filauro M, Vallin A, Mora F, Crosetti E, Succo G, Peretti G, Benazzo M. Recurrent laryngeal papillomatosis: multimodal therapeutic strategies. Literature review and multicentre retrospective study. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2023; 43:S111-S122. [PMID: 37698108 PMCID: PMC10159644 DOI: 10.14639/0392-100x-suppl.1-43-2023-14] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 01/19/2023] [Indexed: 09/13/2023]
Abstract
Objectives Recurrent respiratory papillomatosis (RRP) is a benign, rare disease caused by Human Papilloma Virus (HPV) that can be divided into juvenile and adult forms. The course of the disease is variable, but is usually more aggressive in the juvenile form. The standard surgical treatment is represented by CO2 laser resection, although photoangiolytic lasers represent a valid alternative. Adjuvant therapies have been proposed for disease control in case of frequent surgical resections or spreading into the lower airways. In recent years, the development of immunotherapy led to the use of bevacizumab either intratumorally or intravenously, but the most promising therapeutic development is represented by HPV vaccination. This paper aims to present a narrative review of the literature and the experience of three different University Centres in the treatment of RRP. Methods A retrospective analysis of the clinical charts of all patients affected by laryngeal papillomatosis and treated in three different University Centres between 2002 and 2022 was performed. The following parameters were collected: sex, age at first evaluation, sites of larynx involved, HPV type, type of first surgical treatment, presence and number of recurrences, surgical treatment of recurrences, adjuvant therapies, side effects and status at last follow-up. Results Seventy-eight patients were available for evaluation. Of these, 88% had adult onset RRP (Ao-RRP) and 12% juvenile onset RRP (Jo-RRP). The glottis was the most frequently involved subsite; all patients were submitted to surgical resection with CO2 laser under general anaesthesia. Recurrences appeared in 79% of the patients, the patients who did not recur were all adults. The mean number of recurrences was 9 (range 1-110). Recurrences were more frequent in children (M = 20; range 2-110) than adults (M = 5; range 1-21). Thirty-two (52%) of the 62 patients who recurred were re-treated with CO2 laser under general anaesthesia, while office-based treatment with a photoangiolytic laser was preferred in the remaining 30 (48%) patients. Adjuvant treatments were applied in 26 patients. The analysis of the course of the disease showed that in the 9 patients with Jo-RRP, 6 (67%) were free of lesions at the last follow-up, while the other 3 (33%) had papillomas. Of the 69 patients with Ao-RRP, 53 (77%) were alive and free of disease at the last visit, 14 (21%) were alive with disease, 1 (1%) was lost at follow-up and 1 (1%) died for other disease. Severe side effects were not observed except for 2 patients, who developed posterior glottic stenosis. Conclusions Our results confirmed the literature review. RRP is a potentially aggressive disease, especially in juvenile onset. Surgical resection is still first-line treatment, but in case of multiple recurrences the use of adjuvant therapies must be taken into consideration.
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Affiliation(s)
- Giulia Bertino
- Department of Otolaryngology Head and Neck Surgery, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Fabio Pedretti
- Department of Otolaryngology Head and Neck Surgery, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Simone Mauramati
- Department of Otolaryngology Head and Neck Surgery, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Marta Filauro
- Unit of Otolaryngology Head and Neck Surgery, IRCCS Policlinico San Martino Hospital, Genoa, Italy
| | - Alberto Vallin
- Unit of Otolaryngology Head and Neck Surgery, IRCCS Policlinico San Martino Hospital, Genoa, Italy
- DISC, University of Genoa, Italy
| | - Francesco Mora
- Unit of Otolaryngology Head and Neck Surgery, IRCCS Policlinico San Martino Hospital, Genoa, Italy
- DISC, University of Genoa, Italy
| | - Erika Crosetti
- ENT Unit, Oncology Department, University of Turin, Orbassano (Turin), Italy
| | - Giovanni Succo
- ENT Department, San Giovanni Bosco Hospital, Turin, Italy
- Oncology Department, University of Turin, Turin, Italy
| | - Giorgio Peretti
- Unit of Otolaryngology Head and Neck Surgery, IRCCS Policlinico San Martino Hospital, Genoa, Italy
- DISC, University of Genoa, Italy
| | - Marco Benazzo
- Department of Otolaryngology Head and Neck Surgery, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
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NBI and Laryngeal Papillomatosis: A Diagnostic Challenge: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148716. [PMID: 35886569 PMCID: PMC9317038 DOI: 10.3390/ijerph19148716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/14/2022] [Accepted: 07/16/2022] [Indexed: 11/21/2022]
Abstract
Highlights Abstract Narrow-band imaging (NBI) represents a valid aid in laryngeal squamous cell carcinoma (LSCC) diagnosis for detecting vascular changes. However, LSCC and laryngeal papillomatosis (LP) show similar vascular patterns that may lead to misdiagnosis and improper treatment. This review aims to deepen this NBI limit in order to stress a careful preoperative evaluation of laryngeal lesions. The research was carried out on PubMed, Web of Science and Scopus databases using specific keywords. The topic of research was assessed by these parameters: accuracy, sensitivity, specificity, and positive and negative predictive values. This review included only five articles: they demonstrated that NBI is better than white-light endoscopy in detecting LSCC and LP. They also reported that LP is frequently mistaken for LSCC, resulting in high rates of false positives using NBI. This is the first review that emphasized this NBI limitation in distinguishing between LP and LSCC in cases of a type V pattern of intraepithelial papillary capillary loop. Although NBI application increased the rate of early cancer detection, LP reduces NBI accuracy. This drawback may lead to misdiagnosis and improper treatment. Our advice is to be careful in cases of type V pattern on NBI and to research LP epithelial and clinical features because it could be a pitfall.
