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1.
Clin Otolaryngol ; 49(4): 429-435, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38400826

RESUMO

OBJECTIVE: To assess whether narrow band imaging (NBI) detects fields of cancerisation around suspicious lesions in the upper aerodigestive tract, which were undetected by white light imaging (WLI). METHODS: In 96 patients with laryngeal and pharyngeal lesions suspicious for malignancy, 206 biopsies were taken during laryngoscopy: 96 biopsies of suspicious lesions detected by both WLI and NBI (WLI+/NBI+), 60 biopsies adjacent mucosa only suspicious with NBI (WLI-/NBI+), and 46 biopsies of NBI and WLI unsuspicious mucosa (WLI-/NBI-) as negative controls. Optical diagnosis according to the Ni-classification was compared with histopathology. RESULTS: Signs of (pre)malignancy were found in 88% of WLI+/NBI+ biopsies, 32% of WLI-/NBI+ biopsies and 0% in WLI-/NBI- (p < .001). In 58% of the WLI-/NBI+ mucosa any form of dysplasia or carcinoma was detected. CONCLUSION: The use of additional NBI led to the detection of (pre)malignancy in 32% of the cases, that would have otherwise remained undetected with WLI alone. This highlights the potential of NBI as a valuable adjunct to WLI in the identification of suspicious lesions in the upper aerodigestive tract.


Assuntos
Neoplasias Laríngeas , Laringoscopia , Imagem de Banda Estreita , Humanos , Imagem de Banda Estreita/métodos , Feminino , Masculino , Laringoscopia/métodos , Pessoa de Meia-Idade , Idoso , Neoplasias Laríngeas/patologia , Neoplasias Laríngeas/diagnóstico por imagem , Neoplasias Laríngeas/diagnóstico , Biópsia , Adulto , Neoplasias Faríngeas/patologia , Neoplasias Faríngeas/diagnóstico por imagem , Neoplasias Faríngeas/diagnóstico , Lesões Pré-Cancerosas/patologia , Lesões Pré-Cancerosas/diagnóstico por imagem , Lesões Pré-Cancerosas/diagnóstico , Idoso de 80 Anos ou mais , Brancos
2.
J Laryngol Otol ; 138(4): 425-430, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-37880146

RESUMO

BACKGROUND: Fibre-optic laryngoscopy is still widely used in daily clinical practice; however, high-definition laryngoscopy using narrow band imaging could be more reliable in characterising pharyngeal and laryngeal lesions. METHODS: Endoscopic videos were assessed in a tertiary referral hospital by 12 observers with different levels of clinical experience. Thirty pairs of high-definition laryngoscopy with narrow band imaging and fibre-optic laryngoscopy videos were judged twice, with an interval of two to four weeks, in a random order. Inter- and intra-observer reliability, sensitivity and specificity were calculated in terms of detecting a malignant lesion and a specific histological entity, for beginners, trained observers and experts. RESULTS: Using high-definition laryngoscopy with narrow band imaging, inter-observer reliability for detecting malignant lesions increased from moderate to substantial in trained observers and experts (high-definition laryngoscopy with narrow band imaging κ = 0.66 and κ = 0.77 vs fibre-optic laryngoscopy κ = 0.51 and κ = 0.56, for trained observers and experts respectively) and sensitivity increased by 16 per cent. CONCLUSION: Inter-observer reliability increased with the level of clinical experience, especially when using high-definition laryngoscopy with narrow band imaging.


Assuntos
Neoplasias Laríngeas , Laringe , Humanos , Laringoscopia/métodos , Imagem de Banda Estreita/métodos , Reprodutibilidade dos Testes , Laringe/diagnóstico por imagem , Laringe/patologia , Endoscopia , Neoplasias Laríngeas/diagnóstico por imagem , Neoplasias Laríngeas/patologia
3.
Otolaryngol Head Neck Surg ; 169(3): 606-614, 2023 09.
Artigo em Inglês | MEDLINE | ID: mdl-36821814

