NBI utility in the pre-operative and intra-operative assessment of oral cavity and oropharyngeal carcinoma

Tirelli, Gian Carlo; Piovesana, Marco; Gatto, Annalisa; Torelli, Lucio; Lenarda, Roberto Di; Nata, Francesca Boscolo

doi:10.1016/j.amjoto.2016.09.020

Cited by 23 publications

(35 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Several approaches have been proposed to enhance the traditional white-light macroscopic margins (MM) identification in OSCC. Among them, the Narrow Band Imaging (NBI) technology have shown good performance and is currently employed in several Centers [9, 10]. This augmented reality tool increases the contrast between the epithelial surface and the subjacent vascular network, allowing for the visualization of the mucosal and submucosal (micro) vascular patterns.…”

Section: Introductionmentioning

confidence: 99%

A novel integrated platform for the identification of surgical margins in oral squamous cell carcinoma: results from a prospective single-institution series

et al. 2019

View full text Add to dashboard Cite

Background The optimal surgical margins assessment is capital in oral squamous cell carcinoma (OSCC) management. We evaluated the clinical benefits of integrating intraoperative macroscopic margin (MM) assessment and narrow band imaging (NBI). Methods Sixteen OSCC patients eligible for surgery were prospectively enrolled. For each patient, 2 to 6 bioptic samples of MM and NBI margins were obtained and histologically analyzed for the presence of dysplasia and lymphocytes. Microvessel density was investigated by CD34 immunohistochemistry. Results Taken together, 104 specimens were analyzed, including 15% tumors, 33% MM, 33% NBI margins, and 19% MM-NBI overlapping margins. The NBI margins were closer to the lesion in 50% cases, while the same number of MM were more conservative than NBI, irrespective of the tumor site. The rate of histologically positive margins was similar among the two methods, akin to the microvessel density. Conclusions MM assessment should be integrated but not replaced with the NBI technology to allow for more conservative surgery.

show abstract

Section: Introductionmentioning

confidence: 99%

A novel integrated platform for the identification of surgical margins in oral squamous cell carcinoma: results from a prospective single-institution series

et al. 2019

View full text Add to dashboard Cite

show abstract

“…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.…”

Section: Introductionmentioning

confidence: 99%

Frozen sections and complete resection in oral cancer surgery

et al. 2019

Self Cite

View full text Add to dashboard Cite

Objectives Although the reliability of frozen sections for the intraoperative assessment of complete tumour excision has been established, the best location for collection and the impact of the type of sampling are still debated. We retrospectively investigated the reliability of frozen sections when collected from the surgical bed as tissue strips representative of the whole superficial margin and as a bowl of tissue underlying the resection site for deep margin, and the possibility of relying on frozen section negativity to consider resections complete. Materials and Methods Frozen section reliability was calculated by comparing histology before and after formalin embedding and then categorised by sampling type, in 182 patients undergoing transoral resection of oral cancer. Results Comparing frozen and permanent histology, sensitivity, specificity and accuracy were 69%, 98% and 96%, respectively; categorisation by sampling type failed to produce statistically significant differences. Based on frozen section negativity after formalin embedding, complete resections were obtained in 91.7% of patients with multiple‐strip and bowl frozen sections. Conclusion Frozen sections collected as tissue strips and bowl are as reliable as point sampling in the intraoperative guidance of surgical resections. They effectively provide for margin enlargement, thereby increasing the surgeon's confidence that negative margins are clear.

show abstract

“…This should allow a better intraoperative evaluation of the depth of invasion . Indeed, deep margins represent a major problem for the surgeon compared to mucosal margins, which are more visible, palpable, and assessable by optical imaging such as NBI . Woolgar and Triantafyllou, in a very detailed appraisal on 301 specimens of oral and oropharyngeal cancers, found 70 cases with positive margins (23.25%), 50 of which (71%) had only deep infiltrated margins.…”

Section: Discussionmentioning

confidence: 99%

“…12,[17][18][19][20][21] Indeed, deep margins represent a major problem for the surgeon 36 compared to mucosal margins, which are more visible, palpable, and assessable by optical imaging such as NBI. 7,10,37 Woolgar and Triantafyllou, 38 in a very detailed appraisal on 301 specimens of oral and oropharyngeal cancers, found 70 cases with positive margins (23.25%), 50 of which (71%) had only deep infiltrated margins. Some reports tried to face this crucial problem using vital staining or digital microscopy to detect deep residual cancer tissue.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Margin Control in Transoral Approach for Oral and Oropharyngeal Cancer

et al. 2018

Self Cite

View full text Add to dashboard Cite

Objectives Piecemeal resection provides an innovative conceptual tool for margins surveillance because it entails the intraoperative evaluation of the whole resection margins and not just sample points, which should result in a better control of deep margins compared to en bloc resection. Although it is recognized that the intraoperative use of narrow band imaging (NBI) results in a better control of superficial margins, in this exploratory study we investigated whether NBI and piecemeal resection could be used in combination to improve margin control at both superficial and deep levels. Because piecemeal resection is based on frozen section analysis, we wanted to verify its reliability compared to definitive histological examination. Methods The status of resection margins in a group of patients with oral and oropharyngeal cancers treated with NBI and laser CO2 piecemeal resection (group 1) was compared with that of an historical group of patients (group 2) treated with NBI and conventional en bloc resection. In group 1, sensitivity, specificity, and positive and negative predictive values were used to verify the rate of concordance between frozen section and definitive histology. Results The difference between deep positive margins in the two groups was statistically significant (P = 0.042). The high sensitivity and specificity (94.6% and 94.7%, respectively) of frozen section analysis also demonstrated its reliability in the examination of larger samples corresponding to the whole margin. Conclusion Even if our findings are limited by the small number of patients, we are confident that the combined use of NBI and piecemeal resection could represent an attractive surgical strategy to improve margin control. Level of Evidence 2b Laryngoscope, 129:1810–1815, 2019

show abstract

NBI utility in the pre-operative and intra-operative assessment of oral cavity and oropharyngeal carcinoma

Cited by 23 publications

References 42 publications

A novel integrated platform for the identification of surgical margins in oral squamous cell carcinoma: results from a prospective single-institution series

A novel integrated platform for the identification of surgical margins in oral squamous cell carcinoma: results from a prospective single-institution series

Frozen sections and complete resection in oral cancer surgery

Intraoperative Margin Control in Transoral Approach for Oral and Oropharyngeal Cancer

Contact Info

Product

Resources

About