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Smahelova J, Hamsikova E, Ludvikova V, Vydrova J, Traboulsi J, Vencalek O, Lukeš P, Tachezy R. Outcomes After Human Papillomavirus Vaccination in Patients With Recurrent Respiratory Papillomatosis: A Nonrandomized Clinical Trial. JAMA Otolaryngol Head Neck Surg 2022; 148:654-661. [PMID: 35653138 DOI: 10.1001/jamaoto.2022.1190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Recurrent respiratory papillomatosis (RRP) is a rare benign chronic disease of the larynx etiologically linked with the infection of low-risk human papillomavirus (HPV). Combination of surgical and immunomodulatory therapy has limited success. Possible use of prophylactic HPV vaccine that includes HPV-6 and HPV-11 antigens has been studied. Objective To evaluate if the HPV vaccination is associated with a lower number of recurrences requiring surgical intervention in patients with new and recurrent RRP. Design, Setting, and Participants This was a non-placebo-controlled intervention study. Enrollment data were collected from October 2011 to August 2013. The patients were followed up at 1 month, 12 months, and 5 years after the third dose of the vaccine and clinically monitored until December 31, 2018. Data were analyzed from 2019 to 2021. Altogether, 50 adults with active RRP were enrolled and followed up in referral centers. For the final outcome, follow-up data for 42 patients were available. Eight patients who did not fulfill the protocol were excluded. Interventions All patients received HPV vaccine as an adjuvant treatment and were clinically followed up. When RRP progression or a significant recurrent lesion was detected, surgical removal via direct laryngoscopy was indicated. No adjuvant therapy with antiviral or biological agents was used. Main Outcomes and Measures This study compared the prevaccination and postvaccination positivity for HPV-specific antibodies. The main outcome was the difference in the frequency of RRP recurrences in the prevaccination and postvaccination period. Results A total of 50 patients with RRP were enrolled (median [SD] age, 41.5 [12.3] years [range, 21-73 years]; 39 [78%] men and 11 [22%] women). After HPV vaccination, patients with previously no HPV-specific antibodies showed seroconversion, and all patients developed 100-fold higher levels of HPV vaccine type-specific antibodies compared with the prevaccination period. In patients with recurrent RRP, decreased frequency of recurrences requiring surgical treatment was present after vaccination (from 0.85 to 0.36 recurrences/y). No difference in postvaccination recurrences was found between patients with newly diagnosed and recurrent RRP. Conclusions and Relevance In this nonrandomized clinical trial, the frequency of RRP recurrences was significantly lower after HPV vaccination, and patients with RRP thus had a reduced burden of disease. Because no difference was detected in the frequency of recurrent postvaccination lesions in patients with new and recurrent disease, it appears that both groups showed equal benefit following HPV vaccination. These findings suggest that the earlier that patients with RRP receive HPV vaccine, the sooner they may show reduced burden of disease. Trial Registration EudraCT Identifier: 2011-002667-14; ClinicalTrials.gov Identifier: NCT01375868.
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Affiliation(s)
- Jana Smahelova
- Department of Genetics and Microbiology, Faculty of Science, BIOCEV, Charles University, Prague, Czech Republic.,Institute of Hematology and Blood Transfusion, National Reference Laboratory for Papillomaviruses and Polyomaviruses, Prague, Czech Republic
| | - Eva Hamsikova
- Institute of Hematology and Blood Transfusion, National Reference Laboratory for Papillomaviruses and Polyomaviruses, Prague, Czech Republic
| | - Viera Ludvikova
- Institute of Hematology and Blood Transfusion, National Reference Laboratory for Papillomaviruses and Polyomaviruses, Prague, Czech Republic
| | - Jitka Vydrova
- Prague Voice Centre/Medical Healthcom, Prague, Czech Republic
| | - Joseph Traboulsi
- Department of ENT/Head and Neck Surgery, Na Homolce Hospital, Prague, Czech Republic
| | - Ondrej Vencalek
- Department of Mathematical Analysis and Applications of Mathematics, Faculty of Science, Palacky University, Olomouc, Czech Republic
| | - Petr Lukeš
- Department of Otorhinolaryngology and Head and Neck Surgery, First Faculty of Medicine, Charles University, Motol University Hospital, Prague, Czech Republic
| | - Ruth Tachezy
- Department of Genetics and Microbiology, Faculty of Science, BIOCEV, Charles University, Prague, Czech Republic.,Institute of Hematology and Blood Transfusion, National Reference Laboratory for Papillomaviruses and Polyomaviruses, Prague, Czech Republic
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9
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Staníková L, Formánek M, Hurník P, Kántor P, Komínek P, Zeleník K. Diagnosis of Laryngeal Pemphigus Vulgaris Can Be Facilitated Using Advanced Endoscopic Methods. ACTA ACUST UNITED AC 2021; 57:medicina57070686. [PMID: 34356968 PMCID: PMC8305305 DOI: 10.3390/medicina57070686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 06/24/2021] [Accepted: 07/04/2021] [Indexed: 11/16/2022]
Abstract
Background: Isolated laryngeal pemphigus vulgaris (LPV) is rare; however, early diagnosis is crucial in determining its course and prognosis. This paper aims to describe mucosal vascular changes typical for LPV using advanced endoscopic methods, which include Narrow Band Imaging (NBI), IMAGE1-S video-endoscopy and enhanced contact endoscopy (ECE). Materials and Methods: Retrospective analysis of all laryngeal mucosal lesion examined using advanced endoscopic methods during 2018-2020 at tertiary hospital was performed. Results: Videolaryngoscopy examination records of 278 patients with laryngeal mucosal lesions were analyzed; three of them were diagnosed with LPV. Epithelial vascularization of LPV included specific pattern. Intraepithelial papillary capillary loops were symmetrically stratified and were organized into "contour-like lines". This specific vascularization associated with LPV were different from other laryngeal mucosal pathologies. Conclusions: Using advanced endoscopic methods supports early diagnosis of LPV and accelerate the diagnosis and treatment.
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Affiliation(s)
- Lucia Staníková
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, 17. Listopadu 1790, 70800 Ostrava, Czech Republic; (L.S.); (M.F.); (P.K.); (P.K.)
| | - Martin Formánek
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, 17. Listopadu 1790, 70800 Ostrava, Czech Republic; (L.S.); (M.F.); (P.K.); (P.K.)
- Department of Craniofacial Surgery, Faculty of Medicine, University of Ostrava, Syllabova 19, 70300 Ostrava, Czech Republic
| | - Pavel Hurník
- Department of Pathology, University Hospital Ostrava, 17. listopadu 1790, 70800 Ostrava, Czech Republic;
| | - Peter Kántor
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, 17. Listopadu 1790, 70800 Ostrava, Czech Republic; (L.S.); (M.F.); (P.K.); (P.K.)
- Department of Craniofacial Surgery, Faculty of Medicine, University of Ostrava, Syllabova 19, 70300 Ostrava, Czech Republic
| | - Pavel Komínek
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, 17. Listopadu 1790, 70800 Ostrava, Czech Republic; (L.S.); (M.F.); (P.K.); (P.K.)
- Department of Craniofacial Surgery, Faculty of Medicine, University of Ostrava, Syllabova 19, 70300 Ostrava, Czech Republic
| | - Karol Zeleník
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, 17. Listopadu 1790, 70800 Ostrava, Czech Republic; (L.S.); (M.F.); (P.K.); (P.K.)
- Department of Craniofacial Surgery, Faculty of Medicine, University of Ostrava, Syllabova 19, 70300 Ostrava, Czech Republic
- Correspondence:
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Chabrillac E, Dupret-Bories A, Vairel B, Woisard V, De Bonnecaze G, Vergez S. Narrow-Band Imaging in oncologic otorhinolaryngology: State of the art. Eur Ann Otorhinolaryngol Head Neck Dis 2021; 138:451-458. [PMID: 33722467 DOI: 10.1016/j.anorl.2021.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To describe the diagnostic performance of Narrow Band Imaging (NBI) combined with White Light Imaging (WLI) in the diagnosis of mucosal lesions at each location of the upper aerodigestive tract, for detection of primary tumor in case of carcinoma of unknown primary, for determination of intraoperative resection margins, and to describe its main diagnostic pitfalls. MATERIAL AND METHODS A PubMed search was carried out according to the PRISMA method. RESULTS Four hundred and seventy-seven articles published between 2007 and 2020 were identified, 133 of which met the study inclusion criteria and were assessed. CONCLUSION The current literature seems to support the use of NBI in diagnosis and/or follow-up of (pre-)malignant head & neck tumors, and in the determination of intraoperative resection margins.
