Leukoplakia: An Invasive Cancer Hidden within the Vocal Folds. A Multivariate Analysis of Risk Factors

IntroductionDiscerning the preoperative nature of vocal fold leukoplakia (VFL) with a substantial degree of certainty is fundamental, seeing that the histological diagnosis of VFL includes a wide spectrum of pathology and there is no consensus on an appropriate treatment strategy or frequency of surveillance. The goal of our study was to establish a clear schedule of the diagnostics and decision-making in which the timing and necessity of surgical intervention are crucial to not miss this cancer hidden underneath the white plaque.Material and MethodsWe define a schedule as a combination of procedures (white light and Narrow Band Imaging diagnostic tools), methods of evaluating the results (a combination of multiple image classifications in white light and Narrow Band Imaging), and taking into account patient-related risk factors, precise lesion location, and morphology. A total number of 259 patients with 296 vocal folds affected by leukoplakia were enrolled in the study. All patients were assessed for three classifications, in detail according to Ni 2019 and ELS 2015 for Narrow Band Imaging and according to Chen 2019 for white light. In 41 of the 296 folds (13.9%), the VFL specimens in the final histology revealed invasive cancer. We compared the results from the classifications to the final histology results.ResultsThe results showed that the classifications and evaluations of the involvement of anterior commissure improve the clinical utility of these classifications and showed improved diagnostic performance. The AUC of this model was the highest (0.973) with the highest sensitivity, specificity, PPV, and NPV (90.2%, 89%, 56.9%, and 98.3%, respectively).ConclusionThe schedule that combines white light and Narrow Band Imaging, with a combination of the two classifications, improves the specificity and predictive value, especially of anterior commissure involvement.

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Faculty Opinions recommendation of Randomized, controlled trial of standard-definition white-light, high-definition white-light, and narrow-band imaging colonoscopy for the detection of colon polyps and prediction of polyp histology.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.13484029.14861138 ◽

2012 ◽

Author(s):

Matthew Banks ◽

Jayan Mannath

Keyword(s):

Randomized Controlled Trial ◽

White Light ◽

Narrow Band ◽

Narrow Band Imaging ◽

Controlled Trial ◽

Colon Polyps ◽

High Definition ◽

Standard Definition ◽

Randomized Controlled

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Faculty Opinions recommendation of Comparison of detection and miss rates of narrow band imaging, flexible spectral imaging chromoendoscopy and white light at screening colonoscopy: a randomised controlled back-to-back study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718030827.793485786 ◽

2013 ◽

Author(s):

Kellie Mathis

Keyword(s):

White Light ◽

Narrow Band ◽

Narrow Band Imaging ◽

Spectral Imaging ◽

Screening Colonoscopy ◽

Randomised Controlled

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

International Archives of Otorhinolaryngology ◽

10.1055/s-0040-1719119 ◽

2020 ◽

Author(s):

Carmelo Saraniti ◽

Enzo Chianetta ◽

Giuseppe Greco ◽

Norhafiza Mat Lazim ◽

Barbara Verro

Keyword(s):

White Light ◽

Diagnostic Tool ◽

Narrow Band ◽

Narrow Band Imaging ◽

Resection Margins ◽

Predictive Values ◽

White Light Endoscopy ◽

Laryngeal Lesions ◽

Sensitivity Specificity ◽

The Impact

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

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Evaluating Laryngopharyngeal Tumor Extension Using Narrow Band Imaging Versus Conventional White Light Imaging

The Laryngoscope ◽

10.1002/lary.29361 ◽

2021 ◽

Author(s):

Manon A. Zwakenberg ◽

Gyorgy B. Halmos ◽

Jan Wedman ◽

Bernard F. A. M. Laan ◽

Boudewijn E. C. Plaat

Keyword(s):

White Light ◽

Narrow Band ◽

Narrow Band Imaging ◽

Tumor Extension ◽

White Light Imaging

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The Comparison of Narrow Band Imaging, White Light Laryngoscopy and Videolaryngostroboscopy in the Evaluation of Benign Vocal Fold Lesions

Journal of Voice ◽

10.1016/j.jvoice.2020.12.030 ◽

2021 ◽

Author(s):

Yetkin Zeki Yılmaz ◽

Müge Uğurlar ◽

Begüm Bahar Yılmaz ◽

Züleyha Dilek Gülmez ◽

Hasan Ahmet Özdoğan ◽

...

