The Role of Narrow Band Imaging in the Detection of Recurrent Laryngeal and Hypopharyngeal Cancer after Curative Radiotherapy

Abstract

Narrow band imaging is considered a significant improvement in the possibility of detecting early mucosal lesion of the upper aerodigestive tract. Early detection of mucosal neoplastic lesions is of utmost importance for patients survival. There is evidence that, especially in patients previously treated by means of curative radiotherapy or chemoradiotherapy, the early detection rate of recurrent disease is quite low. The aim of this study was to prove whether the videoendoscopy coupled with NBI might help detect recurrent or secondary tumors of the upper aerodigestive tract. 66 patients previously treated by means of RT or CRT with curative intent were enrolled in the study. All patients underwent transnasal flexible videoendoscopy with NBI mode under local anesthesia. When a suspicious lesion was identified in an ambulatory setting, its nature was proved histologically. Many of these changes were not identifiable by means of conventional white light (WL) endoscopy. The accuracy, sensitivity, specificity, and positive and negative predictive value of the method are very high (88%, 92%, 76%, 96%, and 91%, resp.). Results demonstrate that outpatient transnasal endoscopy with NBI is an excellent method for the follow-up of patients with carcinomas of the larynx and the hypopharynx primarily treated with radiotherapy.

Narrow band imaging versus laryngovideostroboscopy in precancerous and malignant vocal fold lesions

“…All published studies consider NBI to be a significant improvement in the early detection of malignancies within laryngeal mucosa . Additionally, evidence exists that NBI has high accuracy in the detection of recurrent disease after primary radiotherapy or chemoradiotherapy . Unfortunately, there are a few reported limitations of NBI visualization.…”

Usefulness of office examination with narrow band imaging for the diagnosis of head and neck squamous cell carcinoma and follow-up of premalignant lesions

“…The same study reported the role (value) of NBI in the postoperative surveillance for early detection of recurrences and metachronous tumors, with an overall gain of 9.2% when compared to standard WLE. Zabrodsky et al studied the results of transnasal endoscopy with NBI in the outpatient office for the follow‐up of 66 patients with laryngeal or hypopharyngeal carcinomas primarily treated with RT or chemoradiotherapy. Seventeen patients (25.7%) presented a tumor relapse.…”

Detection of high‐grade dysplasia, carcinoma in situ and squamous cell carcinoma in the upper aerodigestive tract: Recommendations for optimal use and interpretation of narrow‐band imaging

“…The reported sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) in studies that were not included in this meta‐analysis were 88.9%‐100%, 84.6%‐97.5%, 79%‐91.6% and 91.7%‐100%, respectively . Besides these promising results, problems in the interpretation have also been reported, especially in irradiated mucosa and in the differentiation between papilloma and carcinoma . Little is known about poor photograph quality due to incorrect NBI usage.…”

“…Recently, a systematic review of the diagnostic performance of NBI has appeared; a meta‐analysis of six studies revealed a pooled sensitivity of 94% and specificity of 89% of evaluations with NBI, compared to values of 81% and 92%, respectively, from white light endoscopy . The reported sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) in studies that were not included in this meta‐analysis were 88.9%‐100%, 84.6%‐97.5%, 79%‐91.6% and 91.7%‐100%, respectively . Besides these promising results, problems in the interpretation have also been reported, especially in irradiated mucosa and in the differentiation between papilloma and carcinoma .…”

“…Narrow‐band imaging (NBI) enhances visualisation of superficial mucosal vascular patterns, and it identifies intraepithelial papillary capillary loops (IPCLs), which are important determinants for the histopathological diagnosis . NBI is superior to conventional white light imaging (WLI), since it improves the detection rate of small superficial malignant lesions . The classification introduced by Ni (varying from I to Vabc) is commonly used to categorise vascular patterns of the larynx .…”