RESUMO

OBJECTIVE: Assessing whether the additional use of narrow-band imaging (NBI) in transoral laser surgery (TOLS) for early laryngeal cancer improves clinical outcomes. STUDY DESIGN: Randomized controlled trial, performed between September 2015 and November 2022. SETTING: A tertiary referral hospital in The Netherlands. METHODS: TOLS was carried out in 113 patients. The procedure was performed with white light imaging (WLI, n = 56) alone, or combined with NBI (n = 57). Patients received frequent follow-up laryngoscopy. Resection margin status, recurrence rate, and recurrence-free survival at 12 months, 18 months, and after study termination (maximum 86 months) were analyzed. RESULTS: Thirty-one cases in the WLI group had a positive resection margin, versus 16 in the NBI group (p = .002). After 12 months, the recurrence-free survival was 92%: 87% for WLI versus 96% for NBI, p = .07. The recurrence rate was 7/56 (13%) for WLI, versus 2/57 (4%) for NBI, p = .09. After 18 months, the recurrence-free survival was 84% for WLI versus 96% for NBI, p = .02. The recurrence rate was 9/56 (16%) for WLI, versus 2/57 (4%) for NBI, p = .02. After study termination, the recurrence-free survival was 71% for WLI versus 83% for the NBI group (p = .08). The recurrence rate was 16/56 for WLI, versus 10/57 for NBI (p = .16). CONCLUSION: The additional use of NBI during TOLS significantly decreased the number of positive resection margins. Although not statistically significant at all time points, patients treated with NBI-supported TOLS showed a lower recurrence rate and better recurrence-free survival. Further studies in larger patient groups are needed to confirm these results.


Assuntos
Neoplasias Laríngeas , Terapia a Laser , Neoplasias da Bexiga Urinária , Humanos , Neoplasias da Bexiga Urinária/cirurgia , Margens de Excisão , Neoplasias Laríngeas/diagnóstico por imagem , Neoplasias Laríngeas/cirurgia , Imagem de Banda Estreita/métodos
4.
Eur Arch Otorhinolaryngol ; 278(6): 1927-1932, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33606082

RESUMO

PURPOSE: This study aims to analyse differences in fiberoptic laryngoscopy (FOL) versus high definition laryngoscopy (HDL) by examining videolaryngoscopy images by a large group of observers with different levels of clinical expertise in ear, nose and throat (ENT) medicine. METHODS: This study is a 111 observer paired analysis of laryngoscopy videos during an interactive presentation. During a National Meeting of the Dutch Society of ENT/Head and Neck Surgery, observers assessed both FOL and HDL videos of nine cases with additional clinical information. Observers included 41 ENT consultants (36.9%), 34 ENT residents (30.6%), 22 researchers with Head and Neck interest (19.8%) and 14 with unspecified clinical expertise (12.6%). For both laryngoscopic techniques, sensitivity, specificity, positive and negative predictive value and diagnostic accuracy were determined for identifying a normal glottis, hyperkeratosis, radiotherapy adverse effects and squamous cell carcinoma. The sensitivities for FOL and HDL were analysed with regard to the different levels of clinical expertise. RESULTS: The overall sensitivity for correctly identifying the specific histological entity was higher in HDL (FOL 61% vs HDL 66.3%, p < 0.05). HDL was superior to FOL in identifying a normal glottis (FOL 68.1% vs HDL 91.6%, p < 0.01) and squamous cell carcinoma (FOL 70.86% vs HDL 79.41%, p = 0.02). Residents and researchers with Head and Neck interest diagnosed laryngeal lesions more correctly with HDL (p < 0.05). CONCLUSIONS: In a large population of observers with different levels of clinical expertise, HDL is superior to FOL in identifying laryngeal lesions.


Assuntos
Laringoscópios , Laringe , Laringoscopia , Valor Preditivo dos Testes , Gravação de Videoteipe
5.
Laryngoscope ; 131(7): E2222-E2231, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33393666

RESUMO

OBJECTIVE/HYPOTHESIS: Comparing detection and extension of malignant tumors by flexible laryngoscopy in the outpatient setting with laryngoscopy under general anesthesia using both White Light Imaging (WLI) and Narrow Band Imaging (NBI). STUDY DESIGN: Prospective study. METHODS: Two hundred and thirty-three patients with laryngeal and pharyngeal lesions underwent flexible and rigid laryngoscopy, with both WLI and NBI. Extension of malignant lesions (n = 132) was compared between both techniques in detail. RESULTS: Sensitivity of NBI during flexible endoscopy (92%), was comparable with that of WLI during rigid endoscopy (91%). The correlation of tumor extension between flexible and rigid laryngoscopy was high (rs  = 0.852-0.893). The observed tumor extension was significantly larger when using NBI in both settings. The use of NBI during flexible laryngoscopy leads to upstaging (12%) and downstaging (2%) of the T classification. CONCLUSIONS: NBI during flexible laryngoscopy could be an alternative to WLI rigid endoscopy. NBI improves visualization of tumor extension and accuracy of T staging. LEVEL OF EVIDENCE: 3 Laryngoscope, 131:E2222-E2231, 2021.


