Clinical Appraisal of Endoscopy with Narrow-Band Imaging System in the Evaluation and Management of Homogeneous Oral Leukoplakia

Abstract

<i>Purpose:</i> To evaluate the clinical usefulness of endoscopy with a narrow-band imaging (NBI) system for the evaluation and management of homogeneous oral leukoplakia. <i>Methods:</i> The chart records, morphology of vascular architecture of NBI, and histopathology of patients with homogeneous leukoplakia were retrospectively reviewed and analyzed. <i>Results:</i> A total of 160 patients, with an average age of 50.96 ± 10.25 years, were enrolled. In 35 cases of thin leukoplakia, only intraepithelium papillary capillary loop (IPCL) type I was shown by NBI, and only squamous hyperplasia was revealed pathologically. In 125 cases of thick leukoplakia, IPCL type I was found in 94, IPCL type II in 29, and IPCL type III in 2. The Kendall rank correlation between pathology and NBI images was significant (p < 0.0001). <i>Conclusions:</i> The dichotomous classification of homogeneous leukoplakia by NBI is meaningful, and endoscopy with the NBI system is a promising tool for the evaluation and management of homogeneous oral leukoplakia.

Advances in Optical Adjunctive Aids for Visualisation and Detection of Oral Malignant and Potentially Malignant Lesions

“…Type IV IPCL pattern, however, is indicative of neoplasia [65] and is characterised by large vessels IPCL pattern destruction and angiogenesis (Figure 3) [61]. Any lesion with Types III and IV should therefore be biopsied [67], particularly since the use of Types III and IV as the criteria for differentiating high-grade dysplasia, CIS, and invasive carcinoma from normal mucosa has been shown to have 85% sensitivity, 95% specificity, 74% positive predictive value (PPV), 97% negative predictive value (NPV), and 93% accuracy (Table 3) [65]. …”

“…A study by Lin et al [70] found that areas with nonkeratinized thin stratified squamous epithelium had a significantly higher prevalence of brownish spots than areas with keratinized epithelium or epithelium thicker than 500  μ m. However, Yang et al [65] reported that the degree of keratinization did not affect visualisation of the underlying vasculature unless hyperkeratosis associated with leukoplakia was present. Visualisation of the microvasculature is possible through thin homogenous leukoplakia, but the vasculature will appear vague, blurry, or be completely obstructed where there is thick homogenous leukoplakia [67]. In the latter case, the IPCL pattern of the surrounding mucosa is often observed to guide the determination of the lesion's IPCL class; however, this is not completely reliable as one study [67] found dysplasia in 28% of thick homogenous leukoplakia surrounded by IPCL Type I.…”

“…Visualisation of the microvasculature is possible through thin homogenous leukoplakia, but the vasculature will appear vague, blurry, or be completely obstructed where there is thick homogenous leukoplakia [67]. In the latter case, the IPCL pattern of the surrounding mucosa is often observed to guide the determination of the lesion's IPCL class; however, this is not completely reliable as one study [67] found dysplasia in 28% of thick homogenous leukoplakia surrounded by IPCL Type I. Instead, the degree of hyperkeratinization may be indicative of the degree of dysplasia, as IPCL Type I was only found beneath thin homogenous leukoplakia, whereas Types II and III were observed around thick homogenous leukoplakia.…”

“…While applying a defined classification system is beneficial for interpreting IPCL patterns, it is still a subjective method and is not infallible as each class of IPCL pattern does not always correspond to a particular histopathological diagnosis [65]. Further complicating the matter is keratosis, which prevents clear visualisation of the underlying microvasculature [67]. Abnormal microvasculature patterns associated with chronic inflammation or vascular lesions can also act as confounders when using NBI [69].…”

Narrow‐band imaging in transoral laser surgery for early glottic cancer in relation to clinical outcome

“…NBI is an imaging technique that accentuates abnormalities in the superficial vasculature of mucosal lesions by using narrow‐bandwidth filters in a sequential red/green‐blue illumination system. NBI, which is used in both flexible and rigid endoscopes, is now established as an important tool in the detection of various head and neck tumors and is helpful in differentiating malignant from benign lesions . Since the first studies with NBI by Muto et al, the number of NBI studies in head and neck cancer has been growing rapidly.…”