Narrow band imaging for early diagnosis of epithelial dysplasia and microinvasive tumors in the upper aerodigestive tract

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 toward a so-called optical biopsy. Flexible endoscopy in combination with NBI allows for a detailed assessment of areas of the upper aerodigestive tract that are difficult to assess by rigid endoscopy. Papillomas along with 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 offers a significant improvement in the pre- and intraoperative assessment of superficial resection margins. In particular, the combination of NBI and contact endoscopy (compact endoscopy) facilitates excellent therapeutic decisions during tumor surgery. Intraoperative determination of resection margins at an 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.

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

“…In Figure , three type III lesions are presented, with histopathological diagnoses ranging from hyperplasia to high‐grade dysplasia. The difference between benign and malignant type III lesions is a thin, transparent white layer with a symmetrical border in benign lesions vs a more irregular leukoplakia regarding both border and thickness when the epithelium becomes dysplastic, as described by Arens et al …”

“…To adequately distinguish between cancer and papillomas, IPCLs must be evaluated, but several typical clinical characteristics must also be taken into account . Unlike in malignant lesions, IPCLs in papillomas are often symmetrical . Papillomas present with a typical shimmering, pale, wart‐like appearance, with a central vessel in each papilla, often on multiple locations in one patient .…”

“…Unlike in malignant lesions, IPCLs in papillomas are often symmetrical . Papillomas present with a typical shimmering, pale, wart‐like appearance, with a central vessel in each papilla, often on multiple locations in one patient . Leukoplakia, ulceration and a rough surface are uncommon in papillomas …”

Can the Ni classification of vessels predict neoplasia? A systematic review and meta‐analysis

“…The use of NBI in head and neck oncology was first described by Muto et al in 2004 . Since then, numerous reports have recommended pre‐ and intraoperative visualization of the vascular pattern in premalignant and malignant lesions, as well as in the follow‐up after surgery or radiotherapy …”

Preliminary experience with 4K ultra-high definition endoscope: analysis of pros and cons in skull base surgery

“…4K endoscope combined with NBI technology 4 has in our opinion the potential to start a revolution in skull base surgery, even if Akutsu used a flexible scope and standard HD monitor after removal of pituitary adenoma to check if there is still pathology in a series of 25 cases 5 .…”