Assuntos
Neoplasias Laríngeas/diagnóstico por imagem , Laringoscopia/métodos , Imagem de Banda Estreita/estatística & dados numéricos , Imagem Óptica/estatística & dados numéricos , Neoplasias Faríngeas/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Desenho de Equipamento , Feminino , Humanos , Laringoscópios , Laringoscopia/instrumentação , Luz , Masculino , Pessoa de Meia-Idade , Imagem de Banda Estreita/métodos , Estadiamento de Neoplasias/métodos , Imagem Óptica/métodos , Valor Preditivo dos Testes , Estudos Prospectivos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Adulto Jovem
6.
Clin Otolaryngol ; 45(1): 119-125, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31747481

RESUMO

OBJECTIVES: High definition laryngoscopy (HDL) could lead to better interpretation of the pharyngeal and laryngeal mucosa than regularly used fiberoptic laryngoscopy (FOL). The primary aim of this study is to quantify the diagnostic advantage of HDL over FOL in detecting mucosal anomalies in general, in differentiating malignant from benign lesions and in predicting specific histological entities. The secondary aim is to analyse image quality of both laryngoscopes. DESIGN: Retrospective paired analysis with multiple observers evaluating endoscopic videos simulating daily clinical practice. SETTING: A tertiary referral hospital. PARTICIPANTS: In 36 patients, both FOL and HDL videos were obtained. Six observers were provided with additional clinical information, and 36 FOL and HDL videos were evaluated in a randomised order. MAIN OUTCOME MEASURES: Sensitivity, specificity, positive and negative predictive value and diagnostic accuracy of observers using both flexible laryngoscopes were calculated for detection of mucosal lesions in general and uncovering malignant lesions. Sensitivities were calculated for prediction of specific histological entities. Image quality (scale 1-10) was assessed for both flexible laryngoscopes. RESULTS: HDL reached higher sensitivity compared to FOL for detection of mucosal abnormalities in general (96.0% vs 90.4%; P = .03), differentiating malignant from benign lesions (91.7% vs 79.8%; P = .03) and prediction of specific histological entities (59.7% vs 47.2%; P < .01). Image quality was judged better with HDL in comparison with FOL (mean: 8.4 vs 5.4, P < .01). CONCLUSIONS: HDL is superior to FOL in detecting mucosal anomalies in general, malignancies and specific histological entities. Image quality is considered as superior using HDL compared to FOL.


Assuntos
Tecnologia de Fibra Óptica/métodos , Aumento da Imagem/métodos , Doenças da Laringe/diagnóstico , Laringoscopia/métodos , Doenças Faríngeas/diagnóstico , Gravação em Vídeo , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Curva ROC , Estudos Retrospectivos
8.
Clin Otolaryngol ; 44(1): 39-46, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30222908

RESUMO

OBJECTIVES: The primary goal was to study the diagnostic potential of narrow-band imaging (NBI), and the secondary goal was to evaluate the most common mistakes when using and interpreting NBI. DESIGN: Retrospective study. SETTING: University Medical Center Groningen, tertiary referral hospital, the Netherlands. PARTICIPANTS: Three hundred and seventy patients who underwent rigid endoscopy of the upper aerodigestive tract. Two observers assessed all lesions. Twelve observers assessed a selection of 100 lesions. All observers were provided with both white light imaging and NBI. MAIN OUTCOME MEASURES: Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy and reasons for insufficient photograph quality. RESULTS: When using NBI, the sensitivity, specificity, PPV, NPV and accuracy for detecting invasive carcinoma, carcinoma in situ or high-grade dysplasia were 92%, 68%, 61%, 94% and 77%, respectively. In multiple-observer analysis, values were 76%, 58%, 53%, 83% and 65% with the evaluation strictly based on type V patterns of Ni's classification, vs 83%, 68%, 64%, 85% and 74% when evaluation was also based on lesion-specific clinical characteristics. Lesions that caused misinterpretations were leukoplakia, papillomas and mucosal lesions after irradiation. In total, 185 photographs were assessed to be of suboptimal quality due to blurring (36%), bleeding (6%), insufficient zooming (15%) and/or insufficient lighting (17%). CONCLUSION: NBI is a relatively reliable screening method for detecting malignancy. Evaluation based on Ni's classification alone is not sufficient. To optimise NBI photograph quality, we recommend sufficient zooming and prevention of bleeding, blurring and inadequate lighting.


