The role of Narrow Band Imaging (NBI) in the diagnosis of sinonasal diseases

Enhanced Detection of Sinonasal and Nasopharyngeal Pathologies by Narrow-Band Imaging- a Prospective Observational Study

Narrow-band imaging (NBI) is an advanced endoscopic technique that uses filtered light to enhance the visualization of microvascular patterns, which can aid in identifying preneoplastic and cancerous lesions in the upper aerodigestive tract. While conventional fiber optic endoscopy under white light (WL) is essential for examining the sinonasal region, NBI offers a unique advantage by focusing on the vascular patterns rather than the lesions themselves. Literature on NBI's diagnostic applications, especially for distinguishing normal from pathological nasal mucosa, remains sparse. This study aims to classify sinonasal lesions based on the Bruno et al. classification system and evaluate the microvascular features of various pathologies under NBI, comparing these findings with histopathological results. A prospective observational study was conducted in a tertiary care setting enrolling 60 patients presenting with endoscopically identified sinonasal and nasopharyngeal lesions requiring biopsy. All patients were subjected to narrow-band imaging, followed by biopsy. Microvascular changes in the mucosa were classified using the Bruno et al. system, and were then compared against blinded histopathology results. Among the 60 patients, 50 exhibited NBI patterns classified as SN 1, 2, 3, or 4 (considered unsuspicious), while 10 displayed the SN 5 pattern (suspicious). Of the lesions categorized as suspicious, 9 were confirmed malignant through biopsy, while 1 was negative for malignancy. Using HPE as the gold standard, NBI demonstrated 88.8% sensitivity and 96% specificity in identifying malignancy with a PPV of 80%, NPV of 98% and diagnostic accuracy of 95%. Narrow-band imaging (NBI) proves to be an effective tool for distinguishing between benign and malignant sinonasal pathologies. Our study contributes valuable insights to the limited literature on the application of NBI technology in nasal pathologies.

Extracapsular Dissection With Narrow-Band Imaging Using the Transnasal Endoscopic Tri-port Approach for Extracranial Trigeminal Schwannoma: A Case Report

The pterygopalatine fossa and infratemporal fossa are often approached through an external incision because of their deep facial location, but this can present problems such as facial scarring and deformity. In schwannoma surgery, intraneural dissection is a useful surgical technique for achieving gross total resection while preserving the capsule, including the nerves. For appropriate enucleation and preservation of the functional nerve, it is indispensable to distinguish between the pseudocapsule and the tumor capsule. This case report presents a case of endonasal surgical intervention for an extracranial trigeminal schwannoma employing the tri-port approach and narrow-band imaging.

Diagnostic therapeutic assistance pathway (PDTA) of type 2 chronic rhinosinusitis

Chronic rhinosinusitis (CRS) is a complex and heterogeneous disorder whose etiopathogenetic picture is not yet completely known and is classically divided into CRS with (CRSwNP) and without nasal polyps (CRSsNP). But today the distinction is made with type 2 and nontype 2 variants. A rational and defined pathway for the diagnosis of chronic rhinosinusitis is an indispensable means to be able to arrive at a correct identification of the patient. This typing is essential to be able to arrive at the correct course of treatment, which turns out to be different for different types of patients. For this reason, the realization of a diagnostic therapeutic pathway represents a fundamental way for the otolaryngologist specialist but not only, since today diagnostics has a multidisciplinary framework. In the present work, precise indications have been developed to arrive at a correct diagnosis. The various diagnostic pathways and processes to arrive at a correct therapeutic framing have been highlighted. Therapy ranging from medical therapy to surgical therapy without neglecting the new biological therapies. It does not represent a guideline but a diagnostic method that can be adapted to all the various territorial realities.

Otoendoscopy in the era of narrow-band imaging: a pictorial review

PURPOSE

Otoendoscopy represents the initial non-invasive diagnostic cornerstone for external and middle ear disorders. Recently, new techniques of enhanced imaging such as narrow-band imaging (NBI) have been introduced but their role as a potential aid in otological practice remains unproven. In this pictorial review, we want to present the potential application of this endoscopic method, highlight its limitations, and give some hints regarding its future implementation.

METHODS

Representative cases of external and/or middle ear pathologies were selected to illustrate the role of NBI in this regard.

RESULTS

NBI may represent a useful aid in the otological work-up, in the differential diagnosis of ear tumor-like masses, and, possibly, in the prognosis of tympanic perforations. For other ear disorders, instead, this technique does not seem to add anything to the standard clinical practice.

CONCLUSIONS

NBI might prove useful in the assessment of selected external and middle ear disorders but its role must be prospectively validated.

Flexible endoscopy in the visualization of 3D-printed maxillary sinus and clinical application

Background

During postoperative follow-up, the visible range of maxillary sinus (MS) is limited, even combining 0° and 70° rigid endoscopes together. Flexible endoscope has been used in larynx examinations for a long time, but rarely in nasal cavity and sinus. We aimed to evaluate the application values of rigid and flexible endoscopes for visualization of MS.

Methods

We followed up 70 patients with lesions in MS via both rigid and flexible endoscopes. In addition, we used thin-slice CT image of the sinus to create a MS model and divided it into two parts for 3D printing. The inner surface of the 3D-printed sinus was marked with grid papers of the same size (5 mm × 5 mm), then the visual range under rigid endoscopes with different angle and flexible endoscopes was calculated and analyzed.

Results

In clinical follow-up, we found that flexible endoscopy can reach where rigid endoscopy cannot, which is more sensitive than medical imaging. Endoscopes showed the largest observation range of the posterolateral wall, more than half of which can be visualized by 0° endoscope. Almost all of the posterolateral wall can be revealed under 45° endoscope, 70° endoscope and flexible endoscope. The visual range of each wall under flexible endoscope is generally greater than that under rigid endoscopes, especially of the anterior wall, medial wall and inferior wall.

Conclusion

There was obviously overall advantage of using flexible endoscope in postoperative follow-up of MS lesions. Flexible endoscopy can expand the range of observation, and improve the early detection of the recurrent lesion. We recommend flexible endoscope as a routine application.

Graphical abstract

Supplementary Information

The online version contains supplementary material available at 10.1007/s00464-022-09410-8.

The Role of Elective Neck Treatment in the Management of Sinonasal Carcinomas: A Systematic Review of the Literature and a Meta-Analysis

The impact of elective neck treatment (ENT), whether by irradiation or dissection, on the prognosis of patients with cN0 sinonasal carcinomas (SNCs) remains an understudied issue. METHODS: A systematic review and meta-analysis of the literature were performed according to PRISMA guidelines in order to assess regional nodal relapse rate after ENT compared to observation in cN0 SNCs patients. Twenty-six articles for a total of 1178 clinically N0 patients were analyzed. Globally, the 5-year overall survival was 52%; 34.6% of patients underwent ENT and 140 regional recurrences were registered (5.9% in the ENT cohort and 15% in the observation group). ENT appears to confer a lower risk of regional recurrence compared to observation alone, with a cumulative OR of 0.38 (95% CI 0.25-0.58). Our meta-analysis supports the efficacy of ENT for reducing the risk of regional recurrence, but its overall impact on survival remains uncertain.