Narrow‐band imaging pattern classification in oral cavity

Abstract

The proposed classification could serve as a guide for clinicians approaching narrowband imaging, especially at early stages of the learning curve, to differentiate normal mucosa from malignant lesions and possibly reduce the number of unnecessary biopsies.

Frozen sections and complete resection in oral cancer surgery

“…A second criticism of FS is the high costs and time needed. However, as described by Di Nardo et al, an intelligent use is mandatory (Di Nardo et al, ): in our operating room, we start the operation with an NBI‐guided tattoo (Tirelli, Marcuzzo, et al, ) followed by tumour removal and FS sampling, and then, while waiting for the response (40–60 min depending on the number), we perform neck dissection so as not to waste time; moreover, we continuously work together with the pathologist to minimise sampling and reading errors.…”

“…In the recent literature, two different approaches to help the surgeon reduce the rate of positive margins have been proposed and validated: narrow‐band imaging (NBI) and piecemeal resection. By enhancing mucosal and submucosal vessels and the vascular pattern alterations indicative of malignant transformation (Tirelli, Marcuzzo, & Boscolo Nata, ), intraoperative NBI reduces the rate of positive superficial margins (Tirelli, Marcuzzo, et al, ; Tirelli et al, ; Tirelli, Piovesana, Gatto, Torelli, & Boscolo Nata, ; Tirelli, Piovesana, et al, ). On the other hand, piecemeal resection, introduced to allow laryngeal tumour removal through the small diameter of laryngoscopes (Steiner & Ambrosch, ), has been used in TOS for oropharyngeal (Hinni, Zarka, & Hoxworth, ) and oral cancer (Choi et al, ; Tirelli, Piovesana, et al, ) because it allows one to identify the transition from cancer to healthy tissue thereby improving deep margin control.…”

Oral lichen planus and other confounding factors in narrow band imaging (NBI) during routine inspection of oral cavity for early detection of oral squamous cell carcinoma: a retrospective pilot study

“…In a recent systematic review [10], the four pattern system [2] is considered the most effective in oral cavity, being the all types: type I (physiological arborization of IPCL), type II (circuitous or dilated IPCL), type III (convoluted/winding and/or elongated IPCL) and type IV (complete loss of organization/annihilation of IPCL). A more recent classification has been proposed for oral cavity [11], but it cannot be taken into account as the authors do not show any statistical analysis to corroborate their results. Data from the literature have shown that oral lesions with NBI pattern III and IV have increased chances of anatomopathological diagnosis of High Grade Dysplasia (HGD), oral SCC (OSCC) and OSCC in situ (Cis), when compared to those with the NBI pattern I and II [10, 12, 13].…”

“…Despite these excellent results, routine clinical use in the inspection of oral cavity may present some difficulties. Many studies often exclude Oral Potentially Malignant Disorders (OPMDs), as they are considered confounding factors [9], especially in case of patients with Oral Lichen Planus (OLP) [9–11] due to the dishomogeneous/ulcerated aspect of the lesions and the correlation with high-grade NBI patterns. The site of the lesion is sometimes considered as bias too, due to different types of epithelium found in oral cavity; usually, epithelium of the oral cavity is classified into four categories, namely: lining epithelium (non-keratinized; e.g.…”

“…It has been hypothesized that thicker (e.g. : tongue and masticatory) types of epithelium may obstruct IPCL visualization in the submucosa, but literature is not concordant on this aspect [10, 11]. Furthermore, history of head & neck radiotherapy has been investigated to understand a possible alteration of NBI visualization of the larynx/pharynx [17], but there are no data about oral cavity; the same happens for smoking habits.…”