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Affiliation(s)
- E Chabrillac
- Department of ENT-Head and Neck Surgery, University Cancer Institute Toulouse and Toulouse University Hospital, Hôpital Larrey, 24 Chemin de Pouvourville, 31059 Toulouse, France; Department of Surgery, University Cancer Institute Toulouse-Oncopole, 1 Avenue Irène Joliot-Curie, 31059 Toulouse, France
| | - A Dupret-Bories
- Department of Surgery, University Cancer Institute Toulouse-Oncopole, 1 Avenue Irène Joliot-Curie, 31059 Toulouse, France
| | - B Vairel
- Department of ENT-Head and Neck Surgery, University Cancer Institute Toulouse and Toulouse University Hospital, Hôpital Larrey, 24 Chemin de Pouvourville, 31059 Toulouse, France; Department of Surgery, University Cancer Institute Toulouse-Oncopole, 1 Avenue Irène Joliot-Curie, 31059 Toulouse, France
| | - V Woisard
- Department of ENT-Head and Neck Surgery, University Cancer Institute Toulouse and Toulouse University Hospital, Hôpital Larrey, 24 Chemin de Pouvourville, 31059 Toulouse, France; Department of Surgery, University Cancer Institute Toulouse-Oncopole, 1 Avenue Irène Joliot-Curie, 31059 Toulouse, France
| | - G De Bonnecaze
- Department of ENT-Head and Neck Surgery, University Cancer Institute Toulouse and Toulouse University Hospital, Hôpital Larrey, 24 Chemin de Pouvourville, 31059 Toulouse, France
| | - S Vergez
- Department of ENT-Head and Neck Surgery, University Cancer Institute Toulouse and Toulouse University Hospital, Hôpital Larrey, 24 Chemin de Pouvourville, 31059 Toulouse, France; Department of Surgery, University Cancer Institute Toulouse-Oncopole, 1 Avenue Irène Joliot-Curie, 31059 Toulouse, France.
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11
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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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12
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Zwakenberg MA, Halmos GB, Wedman J, van der Laan BFAM, Plaat BEC. Evaluating Laryngopharyngeal Tumor Extension Using Narrow Band Imaging Versus Conventional White Light Imaging. Laryngoscope 2021; 131:E2222-E2231. [PMID: 33393666 DOI: 10.1002/lary.29361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/09/2020] [Accepted: 12/18/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVE/HYPOTHESIS Comparing detection and extension of malignant tumors by flexible laryngoscopy in the outpatient setting with laryngoscopy under general anesthesia using both White Light Imaging (WLI) and Narrow Band Imaging (NBI). STUDY DESIGN Prospective study. METHODS Two hundred and thirty-three patients with laryngeal and pharyngeal lesions underwent flexible and rigid laryngoscopy, with both WLI and NBI. Extension of malignant lesions (n = 132) was compared between both techniques in detail. RESULTS Sensitivity of NBI during flexible endoscopy (92%), was comparable with that of WLI during rigid endoscopy (91%). The correlation of tumor extension between flexible and rigid laryngoscopy was high (rs = 0.852-0.893). The observed tumor extension was significantly larger when using NBI in both settings. The use of NBI during flexible laryngoscopy leads to upstaging (12%) and downstaging (2%) of the T classification. CONCLUSIONS NBI during flexible laryngoscopy could be an alternative to WLI rigid endoscopy. NBI improves visualization of tumor extension and accuracy of T staging. LEVEL OF EVIDENCE 3 Laryngoscope, 131:E2222-E2231, 2021.
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Affiliation(s)
- Manon A Zwakenberg
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gyorgy B Halmos
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jan Wedman
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Bernard F A M van der Laan
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Otorhinolaryngology, Head and Neck Surgery, Haaglanden Medical Center, The Hague, The Netherlands
| | - Boudewijn E C Plaat
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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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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14
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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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Šifrer R, Šereg-Bahar M, Gale N, Hočevar-Boltežar I. The diagnostic value of perpendicular vascular patterns of vocal cords defined by narrow-band imaging. Eur Arch Otorhinolaryngol 2020; 277:1715-1723. [PMID: 32112142 DOI: 10.1007/s00405-020-05864-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 02/12/2020] [Indexed: 01/19/2023]
Abstract
PURPOSE According to the classification of glottic lesions by narrow-band imaging (NBI) proposed by the European Laryngological Society (ELS), lesions without perpendicular patterns are benign, while wide- and narrow-angled perpendicular lesions include both papilloma and carcinoma/high-grade lesions, respectively. The purpose of the study was to investigate the effectiveness of the ELS classification. METHODS One hundred and forty four patients with glottic lesions underwent microlaryngoscopy with NBI. The affected vocal cords (arm A) were histologically analysed. The unaffected vocal cords (arm B) were not histologically analysed and were considered to be true negatives if no suspicious changes appeared during the follow-up. The vocal cords from arm A were categorised into three groups-those with a benign disease (papilloma excluded), those with a carcinoma/high-grade lesion and those with papilloma. The ratio of vascular patterns was determined and the groups were statistically compared using the Chi-square test. RESULTS Perpendicular patterns were identified only in 9.3% (9/97) of those in the benign group (without papilloma). Wide-angled patterns were mainly identified in cases of papilloma (80%, 12/15), while the narrow-angled ones were mostly identified in cases of carcinoma and high-grade lesions (96.2%, 76/79) (P < 0.001). The sensitivity, specificity, positive and negative predictive values and accuracy were 98%, 95%, 88%, 99% and 95%, respectively. CONCLUSION The ELS classification of vocal cord lesions by NBI is effective in differentiating between carcinoma/high-grade lesions and papilloma and the remaining benign lesions of the vocal cords.
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Affiliation(s)
- Robert Šifrer
- University Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, Zaloška 2, 1000, Ljubljana, Slovenia. .,Faculty of Medicine, Korytkova 2, 1000, Ljubljana, Slovenia.
