Narrow band imaging in transoral laser microsurgery (TLM) in moderately advanced (T2, T3) glottic cancer

Abstract

Introduction: Treatment planning in T2, T3 laryngeal carcinoma is based on clinical assessment and radiological imaging. However, to delineate precise mucosal margins for transoral laser microsurgery (TLM), a high class, sophisticated endoscopy is indispensable. Narrowband imaging (NBI) which is an optical filter technology, seems to be a useful adjunctive tool in marking superficial margins. Materials and Methods: A total of 98 patients diagnosed with HNSCC underwent cordectomies and were enrolled in the evaluation. T2 and T3 stage cancer were diagnosed in 90 and 8 patients, respectively. Intraoperatively, prior to the first laser shot, all anatomical sites were endoscopically evaluated by WL and NBI. Results: In 10/98 patients (10.2%), 10 samples were taken based only on NBI findings to guarantee better delineation of superficial margins. The result of histology revealed moderate dysplasia in 4 cases (40%), severe dysplasia in 2 (20%), carcinoma in situ in 3 (30%) and hyperkeratosis in 1 (10%). Based on presented results, combined NBI/WL endoscopy reached the sensitivity of 100%, specificity 98.88%, positive predictive value 90%, negative predictive value 100% and accuracy 98.98%. All patients had clear margins according to definitive histology results. Discussion: In this paper, we aimed to assess the usefulness of NBI in intraoperative imaging of laryngeal mucosa and delineation of superficial margins in patients with selected T2 and T3 laryngeal cancer treated with TLM. We proved in our study that with the support of NBI endoscopy, it is possible to increase the accuracy of superficial resection margins in patients with moderately advanced laryngeal cancer (T2, T3).

The Prognostic Value of Adding Narrow‐Band Imaging in Transoral Laser Microsurgery for Early Glottic Cancer: A Review

“…Piersiala et al in a sample of 98 patients reported that the intraoperative use of WL and NBI provided negative margins in all patients; however the use of NBI allowed identification of lesions invisible in WL in 10 patients (10.2%) that required further samples.…”

“…Among these, five primary research papers met the minimum eligibility criteria and were included in the systematic review. They included three retrospective studies , one descriptive study , and one prospective study . The main characteristics of the selected studies (type of study, length of follow‐up, and principal endpoint investigated) are summarized in Table .…”

“…The proposal of an additional treatment, such as a new laser resection and/or RT, should be carefully discussed; alternatively, the patient may be sent to a close follow-up program. Additional treatments may cause some disadvantages such as the loss of other laryngeal tissue with Fiz et al [16] Piersialia et al [9] Plaat et al [11] Klimza et al [17] Total Total (%) consequent worsening of the quality of the voice [29]. Moreover, a complementary RT encompasses a multimodal therapeutic approach for early tumors that could have been managed by RT alone from the beginning [30].…”

“…NBI is a video endoscopic system with narrow band filters that allow for the passage of only two specific bands of the visible spectrum, corresponding to the absorption peak of hemoglobin. Thus, NBI increases the evaluation of the microvascular abnormalities associated with preneoplastic and neoplastic changes of the mucosa by improving the contrast of mucosal and submucosal vessel loops and cancer foci around the lesion invisible in White Light (WL) endoscopy, due to their isochromatic and flat‐shaped nature .…”

The usefulness of the narrow band imaging (NBI) in decision-making process regarding second look procedure (SL) in laryngeal cancer follow-up after transoral laser microsurgery

“…Definitions of surgical margins status in laryngeal cancer depend on the T stage of the primary tumour. Some experts distinguish ultra negative margins defined as >1 mm in T1 glottic cancer [10,11] and >3 mm in T2-T3 glottic cancer [10]. In our paper, we decided to unify margins definition criteria for the whole group.…”