Assuntos
Carcinoma in Situ/diagnóstico por imagem , Carcinoma de Células Escamosas/diagnóstico por imagem , Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Imagem de Banda Estreita , Carcinoma in Situ/patologia , Carcinoma de Células Escamosas/patologia , Esofagoscopia , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Hiperplasia , Gradação de Tumores , Estudos Retrospectivos
9.
Head Neck ; 39(7): 1343-1348, 2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-28370672

RESUMO

BACKGROUND: The purpose of this study was to validate the prognostic value of adding narrow-band imaging (NBI) during transoral laser surgery (TLS) for early glottic cancer. METHODS: In 84 patients, 93 transoral laser resections were performed for carcinoma in situ (Tcis), T1, or T2 glottic cancer. TLS was preceded by intraoperative evaluation using traditional white-light imaging (WLI) in 51 cases. In 42 cases, NBI was used in addition to WLI. Local recurrence rate and recurrence-free survival were retrospectively compared between both groups. RESULTS: Local recurrences developed in 14% of the 93 cases: 12 of 51 patients (24%) were treated by TLS based on WLI alone, and in 1 of 42 patients (2%) in the NBI group (P < .01). Two-year recurrence-free survival was 82% in the WLI group and 98% in the NBI group (P < .05). CONCLUSION: Additional use of NBI during TLS for early glottic cancer significantly improves clinical outcome.


Assuntos
Glote/cirurgia , Neoplasias Laríngeas/cirurgia , Terapia a Laser/métodos , Monitorização Intraoperatória/métodos , Imagem de Banda Estreita/métodos , Cirurgia Endoscópica por Orifício Natural/métodos , Idoso , Distribuição de Qui-Quadrado , Estudos de Coortes , Intervalo Livre de Doença , Feminino , Glote/patologia , Humanos , Estimativa de Kaplan-Meier , Neoplasias Laríngeas/mortalidade , Neoplasias Laríngeas/patologia , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Invasividade Neoplásica/patologia , Recidiva Local de Neoplasia/mortalidade , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/terapia , Estadiamento de Neoplasias , Países Baixos , Prognóstico , Estudos Retrospectivos , Medição de Risco , Análise de Sobrevida , Resultado do Tratamento
10.
Laryngoscope ; 126(10): 2276-81, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-27074877

RESUMO

OBJECTIVES/HYPOTHESIS: Visualization by endoscopy is essential in the diagnosis of upper aerodigestive tract lesions. Recent studies showed that narrow band imaging (NBI) increases the diagnostic potential of conventional white light imaging (WLI) by highlighting the superficial vessels. The objective of this study was to evaluate whether the use of NBI would influence inter- and intraobserver agreement while making diagnostic decisions using rigid endoscopy of the upper aerodigestive tract. STUDY DESIGN: Retrospective study. METHODS: One hundred routinely collected pictures of laryngeal, hypopharyngeal, and oropharyngeal lesions were used. Rigid endoscopies and patient data collection were performed according to standard protocol. Twelve observers, grouped in different levels of experience, assessed all lesions twice with a 2 to 4 week interval. Fleiss and Cohen's kappa (κ) values were calculated to assess inter- and intraobserver agreement. RESULTS: Overall interobserver agreement increased from κ = 0.34 to κ = 0.40 by adding NBI to WLI (WLI and WLI + NBI, respectively). In experienced observers, an improvement from κ = 0.39 to κ = 0.43 was observed; in less-experienced observers an improvement from κ = 0.30 to κ = 0.37 was observed. Overall intraobserver agreement increased from moderate (κ = 0.54) to substantial (κ = 0.63) with addition of NBI. Intraobserver agreement for less-experienced observers improved remarkably when WLI was combined with NBI (κ = 0.51 vs. κ = 0.67). CONCLUSIONS: Addition of NBI during rigid endoscopies of the upper aerodigestive tract led to improvement of both inter- and intraobserver agreement. LEVEL OF EVIDENCE: 4 Laryngoscope, 126:2276-2281, 2016.


Assuntos
Esofagoscopia/estatística & dados numéricos , Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Luz , Imagem de Banda Estreita/estatística & dados numéricos , Competência Clínica , Esofagoscopia/métodos , Humanos , Imagem de Banda Estreita/métodos , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Estudos Retrospectivos
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