| | - Maja Šereg-Bahar
- University Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, Zaloška 2, 1000, Ljubljana, Slovenia.,Faculty of Medicine, Korytkova 2, 1000, Ljubljana, Slovenia
| | - Nina Gale
- Institute of Pathology, Faculty of Medicine, Korytkova 2, 1000, Ljubljana, Slovenia
| | - Irena Hočevar-Boltežar
- University Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, Zaloška 2, 1000, Ljubljana, Slovenia.,Faculty of Medicine, Korytkova 2, 1000, Ljubljana, Slovenia
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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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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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Lukes P, Zabrodsky M, Syba J, Lukesova E, Votava M, Plzak J. Efficacy of Transnasal Flexible Videoendoscopy With Narrow Band Imaging for Follow-Up of Patients After Transoral Laser Cordectomy. Lasers Surg Med 2019; 52:333-340. [PMID: 31385332 DOI: 10.1002/lsm.23143] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVES Transoral laser surgery is the optimal surgical treatment modality for the early stages of glottic cancer. To allow for further treatment to be as effective and as minimal as possible, persistent or recurrent tumors should be detected very soon. The main aim is to minimize the risk of necessity of performing a total laryngectomy. Flexible videoendoscopy with narrow band imaging (NBI) was recommended by the European Laryngological Society as a diagnostic method for the follow-up of patients treated for laryngeal cancer. Nevertheless, the efficacy of this technique has not been extensively studied in patients after transoral laser cordectomies for vocal fold cancer. The aim of this study was to evaluate the efficacy of in-office transnasal NBI flexible videoendoscopy in the follow-up of patients after transoral laser cordectomy for glottic cancer. We also focused on describing the specific characteristics of recurrent tumor appearance. MATERIALS AND METHODS The presented study was conceived as a prospective study. Ninety-four consecutive patients who underwent transoral laser cordectomy for severe dysplasia, Tis, T1, and T2 glottic cancer in the period from June 2010 to August 2015 were enrolled in the study. All patients were postoperatively regularly followed using transnasal videoendoscopic examinations with NBI. Whenever a suspect lesion was identified during in-office examination, its nature was proven histologically. RESULTS We discovered 23 suspect findings in 21 patients by means of flexible videoendoscopy with NBI. Fifteen (65.2%) of them were histologically confirmed as recurrent tumors, whereas in 8 (34.8%) of them, the recurrent tumor was not proven. In two patients, the recurrent tumor was evident on computed tomography or magnetic resonance imaging, but NBI endoscopy did not reveal relapsing disease. The rest (71 patients) were considered true negative. Of the 15 recurrent tumors detected by NBI-coupled videoendoscopy, 8 (53.3%) were identified as submucosal masses with nonsignificant or no vascular changes, 4 (26.7%) were noted as the progression of leukoplakia without visible vascular changes, only 2 (13.3%) showed typical vascular changes, and, in 1 (6.7%) case, evident, significantly exophytic tumor with pathological vascularization was discovered. The sensitivity, specificity, and positive and negative predictive values of the in-office transnasal videolaryngoscopy with NBI were calculated to be 88%, 92%, 71%, and 97%, respectively. CONCLUSIONS The results of the study demonstrate that transnasal endoscopy with NBI in an outpatient setting is an excellent method for the follow-up of patients after transoral laser cordectomy for glottic cancer. The method achieves high sensitivity, specificity, and negative predictive value and a slightly low positive predictive value. Nevertheless, we must bear in mind that recurrent tumors after previous endoscopic resection may have a completely different appearance than new tumors originating from previously untreated tissues. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- Petr Lukes
- Department of Otorhinolaryngology, Head and Neck Surgery, First Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Michal Zabrodsky
- Department of Otorhinolaryngology, Head and Neck Surgery, First Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Jaroslav Syba
- Department of Otorhinolaryngology, Head and Neck Surgery, First Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Eva Lukesova
- Department of Otorhinolaryngology, Head and Neck Surgery, First Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Michal Votava
- Department of Otorhinolaryngology, Head and Neck Surgery, First Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Jan Plzak
- Department of Otorhinolaryngology, Head and Neck Surgery, First Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
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Campo F, D'Aguanno V, Greco A, Ralli M, de Vincentiis M. The Prognostic Value of Adding Narrow-Band Imaging in Transoral Laser Microsurgery for Early Glottic Cancer: A Review. Lasers Surg Med 2019; 52:301-306. [PMID: 31338852 DOI: 10.1002/lsm.23142] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND AND OBJECTIVES Transoral laser microsurgery (TLM) is a universally recognized safe and minimally invasive approach for early glottic cancer. Narrow band imaging (NBI) is an optical technique working with a filtered light that reveals superficial mucosal abnormalities through the neoangiogenic pattern. The aim of this systematic review is to demonstrate the role of intraoperative NBI during TLM for early glottic cancer to better evaluate tumor extension and for more precise margin resection. STUDY DESIGN/MATERIALS AND METHODS A systematic review of the literature following the PRISMA guidelines was performed. A literature search was performed using the following keywords: TLM, NBI, and early glottic cancer. Two independent authors evaluated the extracted data. Data regarding status of surgical margins after TLM, local recurrence, recurrence-free survival, and need of additional samples following NBI were collected. RESULTS Five articles met inclusion criteria with a total of 577 patients undergoing TLM with intraoperative NBI. A significant reduction of positive superficial margins was found in patients treated with (52%) and without (28.6%) intraoperative use of NBI (P < 0.05) CONCLUSIONS: Routine use of intraoperative NBI increases the accuracy of neoplastic superficial spreading evaluation and accuracy of mass resection during TLM for early glottic cancer. The significant reduction of superficial positive margins dramatically decreases the number of patients at risk and improves clinical outcomes. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- Flaminia Campo
- Department of Sense Organs, Sapienza University of Rome, 00186, Rome, Italy
| | - Vittorio D'Aguanno
- Department of Sense Organs, Sapienza University of Rome, 00186, Rome, Italy
| | - Antonio Greco
- Department of Sense Organs, Sapienza University of Rome, 00186, Rome, Italy
| | - Massimo Ralli
- Department of Sense Organs, Sapienza University of Rome, 00186, Rome, Italy
| | - Marco de Vincentiis
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, 00186, Rome, Italy
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20
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Contrast-Enhancing Snapshot Narrow-Band Imaging Method for Real-Time Computer-Aided Cervical Cancer Screening. J Digit Imaging 2019; 33:211-220. [PMID: 31069586 PMCID: PMC7064463 DOI: 10.1007/s10278-019-00215-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Composition of cervical precancerous lesions and carcinoma in situ is rich in hemoglobin, unlike healthy tissues. In this study, we aimed to utilize this difference to enhance the contrast between healthy and diseased tissues via snapshot narrow-band imaging (SNBI). Four narrow-band images centered at wavelengths of characteristic absorption/reflection peaks of hemoglobin were captured with zero-time delay in between by a custom-designed SNBI video camera. Then these spectral images were fused in real time into a single combined image to enhance the contrast between normal and abnormal tissues. Finally, a Euclidean distance algorithm was employed to classify the tissue into clinical meaningful tissue types. Two pre-clinical experiments were conducted to validate the proposed method. Experimental results indicate that contrast between different grades of diseased tissues in the SNBI generated image was indeed enhanced, as compared to conventional white light image (WLI). The computer-aided classification accuracy was 100% and 50% as compared to the gold standard histopathological diagnosis results with the SNBI and the conventional WLI methods, respectively. Further, the boundary contour between health tissue, cervical precancerous regions, and carcinoma in situ can be automatically delineated in SNBI. The proposed SNBI method was also fast, and it generated automatic diagnostic results with clear boundary contours at over 11 fps on a Pentium 1.6-GHz laptop. Hence, the proposed SNBI is of great significance to enlarge worldwide the coverage of regular cervical screening program, and to live guide surgeries such as biopsy sample collection and accurate cervical cancer treatment.
