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

Abstract

Objectives: The Ni classification of vascular change from 2011 is well documented for evaluating pharyngeal and laryngeal lesions, primarily focusing on cancer. In the planning of surgery it may be more relevant to differentiate neoplasia from non-neoplasia. We aimed to evaluate the ability of the Ni classification to predict laryngeal or hypopharyngeal neoplasia and to investigate if a changed cutoff value would support the recent European Laryngological Society (ELS) proposal of perpendicular vascular changes as indicative of neoplasia.Data Sources: PubMed, Embase, Cochrane, and Scopus databases. Review Methods: A systematic review and meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. We systematically searched for publications from 2011 until 2016. All retrieved studies were reviewed and qualitatively assessed. The pooled sensitivity and specificity of the Ni classification with two different cutoffs were calculated, and bubble and summary receiver operating characteristics plots were created.Results: The combined sensitivity of five studies (n 5 687) with Ni type IV-V defined as test-positive was 0.89 (95% confidence interval [CI]: 0.76-0.95), and specificity was 0.82 (95% CI: 0.72-0.89). The equivalent combined sensitivity of four studies (n 5 624) with Ni type V defined as test-positive was 0.82 (95% CI: 0.75-0.87), and specificity was 0.93 (95% CI: 0.82-0.97).Conclusions: The diagnostic accuracy of the Ni classification in predicting neoplasia was high, without significant difference between the two analyzed cutoff values. Implementation of the proposed ELS classification of vascular changes seems reasonable from a clinical perspective, with comparable accuracy. Attention must be drawn to the accompanying risk of exposing patients to unnecessary surgery.

Diagnosis of vocal cord leukoplakia: The role of a novel narrow band imaging endoscopic classification

“…The present diagnosis and classification using the NBI laryngoscope worldwide basically depends on the Ni classification. Meta‐analysis showed that the overall sensitivity of the laryngeal cancer diagnosis based on type V was 0.82 (95% confidence interval [CI]: 0.75–0.87) and the specificity was 0.93 (95% CI: 0.82–0.97) …”

Prediction of the depth of invasion in superficial pharyngeal cancer: Microvessel morphological evaluation with narrowband imaging

“…There are other methods of microvessel morphological evaluation, aside from the JES classification. The Ni classification of vascular change, proposed in 2011, is probably one of the most well‐documented systems . The Ni classification aims to diagnose early HNSCCs based on microvessel morphological evaluation; however, the literature does not clarify whether the correspondence of the vessel type of Ni classification and the depth of tumor invasion was evaluated in precise.…”

“…The Ni classification of vascular change, proposed in 2011, is probably one of the most well-documented systems. [20][21][22] The Ni classification aims to diagnose early HNSCCs based on microvessel morphological evaluation; however, the literature does not clarify whether the correspondence of the vessel type of Ni classification and the depth of tumor invasion was evaluated in precise. To our knowledge, the types Va and Vb vessels of the Ni classification apparently correspond with the B1 and B2 vessels of the JES classification, respectively.…”

Evaluation of Vascular Patterns Using Contact Endoscopy and Narrow-Band Imaging (CE-NBI) for the Diagnosis of Vocal Fold Malignancy

“…The evaluation of superficial vascular patterns of the vocal folds has emerged in the last years as an important element in the diagnostic workup of vocal fold lesions, in addition to the evaluation of the mucosal surface or volume changes using conventional WLE and the evaluation of vibratory patterns using stroboscopy and high-speed imaging [15]. Modern image-enhancing technologies, such as NBI, SPIES, or i-SCAN, and the technical evolution of endoscopes, which nowadays enable a high image resolution up to 4K, allow a detailed description of minute mucosal and vascular changes [7]. As a result, nonspecific termini such as erythroplakia should be replaced through more precise descriptions of mucosal and vascular patterns [6], leading to increases in the accuracy and reproducibility of endoscopic diagnostics in preoperative and intraoperative settings [3,[16][17][18].…”

“…Changes in the morphology and three-dimensional spread of vocal fold vessels result from various functional, mechanical, or neoplastic stimuli and have been associated with the development of benign or malignant laryngeal pathologies, such as recurrent respiratory papillomatosis or laryngeal carcinoma [1][2][3]. Several classification systems have been proposed to describe and categorize subepithelial and epithelial vascular changes, while different image-enhancing technologies (electronic chromoendoscopy), such as narrow-band imaging (NBI), Storz professional image enhancement system (SPIES), or i-SCAN, have been used to ease their detection [4][5][6][7].…”