Keyword(s):

White Light ◽

Vocal Fold ◽

Narrow Band ◽

Narrow Band Imaging ◽

Benign Vocal Fold Lesions

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Endoscopic Ex Vivo Evaluation of Bile Concentrations by Narrow Band Imaging: A Pilot Study

Gastroenterology Research and Practice ◽

10.1155/2015/367848 ◽

2015 ◽

Vol 2015 ◽

pp. 1-3

Author(s):

Roberta Maselli ◽

Haruhiro Inoue ◽

Haruo Ikeda ◽

Manabu Onimaru ◽

Akira Yoshida ◽

...

Keyword(s):

Pilot Study ◽

White Light ◽

Potential Role ◽

Narrow Band ◽

Ex Vivo ◽

Narrow Band Imaging ◽

Initial Study ◽

Bile Concentration ◽

Duodenogastroesophageal Reflux

Background. Bile juice plays a major role in duodenogastroesophageal reflux (DGERD). Several devices to directly measure the bile concentration have been proposed. We aimed to ex-vivo evaluate the bile concentration by narrow band imaging (NBI).Method. From six surgical cholecystectomies, the content of the gallbladders was aspirated and the total biliary acid (TBA) concentration was evaluated. 2 mL was employed for serial twofold dilutions. Each dilution was scoped. Images on white light (WL) and NBI were captured and grouped accordingly to NBI-appearance and TBA-concentration.Results. Nondiluted bile had a TBA-concentration of 61965 ± 32989 μmol/L. Final dilution (1 : 4096) had 1.16 μmol/L. NBI and correspondent WL images were grouped into seven groups, and an NBI/Bile scale was created.Conclusion. The scale showed that not only NBI scale but also white light scale could be useful to predict the bile concentration. This initial study shows that NBI has a potential role in the detection of DGERD and further investigation is warranted to distinguish the presence and the concentration of bile, especially at very low TBA concentrations.

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Randomized, controlled trial of standard-definition white-light, high-definition white-light, and narrow-band imaging colonoscopy for the detection of colon polyps and prediction of polyp histology

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2011.04.050 ◽

2011 ◽

Vol 74 (3) ◽

pp. 593-602 ◽

Cited By ~ 91

Author(s):

Amit Rastogi ◽

Dayna S. Early ◽

Neil Gupta ◽

Ajay Bansal ◽

Vikas Singh ◽

...

Keyword(s):

Randomized Controlled Trial ◽

White Light ◽

Narrow Band ◽

Narrow Band Imaging ◽

Controlled Trial ◽

Colon Polyps ◽

High Definition ◽

Standard Definition ◽

Randomized Controlled

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P236 Evaluation of histological inflammation by a novel image enhanced endoscopy technique, dual red imaging, in patients with ulcerative colitis: Preliminary study

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.365 ◽

2020 ◽

Vol 14 (Supplement_1) ◽

pp. S261-S261

Author(s):

K FUJIMOTO ◽

K Watanabe ◽

K Hori ◽

K Kaku ◽

N Kinoshita ◽

...