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21
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Hosono H, Katada C, Okamoto T, Ichinoe M, Sakamoto Y, Matsuba H, Kano K, Ishido K, Tanabe S, Koizumi W, Yamashita T. Usefulness of narrow band imaging with magnifying endoscopy for the differential diagnosis of cancerous and noncancerous laryngeal lesions. Head Neck 2019; 41:2555-2560. [PMID: 30843628 DOI: 10.1002/hed.25734] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 01/20/2019] [Accepted: 02/19/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND We evaluated the accuracy of endoscopic findings observed by narrow band imaging (NBI) combined with magnifying gastrointestinal endoscopy (GIE) for the differential diagnosis of cancerous and noncancerous laryngeal lesions. METHODS A total of 166 vocal cord lesions for which good images were obtained on NBI with magnifying GIE were evaluated with respect to the following 6 variables: macroscopic type, tumor location, color, white coat, keratinization, and abnormal microvessels. RESULTS Multivariate analysis showed that white coat (odds ratio [OR], 2.95, P = 0.05), keratosis (OR, 3.14, P = 0.02) and abnormal microvessels (OR, 31.1, P < 0.0001) were significantly related to laryngeal cancer. In the diagnosis of laryngeal cancer, the sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of abnormal microvessels were 84.4%, 88.6%, 91%, 80.5%, and 86.1%, respectively. CONCLUSION The abnormal microvessels on NBI combined with magnifying GIE are useful for the differential diagnosis of laryngeal lesions.
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Affiliation(s)
- Hiroshi Hosono
- Department of Otorhinolaryngology-Head and Neck Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Chikatoshi Katada
- Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Tabito Okamoto
- Department of Otorhinolaryngology-Head and Neck Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Masaaki Ichinoe
- Department of Pathology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Yasutoshi Sakamoto
- Kitasato Clinical Research Center, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Hiroki Matsuba
- Department of Otorhinolaryngology-Head and Neck Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Koichi Kano
- Department of Otorhinolaryngology-Head and Neck Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Kenji Ishido
- Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Satoshi Tanabe
- Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Wasaburo Koizumi
- Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Taku Yamashita
- Department of Otorhinolaryngology-Head and Neck Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
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22
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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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Anis MM. Correlating laryngoscopic appearance of laryngeal lesions with histopathology. Laryngoscope 2018; 129:1308-1312. [PMID: 30484864 DOI: 10.1002/lary.27585] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 07/29/2018] [Accepted: 08/28/2018] [Indexed: 01/24/2023]
Abstract
OBJECTIVES/HYPOTHESIS Meticulous scrutiny of laryngeal lesions with laryngoscopes and microscopes often identify angiogenic activity, one of the hallmarks of neoplastic and preneoplastic lesions. The aim of this study was to determine if there is an association between laryngoscopic appearance and histopathology of laryngeal lesions based on operative biopsies. STUDY DESIGN Retrospective case-control study. METHODS One hundred forty-four laryngeal biopsies from 92 patients between 2015 and 2017 met inclusion criteria. Cases were patients who had biopsy-proven laryngeal dysplasia or malignancy. Controls were patients who had benign laryngeal pathology. All of the laryngeal lesions had either keratosis or vascular stippling, an indication of angiogenic activity. Medical records, videostroboscopies and operative findings of these patients were reviewed. Multivariable logistic regression was used to examine the correlation between laryngoscopic appearance of laryngeal lesions and presence or absence of dysplasia and invasive carcinoma. RESULTS Fifty percent of the 144 laryngeal lesions were classified either as dysplastic or malignant by histopathology. Vascular stippling was present in 31% of all laryngeal lesions. On logistic regression, vascular stippling was significantly associated with dysplastic and malignant lesions (P = .0018). Overall sensitivity and specificity of vascular stippling and the presence of dysplasia and malignancy were 51% and 89%, respectively. CONCLUSIONS Laryngoscopic and microscopic appearance of vascular stippling could inform clinicians on diagnostic sampling of suspicious laryngeal lesions that reduces delay in diagnosis. The low sensitivity of vascular stippling underlies the importance of maintaining high clinical suspicion and proceeding to the operating theater for adequate tissue sampling. LEVEL OF EVIDENCE 3 Laryngoscope, 129:1308-1312, 2019.
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Affiliation(s)
- Mursalin M Anis
- Coastal Ear, Nose and Throat, Neptune, New Jersey; and the Jersey Shore University Medical Center, Neptune, New Jersey, U.S.A
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Zwakenberg MA, Dikkers FG, Wedman J, van der Laan BFAM, Halmos GB, Plaat BEC. Detection of high-grade dysplasia, carcinoma in situ and squamous cell carcinoma in the upper aerodigestive tract: Recommendations for optimal use and interpretation of narrow-band imaging. Clin Otolaryngol 2018; 44:39-46. [DOI: 10.1111/coa.13229] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 05/05/2018] [Accepted: 09/09/2018] [Indexed: 01/26/2023]
Affiliation(s)
- Manon A. Zwakenberg
- Department of Otorhinolaryngology/Head and Neck surgery; University Medical Center Groningen; University of Groningen; Groningen the Netherlands
| | - Frederik G. Dikkers
- Department of Otorhinolaryngology; Academic Medical Center; University of Amsterdam; Amsterdam the Netherlands
| | - Jan Wedman
- Department of Otorhinolaryngology/Head and Neck surgery; University Medical Center Groningen; University of Groningen; Groningen the Netherlands
| | - Bernard F. A. M. van der Laan
- Department of Otorhinolaryngology/Head and Neck surgery; University Medical Center Groningen; University of Groningen; Groningen the Netherlands
| | - Gyorgy B. Halmos
- Department of Otorhinolaryngology/Head and Neck surgery; University Medical Center Groningen; University of Groningen; Groningen the Netherlands
| | - Boudewijn E. C. Plaat
- Department of Otorhinolaryngology/Head and Neck surgery; University Medical Center Groningen; University of Groningen; Groningen the Netherlands
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25
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Jackowska J, Klimza H, Winiarski P, Piersiala K, Wierzbicka M. The usefulness of narrow band imaging in the assessment of laryngeal papillomatosis. PLoS One 2018; 13:e0205554. [PMID: 30300415 PMCID: PMC6177196 DOI: 10.1371/journal.pone.0205554] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 09/27/2018] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES/HYPOTHESIS Recurrent respiratory papillomatosis (RRP) is a benign disease caused by human papillomavirus 6 and 11. The characteristic feature of this disease are wart-like lesions covering the respiratory epithelium with a predilection for the larynx. There is no curative treatment for the disease. The goal of the treatment is a total surgical removal of the papillomatous lesions in order to reduce the number of relapses. Therefore, a good visualization method of papillomas is crucial during surgery. The aim of the study was to compare the accuracy of narrow band imaging (NBI) to the use of white light alone in detecting RRP. METHODS The study was carried out between April 2013 and November 2015 at Poznan University of Medical Sciences, Department of Otolaryngology, Poland. Rigid endoscopy with conventional white light (WL) and NBI (CV-260SL processor and CLV- 260SL light source, Olympus Optical Co. Ltd, Tokyo, Japan) was performed in all patients during direct laryngoscopy. All anatomical sites of the larynx and trachea were assessed using the Dikkers scale and Derkay total site scoring system with WL and NBI. The consensus was reached as to the number of lesions seen in WL compared to NBI. RESULTS During 36 microlaryngoscopies, the number of papillomas detected in the larynx (by Derkay total site score) differed significantly between white light endoscopy and NBI (Wilcoxon test p = 0.000655). In endoscopy with NBI, a mean of 1.3 more papillomas in Derkay total site score was detected in comparison to white light endoscopy NBI showed additional areas of diseased tissue in 15/36 (41.67%) patients. CONCLUSIONS NBI as an additional tool during microlaryngoscopy can improve the detection of papillomatous lesions.
