The Impact of Narrow-band Imaging on the Pre- and Intra- operative Assessments of Neoplastic and Preneoplastic Laryngeal Lesions. A Systematic Review

Abstract

Introduction Narrow-band imaging is an endoscopic diagnostic tool that, focusing on superficial vascular changes, is useful to detect suspicious laryngeal lesions, enabling their complete excision with safe and tailored resection margins. Objectives To analyze the applications and benefits of narrow-band imaging in detecting premalignant and malignant laryngeal lesions through a comparison with white-light endoscopy. Data Synthesis A literature search was performed in the PubMed, Scopus and Web of Science databases using strict keywords. Then, two authors independently analyzed the articles, read the titles and abstracts, and read completely only the relevant studies according to certain eligibility criteria. In total, 14 articles have been included in the present review; the sensitivity, specificity, positive and negative predictive values, and accuracy of pre- and/or intraoperative narrow-band imaging were analyzed. The analysis showed that narrow-band imaging is better than white-light endoscopy in terms of sensitivity, specificity, positive and negative predictive values, and accuracy regarding the ability to identify cancer and/or precancerous laryngeal lesions. Moreover, the intraoperative performance of narrow-band imaging resulted more effective than the in-office performance. Conclusion Narrow-band imaging is an effective diagnostic tool to detect premalignant and malignant laryngeal lesions and to define proper resection margins. Moreover, narrow-band imaging is useful in cases of leukoplakia that may cover a possible malignant lesion and that cannot be easily assessed with white-light endoscopy. Finally, a shared, simple and practical classification of laryngeal lesions, such as that of the European Laryngological Society, is required to identify a shared lesion management strategy. Key Points

NBI and Laryngeal Papillomatosis: A Diagnostic Challenge: A Systematic Review

“…Because of this, Lin et al concluded that NBI is not suitable for diagnosing papillomatosis. On the contrary, NBI SP was better in the case of LP (92–100%) than in the case of LSCC (65–82%), showing another NBI limitation: white plaque that may cover the lesion and lead to false negative [ 6 ]. Only one study reported PPV and NPV data, 52.82% and 86.79% for LP and 91.14% and 68.18% for LSCC, respectively [ 10 ].…”

“…Malignant lesions are characterized by enlarged, brownish vessels, and IPCLs are destroyed with tortuous shape (IPCLs type V) [ 5 ]. Several studies demonstrated the high sensitivity and NPV of type V pattern for detecting early glottic cancer [ 15 , 16 , 17 ]; carcinogenesis is related to blood vessel changes and angiogenesis [ 18 ]. However, LP is also characterized by a type V pattern on NBI, and this may lead to misdiagnosis, as reported by all the studies included in this review.…”

“…This latter pattern could be associated with both LP and LSCC. In this case, Arens et al suggest paying special attention to the IPCL spiraling shape: LP has wide-angled turning points, whereas cancer lesions have narrow-angled turning points [ 6 , 24 , 25 ]. However, as stated by Sifrer et al, these vascular features are not easily visible: otolaryngologist experience and practice with high-quality equipment are necessary, fundamental, and in fact mandatory [ 11 , 14 ].…”

“…In 2011, Ni et al proposed a classification of laryngeal lesions based on changes in intraepithelial papillary capillary loop (IPCL) patterns: Benign lesions have IPCL types I-III, malignant lesions have IPCL type Va,b,c, and precancerous or suspected malignant have IPCL type IV [ 5 ]. NBI use in clinical practice has achieved higher sensitivity and specificity for early laryngeal cancer than WLE [ 6 ]. However, this diagnostic tool has a main limitation: laryngeal papillomatosis (LP).…”

Papillomavirus Infection and Prevention: How Much Does the Sicilian Population Know? An Observational Study

“…Human papillomavirus (HPV) is a sexually transmitted virus and is the leading cause of uterine cervical cancer [ 1 ]. In recent decades, its growing main role in the onset of oral and oropharyngeal carcinoma (OPC) was studied [ 2 ]. In fact, there is a reduction in the incidence of OPC due to smoking and/or alcohol.…”