Identifying epithelial borders in cholesteatoma surgery using narrow band imaging

Abstract

Purpose To quantify changes in the perceived epithelial border with narrow band imaging (NBI) and white light imaging (WLI) during cholesteatoma surgery and to objectify possible benefits of NBI in otology. Methods Perioperative digital endoscopic images were captured during combined approach tympanoplasty at our tertiary referral center using WLI and NBI (415 nm and 540 nm wavelengths). Sixteen otologic surgeon defined the epithelial borders within 16 identical WLI and NBI photos. Pixels of these selections were calculated to analyze the quantitative difference between WLI and NBI. A questionnaire also analyzed the qualitative differences. Results Sixteen otologic surgeons participated in the study. Stratified per photo, only two photos yielded a significant difference: less pixels were selected with NBI than WLI. A Bland–Altman plot showed no systemic error. Stratified per otologist, four participants selected significantly more pixels with WLI than with NBI. Overall, no significant difference between selected pixels was found. Sub-analyses of surgeons with more than 5 years of experience yielded no additional findings. Despite these results, 60% believed NBI could be advantageous in defining epithelial borders, of which 83% believed NBI could reduce the risk of residual disease. Conclusion There was no objective difference in the identification of epithelial borders with NBI compared to WLI in cholesteatoma surgery. Therefore, we do not expect the use of NBI to evidently decrease the risk of residual cholesteatoma. However, subjective assessment does suggest a possible benefit of lighting techniques in otology. Level of evidence 3.

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

“…In the otological field, a recent publication has shown how the use of the former system revealed a sensitivity of 97% and a specificity of 95% in the identification of residual cholesteatoma that was confirmed histologically [ 6 ]. Instead, in a small series of sixteen cases of cholesteatoma surgery, NBI demonstrated no objective difference in the definition of epithelial borders compared to WL [ 7 ]. The NBI technique has been extensively used in the diagnosis and differentiation of premalignant and malignant lesions of the mucosa of the upper aerodigestive tract [ 8 – 11 ]; more recently, our group has shown how NBI might be useful also in differentiating vascularized middle ear masses, such as paragangliomas or aural polyps [ 12 ].…”