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Affiliation(s)
- J. Jackowska
- Department of Otolaryngology, Head and Neck Surgery, Poznań University of Medical Sciences, Poznań, Poland
| | - H. Klimza
- Department of Otolaryngology, Head and Neck Surgery, Poznań University of Medical Sciences, Poznań, Poland
- * E-mail:
| | - P. Winiarski
- Department of Otolaryngology, Otolaryngological Oncology and Maxillofacial Surgery, Uniwersytet Mikolaja Kopernika Collegium Medicum, Bydgoszcz, Poland
| | - K. Piersiala
- Student Research Group at the Department of Otolaryngology, Head and Neck Surgery, Poznań University of Medical Sciences, Poznań, Poland
| | - M. Wierzbicka
- Department of Otolaryngology, Head and Neck Surgery, Poznań University of Medical Sciences, Poznań, Poland
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26
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Staníková L, Walderová R, Jančatová D, Formánek M, Zeleník K, Komínek P. Comparison of narrow band imaging and the Storz Professional Image Enhancement System for detection of laryngeal and hypopharyngeal pathologies. Eur Arch Otorhinolaryngol 2018; 275:1819-1825. [PMID: 29713886 DOI: 10.1007/s00405-018-4987-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 04/26/2018] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The aim of this study was to compare narrow band imaging (NBI) endoscopy and Storz Professional Image Enhancement System (SPIES) in observing epithelial and/or subepithelial microvascular irregularities and pathologies. METHODS A total of 73 patients with laryngeal or hypopharyngeal lesions were investigated using high-definition NBI endoscopy preoperatively in local anesthesia and using SPIES system intraoperatively in general anesthesia from August 2016 to October 2017. Superficial vascular structures were classified preoperatively (NBI) and intraoperatively (SPIES) according to descriptive guidelines of vascular changes by Arens. All lesions were endoscopically evaluated and divided according to the histological examination into four groups (A-benign lesions, B-recurrent respiratory papillomatosis, C-low-grade dysplasia, D-high-grade dysplasia, carcinoma in situ or invasive squamous cell carcinoma), and results were compared with NBI and SPIES optical biopsy. RESULTS Benign lesions (polyps, cysts, chronic inflammation, hyperkeratosis) were histologically confirmed in 26/73 (35.6%) cases and identified by NBI in 20/26 lesions (76.9%) and in 20/26 cases (76.9%) by SPIES, respectively. Recurrent respiratory papillomatosis was confirmed in 16/73 (21.9%) and detected in 15/16 cases (93.8%) by NBI and in 16/16 cases (100.0%) by SPIES. Low-grade dysplasia (mild and moderate dysplasia) was histologically detected in 7/73 patients (9.6%) and accurately identified by NBI in 6/7 (85.7%) and by SPIES in 6/7 (85.7%) cases, respectively. Histopathological features of severe dysplasia, carcinoma in situ or invasive squamous cell carcinoma were detected in 24/73 (32.9%) patients. According to the NBI endoscopy the suspected vascular neoangiogenesis was recognized in 19/24 cases (79.2%) and in 18/24 cases (75.0%) using SPIES endoscopy. Sensitivity and specificity of NBI endoscopy and SPIES system in correct prediction of histological diagnosis of already detected lesions were 83.0 and 98.0% and 86.0 and 96.0%, respectively. Results of NBI/SPIES endoscopy and histopathological features of laryngeal and hypopharyngeal lesions were compared and the level of agreement was 81.43%, kappa index κ = 0.7428 (95% CI 0.682-0.832) (p < 0.001) by NBI endoscopy and 81.16%, kappa index κ = 0.7379 (95% CI 0.638-0.880) (p < 0.001) by SPIES endoscopy, respectively. The agreement was confirmed as substantial and strong. Level of agreement of both endoscopic methods was 92.54%, kappa index κ = 0.8965 (95% CI 0.877-0.954) (p < 0.001), agreement was confirmed as almost perfect. Between NBI and SPIES endoscopic imaging methods is no significant differentiation. CONCLUSION Both methods, NBI endoscopy and SPIES system, are comparable in detection and analysis of superficial neoangiogenesis, typical for benign lesion and for precancerous or cancerous changes in larynx and hypopharynx.
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Affiliation(s)
- L Staníková
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, 17. listopadu 1790, 708 52, Ostrava, Czech Republic.,Department of Craniofacial Surgery, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - R Walderová
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, 17. listopadu 1790, 708 52, Ostrava, Czech Republic
| | - D Jančatová
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, 17. listopadu 1790, 708 52, Ostrava, Czech Republic.,Department of Craniofacial Surgery, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - M Formánek
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, 17. listopadu 1790, 708 52, Ostrava, Czech Republic.,Department of Craniofacial Surgery, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - K Zeleník
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, 17. listopadu 1790, 708 52, Ostrava, Czech Republic.,Department of Craniofacial Surgery, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Pavel Komínek
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, 17. listopadu 1790, 708 52, Ostrava, Czech Republic. .,Department of Craniofacial Surgery, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic.
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Valls-Mateus M, Nogués-Sabaté A, Blanch JL, Bernal-Sprekelsen M, Avilés-Jurado FX, Vilaseca I. Narrow band imaging for head and neck malignancies: Lessons learned from mistakes. Head Neck 2018; 40:1164-1173. [PMID: 29385299 DOI: 10.1002/hed.25088] [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: 04/27/2017] [Revised: 09/17/2017] [Accepted: 12/20/2017] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND The accuracy of white light endoscopy in combination with narrow band imaging (WLE + NBI) for diagnosis of squamous cell carcinoma (SCC) does not reach 100%. We evaluated the characteristics of the false-negative and false-positive cases. METHODS Five hundred thirty lesions of the upper airways were evaluated. The WLE was followed by NBI examination before performing a biopsy. RESULTS The false-negative lesions (7.36%) were represented by submucosal and non-SCC tumors. Among the 25 non-SCC tumors, 72% did not show any suspicious vascular pattern under NBI. The false-positive lesions (6.04%) were mainly represented by postradiotherapy mucosal changes, ulcers, and infections. Regarding papillomas, NBI accuracy reached 95.32%, although cases with dysplasia were difficult to distinguish from SCC. CONCLUSION The WLE + NBI improved diagnostic accuracy, but not all lesions were ideally evaluated with current defined patterns. An accurate anamnesis is mandatory, because, in some cases, it may be more relevant than the NBI pattern.
