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

Abstract

Background The prognostic value of positive surgical margins after transoral laser microsurgery (TOLM) is still under debate. In case of positive superficial margins, some experts recommend a second-look surgery (SL) and some recommend wait and watch approach with close observation. Narrow band imaging (NBI) is an advanced imaging system used to enhance visualization of mucosal vascular pattern. In laryngology, NBI is used to improve the detection of premalignant, dysplastic and malignant lesions. Aim To assess the usefulness of NBI imaging in guiding clinical decision making regarding follow-up plan and SL after TOLM. Materials and methods A prospective cohort of 127 patients was divided into three groups based on the histology results and NBI vascular pattern of the mucosa. Group A (24/127, 18.90%) consisted of patients with suspicious vascular pattern in NBI or/and with positive deep margin. Group B (52/127, 40.94%) consisted of patients with positive or uncertain superficial margins and non-suspicious vascular pattern in NBI. Group C (51/127, 40.15%) had non-suspicious vascular NBI pattern and all negative margins. Results After the first TOLM procedure, 9/24 (37.5%) patients had positive deep margins, 1/24 (4.2%) had uncertain deep margin and 1/24 patient (4.2%) had both positive deep margin

Current Intraoperative Imaging Techniques to Improve Surgical Resection of Laryngeal Cancer: A Systematic Review

“…Distinct from intraoperative margin assessment, an interesting application for NBI is the follow-up of patients with early to moderate stage glottic cancer after curative treatment. Witkiewicz et al recently reported that NBI after TLM is a good predictor of margin positivity, supporting clinical decision-making regarding the need for second-look surgery [ 53 ]. NBI during outpatient transnasal endoscopy was found to be an excellent follow-up tool of laryngeal cancer patients after radiotherapy to screen for recurrent disease [ 54 ].…”

Accuracy of narrow‐band imaging for diagnosing malignant transformation of vocal cord leukoplakia: A systematic review and meta‐analysis

“…Comparison of the morphology of the mucosal epithelium and the microvascular morphology of epithelial cells can enable us to better observe and evaluate the morphology of intraepithelial papillary capillary loop (IPCL) and detect some lesions that are difficult to find under ordinary white light endoscopy; this provides a new approach for the early detection of lesions with different properties and different degrees. 7 , 8 In recent years, NBI endoscopy has been gradually used for diagnosing laryngopharyngeal lesions. 9 Therefore, we compared the diagnostic results of vocal cord lesions examined by NBI endoscopy‐based IPCL classification with those of vocal cord lesions examined by the reference standard pathological test.…”

The combination of brush cytology with the results of histopathological examination in laryngeal cancer diagnosis

“…HPV plays a significant role in the pathogenesis of cancer of the oral pharynx. In contrast, the impact of oncogenic HPV infections (16,18,31,33,35) on the cancer transformation process in laryngeal malignancies appears to be much smaller and not fully understood. It is estimated that viral DNA incidence ranges from 20% to 30%, but this percentage varies among researchers and depends on the detection method applied [9,10].…”

“…This procedure can be performed as a diagnostic and during endoscopic laser cordectomy, as it allows a more precise assessment of the status of surgical margins of early-stage and locally advanced laryngeal cancers [16,17]. Narrow band imaging is also a practical tool in laryngeal cancer follow-up after surgical procedures such as transoral laser microsurgery or radiotherapy [18]. This diagnostic process is not always sufficient; however, it can be supplemented with direct laryngoscopy using the collection of samples for histopathological examination, usually performed under general endotracheal anesthesia in operating room conditions.…”