Flexible hysteroscopy with narrow band imaging (NBI) for endoscopic diagnosis of malignant endometrial lesions

Abstract

Abstract. Narrow band imaging (NBI) for detection of blood vessels and microstructures on the mucosal surface is used in gastrointestinal endoscopy since it can improve qualitative diagnosis and detection of lesion. However, there are no studies on flexible hysteroscopy using NBI. We performed flexible hysteroscopy with NBI for outpatients to investigate the sensitivity and specificity of endoscopic diagnosis of malignant endometrial lesions. Of patients who attended our hospital for suspected lesions in the uterine cavity between April 2009 and May 2010, 104 subjects underwent hysteroscopy with NBI, in addition to white light. Using the pathological diagnosis as the gold-standard, we evaluated the sensitivity and specificity of NBI hysteroscopy for detecting atypical endometrial hyperplasia (AEH) or carcinoma. The results were also compared with historical data (n=209) for conventional hysteroscopy using white light only in 2008. The sensitivities were 97.2% [95% confidence interval (95% CI): 90.3-99.7%] and 82.6% (95% CI: 74.4-89.0%) for NBI hysteroscopy and conventional hysteroscopy, respectively. The 95% CIs for the two methods did not overlap and the sensitivity of lesion detection was higher with NBI hysteroscopy. Specificities were comparable, 90.6% (95% CI: 75.0-98.0%) and between the methods. NBI hysteroscopy has increased sensitivity for detection of atypical endometrial hyperplasia (AEH) or carcinoma. A comparison with historical data suggested that NBI may be useful for diagnosis of malignant endometrial lesions. As far as we are aware, this is the first evaluation of flexible hysteroscopy with NBI for diagnosis of malignant endometrial lesions.

Improving tissue characterization, differentiation and diagnosis in gynecology with the narrow‑band imaging technique: A systematic review

“…Increased sensitivity of NBI vs. WL for the detection of atypical endometrial hyperplasia - high-risk hyperplasia (HRH) was reported in five studies ( 10 , 20-23 ). The reported sensitivity of NBI vs. WL for HRH was 60 vs. 20%, P<0.005( 36 ), 78.38 vs. 64.86%, P<0.005( 20 ), 78.6 vs. 63.7%, P<0.001( 23 ), 93.5 vs. 82.6%, P=0.006( 24 ) and 97.2 vs. 82.6%, P<0.005( 21 ).…”

“…2 . The years with the highest frequency of publications were 2010 and 2011 with 5 studies produced each year and the country which produced the highest number of studies was Japan with 11 studies ( 13 , 18 , 21 , 22 , 28 , 31-33 , 35 ), followed by Italy with 8 studies ( 9 , 10 , 15-17 , 19 , 20 , 36 ).…”

“…The median age of the patients was 45.5±10.5 years. A total of four studies were performed in outpatient office settings using a vaginoscopic approach without any general anesthesia ( 19 , 21 , 23 , 36 ). Conventional hysteroscopy under general anesthesia was performed in seven studies ( 10 , 24 , 25 ).…”

“…The NBI system for image-enhanced endoscopy was first conceived and developed in May 1999 and the product was launched by Olympus Corporation in May 2006( 21 ).…”

Single‑incision surgery for gynecomastia using TriPort: A case report

“…Surgical excision remains one of the most effective methods for gynecomastia management, particularly in patients with fibrosis or with a disease course of >1 year ( 7 ). Previously, minimally invasive techniques, including power-assisted and ultrasound-assisted liposuction, have been a popular approach due to their satisfactory cosmetic outcome ( 12 – 15 ). However, interest is now focused on minimally invasive surgery to minimize external scars ( 14 ).…”