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Affiliation(s)
- Meritxell Valls-Mateus
- Department of Otolaryngology, Hospital Clínic, Barcelona, Spain.,Ear, Nose, and Throat Surgical Oncology Section, Hospital Clínic, Barcelona, Spain
| | | | - Jose Luis Blanch
- Department of Otolaryngology, Hospital Clínic, Barcelona, Spain.,Ear, Nose, and Throat Surgical Oncology Section, Hospital Clínic, Barcelona, Spain
| | - Manuel Bernal-Sprekelsen
- Department of Otolaryngology, Hospital Clínic, Barcelona, Spain.,Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | | | - Isabel Vilaseca
- Department of Otolaryngology, Hospital Clínic, Barcelona, Spain.,Ear, Nose, and Throat Surgical Oncology Section, Hospital Clínic, Barcelona, Spain.,Faculty of Medicine, University of Barcelona, Barcelona, Spain
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28
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Moccia S, De Momi E, Guarnaschelli M, Savazzi M, Laborai A, Guastini L, Peretti G, Mattos LS. Confident texture-based laryngeal tissue classification for early stage diagnosis support. J Med Imaging (Bellingham) 2017; 4:034502. [PMID: 28983494 DOI: 10.1117/1.jmi.4.3.034502] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 09/12/2017] [Indexed: 12/24/2022] Open
Abstract
Early stage diagnosis of laryngeal squamous cell carcinoma (SCC) is of primary importance for lowering patient mortality or after treatment morbidity. Despite the challenges in diagnosis reported in the clinical literature, few efforts have been invested in computer-assisted diagnosis. The objective of this paper is to investigate the use of texture-based machine-learning algorithms for early stage cancerous laryngeal tissue classification. To estimate the classification reliability, a measure of confidence is also exploited. From the endoscopic videos of 33 patients affected by SCC, a well-balanced dataset of 1320 patches, relative to four laryngeal tissue classes, was extracted. With the best performing feature, the achieved median classification recall was 93% [interquartile range [Formula: see text]]. When excluding low-confidence patches, the achieved median recall was increased to 98% ([Formula: see text]), proving the high reliability of the proposed approach. This research represents an important advancement in the state-of-the-art computer-assisted laryngeal diagnosis, and the results are a promising step toward a helpful endoscope-integrated processing system to support early stage diagnosis.
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Affiliation(s)
- Sara Moccia
- Politecnico di Milano, Department of Electronics, Information, and Bioengineering, Milan, Italy.,Istituto Italiano di Tecnologia, Department of Advanced Robotics, Genoa, Italy
| | - Elena De Momi
- Politecnico di Milano, Department of Electronics, Information, and Bioengineering, Milan, Italy
| | - Marco Guarnaschelli
- Politecnico di Milano, Department of Electronics, Information, and Bioengineering, Milan, Italy
| | - Matteo Savazzi
- Politecnico di Milano, Department of Electronics, Information, and Bioengineering, Milan, Italy
| | - Andrea Laborai
- University of Genoa, Department of Otorhinolaryngology, Head, and Neck Surgery, Genoa, Italy
| | - Luca Guastini
- University of Genoa, Department of Otorhinolaryngology, Head, and Neck Surgery, Genoa, Italy
| | - Giorgio Peretti
- University of Genoa, Department of Otorhinolaryngology, Head, and Neck Surgery, Genoa, Italy
| | - Leonardo S Mattos
- Istituto Italiano di Tecnologia, Department of Advanced Robotics, Genoa, Italy
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29
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Huang F, Yu J, Zhang F, He C, Li S, Shao J. The usefulness of narrow-band imaging for the diagnosis and treatment of vocal fold leukoplakia. Acta Otolaryngol 2017; 137:1002-1006. [PMID: 28503988 DOI: 10.1080/00016489.2017.1324216] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE This research was aimed to explore the efficacy of narrow-band imaging (NBI) on distinguishing the degree of dysplasia of vocal fold leukoplakia. METHODS Patients were examined by flexible endoscopy, under white light endoscopy (WLE) and NBI. 78 lesions were divided into two groups according to the NBI classification. Group 1: non-dysplasia (ND), including squamous hyperplasia with hyperkeratosis or parakeratosis; Group 2: squamous hyperplasia with mild or moderate dysplasia (MD) or severe dysplasia (SD), or carcinoma in situ (CIS). RESULTS The diagnostic accuracy of NBI for Group 1 and Group 2 was 69.70% (23/33) and 95.56% (43/45), respectively, and the kappa index was 0.711 and a p value < .05, which was considered statistically significant. CONCLUSIONS The NBI could roughly estimate the degree of dysplasia. Differentiating between ND, MD, SD, and CIS, which may be useful for clinicians on selecting suitable therapies.
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Affiliation(s)
- Fang Huang
- Department of Otorhinolaryngology Heck and Neck Surgery, Eye, Ear, Nose & Throat Hospital, Fudan University, Shanghai, PR China
| | - Jinchao Yu
- Department of Laser and Plastic Surgery, Eye, Ear, Nose & Throat Hospital, Fudan University, Shanghai, PR China
| | - Fan Zhang
- Department of Otorhinolaryngology Heck and Neck Surgery, Eye, Ear, Nose & Throat Hospital, Fudan University, Shanghai, PR China
| | - Changding He
- Department of Otorhinolaryngology Heck and Neck Surgery, Eye, Ear, Nose & Throat Hospital, Fudan University, Shanghai, PR China
| | - Shimin Li
- Department of Pathology, Eye, Ear, Nose & Throat Hospital, Fudan University, Shanghai, PR China
| | - Jun Shao
- Department of Otorhinolaryngology Heck and Neck Surgery, Eye, Ear, Nose & Throat Hospital, Fudan University, Shanghai, PR China
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30
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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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31
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Davaris N, Voigt-Zimmermann S, Roessner A, Arens C. [Narrow band imaging for evaluation of laryngeal mucosal lesions]. HNO 2017; 65:527-542. [PMID: 28484788 DOI: 10.1007/s00106-017-0336-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The use of narrow band imaging (NBI) and further technological achievements concerning the resolution and magnification of endoscopic images have revolutionized laryngology in the past 10 years. The diagnosis and therapy of dysplasia and early laryngeal carcinoma have become significantly easier. There are also clear benefits for benign laryngeal lesions. Central to these techniques is the assessment of epithelial, connective tissue and vascular changes caused by diverse diseases.
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Affiliation(s)
- N Davaris
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum A.ö.R., Otto-von-Guericke-Universität Magdeburg, Leipziger Straße 44, 39120, Magdeburg, Deutschland.
| | - S Voigt-Zimmermann
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum A.ö.R., Otto-von-Guericke-Universität Magdeburg, Leipziger Straße 44, 39120, Magdeburg, Deutschland
| | - A Roessner
- Institut für Pathologie, Universitätsklinikum A.ö.R., Otto-von-Guericke-Universität Magdeburg, Magdeburg, Deutschland
| | - C Arens
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum A.ö.R., Otto-von-Guericke-Universität Magdeburg, Leipziger Straße 44, 39120, Magdeburg, Deutschland
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32
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Arens C, Betz C, Kraft M, Voigt-Zimmermann S. Narrow band imaging for early diagnosis of epithelial dysplasia and microinvasive tumors in the upper aerodigestive tract. HNO 2016; 65:5-12. [DOI: 10.1007/s00106-016-0284-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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33
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Mannelli G, Cecconi L, Gallo O. Laryngeal preneoplastic lesions and cancer: challenging diagnosis. Qualitative literature review and meta-analysis. Crit Rev Oncol Hematol 2016; 106:64-90. [DOI: 10.1016/j.critrevonc.2016.07.004] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 06/04/2016] [Accepted: 07/11/2016] [Indexed: 11/27/2022] Open
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The role of narrow-band imaging (NBI) endoscopy in optical biopsy of vocal cord leukoplakia. Eur Arch Otorhinolaryngol 2016; 274:355-359. [PMID: 27515705 DOI: 10.1007/s00405-016-4244-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 08/02/2016] [Indexed: 01/02/2023]
Abstract
The aim of this study was to investigate whether observing microvascular changes by narrow-band imaging (NBI) endoscopy in the area surrounding leukoplakia is sufficient for discriminating between benign and malignant patterns of vocal cord leukoplakia. A total of 282 patients were investigated using white-light high-definition TV laryngoscopy and NBI endoscopy from 6/2013 to 8/2015, and 63 patients with a primary case of laryngeal leukoplakia were enrolled. Patients were divided into two groups based on leukoplakia with surrounding malignant intraepithelial papillary capillary loops (group I; 26/63) and leukoplakia with a surrounding benign vascular network (group II; 37/63), both by NBI endoscopy. All 63 patients were evaluated by blinded histological examination, and results were compared with NBI optical biopsy. Carcinoma in situ or invasive squamous cell carcinoma was confirmed in 22/26 cases (84.6 %) in group I. Hyperkeratosis or low-grade dysplasia was confirmed histologically in 31/37 (83.8 %) and squamous cell carcinoma in 2/37 (5.4 %) cases in group II. Accordance of NBI endoscopy and histopathological features of vocal cord leukoplakia lesions was statistically significant (kappa index 0.77, p < 0.001), with a sensitivity of 88.0 % (95 % CI 67.8-97.5 %) and specificity of 89.5 % (95 % CI 71.2-97.1 %). NBI is convenient for improving evaluation of laryngeal leukoplakias based on optic prehistological diagnosis. The close accordance between NBI features and histological results suggests that a negative NBI endoscopy may be an indication for long-term endoscopy follow-up without histological evaluation.
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35
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Arens C, Betz C, Kraft M, Voigt-Zimmermann S. [Narrow band imaging for early diagnosis of epithelial dysplasias and microinvasive tumors in the upper aerodigestive tract]. HNO 2015; 64:19-26. [PMID: 26677856 DOI: 10.1007/s00106-015-0108-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The various stages of tumor growth are characterized by typical epithelial, vascular, and secondary connective tissue changes. Narrow band imaging (NBI) endoscopy is a minimally invasive imaging technique that presents vascular structures in particular at a higher contrast than white light endoscopy alone. In combination with high-resolution image recording and reproduction (high-definition television, HDTV; ultra-high definition, 4K), progress has been made in otolaryngological differential diagnostics, both pre- and intraoperatively. This progress represents an important step towards a so-called optical biopsy. Flexible endoscopy in combination with NBI allows detailed assessment of areas of the upper aerodigestive tract which are difficult to assess by rigid endoscopy. Papillomas, precancerous, and cancerous lesions are characterized by epithelial and connective tissue changes, as well as by typical perpendicular vascular changes. Systematic use of NBI is recommended in the differential diagnosis of malignant lesions of the upper aerodigestive tract. NBI also convinces by a significant improvement in pre- and intraoperative assessment of superficial resection margins. In particular, the combination of NBI and contact endoscopy (compact endoscopy) permits excellent therapeutic decisions during tumor surgery. Intraoperative determination of resection margins at unprecedented precision is possible. In addition, assessment of the form and extent of the perpendicular vessel loops stimulated by epithelial signaling enables differential diagnostic decisions to be made, approximating our goal of an optical biopsy.
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Affiliation(s)
- C Arens
- Universitätsklinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Magdeburg A. ö .R., Otto-von-Guericke-Universität Magdeburg, Leipziger Straße 44, 39120, Magdeburg, Deutschland.
| | - C Betz
- Klinik und Poliklinik für Hals-, Nasen-, Ohrenheilkunde, Klinikum Großhadern, Ludwig-Maximilian-Universität, München, Deutschland
| | - M Kraft
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Hals- und Gesichtschirurgie, Kantonsspital Baselland, Liestal, Schweiz
| | - S Voigt-Zimmermann
- Universitätsklinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Magdeburg A. ö .R., Otto-von-Guericke-Universität Magdeburg, Leipziger Straße 44, 39120, Magdeburg, Deutschland
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36
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Arens C, Piazza C, Andrea M, Dikkers FG, Tjon Pian Gi REA, Voigt-Zimmermann S, Peretti G. Proposal for a descriptive guideline of vascular changes in lesions of the vocal folds by the committee on endoscopic laryngeal imaging of the European Laryngological Society. Eur Arch Otorhinolaryngol 2015; 273:1207-14. [PMID: 26677852 DOI: 10.1007/s00405-015-3851-y] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Accepted: 12/07/2015] [Indexed: 10/22/2022]
Abstract
In the last decades new endoscopic tools have been developed to improve the diagnostic work-up of vocal fold lesions in addition to normal laryngoscopy, i.e., contact endoscopy, autofluorescence, narrow band imaging and others. Better contrasted and high definition images offer more details of the epithelial and superficial vascular structure of the vocal folds. Following these developments, particular vascular patterns come into focus during laryngoscopy. The present work aims at a systematic pathogenic description of superficial vascular changes of the vocal folds. Additionally, new nomenclature on vascular lesions of the vocal folds will be presented to harmonize the different terms in the literature. Superficial vascular changes can be divided into longitudinal and perpendicular. Unlike longitudinal vascular lesions, e.g., ectasia, meander and change of direction, perpendicular vascular lesions are characterized by different types of vascular loops. They are primarily observed in recurrent respiratory papillomatosis, and in pre-cancerous and cancerous lesions of the vocal folds. These vascular characteristics play a significant role in the differential diagnosis. Among different parameters, e.g., epithelial changes, increase of volume, stiffness of the vocal fold, vascular lesions play an increasing role in the diagnosis of pre- and cancerous lesions.
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Affiliation(s)
- Christoph Arens
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital, Otto-von-Guericke-University of Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany.
| | - Cesare Piazza
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Mario Andrea
- Faculty of Medicine, University of Lisboa, Lisbon, Portugal
| | - Frederik G Dikkers
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Robin E A Tjon Pian Gi
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Susanne Voigt-Zimmermann
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital, Otto-von-Guericke-University of Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany
| | - Giorgio Peretti
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Genoa, Genoa, Italy
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