Keyword(s):

Ulcerative Colitis ◽

White Light ◽

Narrow Band ◽

Narrow Band Imaging ◽

Topical Steroid ◽

Treatment Goal ◽

Practical Approach ◽

Mayo Score ◽

White Light Imaging ◽

Pathological Assessment

Abstract Background Endoscopic remission is the ideal treatment goal for patients with ulcerative colitis (UC) in clinical practice. However, several recent investigations tried to evaluate histological healing as a more optimal treatment goal. The assessment of histological healing, however, is usually inconvenient and time-consuming because of the requirement of a biopsy and pathological assessment. Dual red imaging (DRI; Olympus Corporation, Japan) is a novel image enhanced endoscopy technique that can visualise the inflammation, including that in the surface crypt, and vessel findings of the brownish surface or green-coloured deeper layer of the mucosa in contrast to narrow band imaging. We preliminarily evaluated the utility of DRI in the assessment of histological healing in UC as a practical approach. Methods We enrolled UC patients who provided consent from May 2018 to September 2019 in our hospital, and performed colonoscopy in the entire colon with white-light imaging and DRI, and then endoscopic pictures and biopsy samples were obtained. Central pathological assessment of histological inflammation based on the Nancy index with individual items was performed for each biopsy sample. We also assessed the clinical background, UC activity according to the Mayo score, white-light endoscopic activity according to the Mayo endoscopic subscore (MES), and DRI findings using a 5-point scale. Results We evaluated a total of 90 sets of DRI and pathological findings from 47 UC patients (20 females; median age, 42 [20–84] years; 25 with pancolitis, 17 left-sided colitis, 3 proctitis, and 2 others; median duration of disease, 83 [1–379] months; median Mayo score, 2 [0–11]). Participants were treated with 5-aminosalicylates (38 oral; 7 topical), steroid (4 systemic; 6 topical), immunomodulator (7), anti-TNF agents (5), tofacitinib (3), and tacrolimus (8). Both the MES (r = 0.70) and DRI scale (r = 0.65) correlated well with the Nancy index. Among individual pathological items with respect to inflammation, ulceration (r = 0.69), chronic inflammatory infiltrate (r = 0.66), neutrophils in the lamina propria (r = 0.65), and serrated architectural abnormalities (r = 0.60) correlated well with the Nancy index in contrast to other pathological items. DRI seemed to facilitate the visualisation of histological inflammation in deeper layers of the mucosa compared with white-light imaging or narrow-band imaging. Conclusion The novel DRI technique has potential in the evaluation of histological inflammation without the requirement of a biopsy in patients with UC as a practical approach. A further prospective multicenter study in this regard is needed.

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Naturally Nasal-esophageal Fiberscope in COVID-19 Pandemic - Prevent Sneezing Without Anesthesia

10.21203/rs.3.rs-360636/v1 ◽

2021 ◽

Author(s):

Koichi Tsunoda ◽

Ko Hentona ◽

Yamanobe Yoshiharu

Keyword(s):

Narrow Band ◽

Narrow Band Imaging ◽

Pathological Condition ◽

Vocal Folds ◽

Pyriform Sinus ◽

Natural Setting ◽

Sitting Position ◽

Case Presentation ◽

Air Supply ◽

Nasal Bleeding

Abstract Background: We are laryngologists, to observe natural phonatory and swallowing functions, in every clinical examination with trans-nasal laryngeal fiberscope (TNLF), before the observation, we use epinephrine to enlarge and smoothen inside common nasal meatus (bottom of nostril), then insert wet swab inside the nose, like a swab culture in nasopharynx. In particular current COVID-19 pandemic situation, this careful technique prevents any complications even nasal bleeding, painfulness, and inducing sneezing. Here we introduce our routine to observe esophageal movement in swallowing in natural setting (sitting position) without anesthesia.Case presentation: A case was 70-year-old female who complained something stuck esophagus or strange sensation below the larynx and pharynx. After enlarge and smoothen inside common nasal meatus we insert the TNLF (slim type ⌀29mm fiberscope, VNL8-J10, PENTAX Medical, Tokyo, Japan.) in a same way. Then observe the phonatory and swallowing movement of vocal folds. To get natural movements we had never used any anesthesia. There was no pathological condition in the pyriform sinus, we asked a patient to swallow the fiberscope. At that timing we push the TNLF and insert the tip a bit deeper simultaneously with swallowing, which make the fiberscope easily enter the esophagus like the insertion of nasogastric tube. Then asked the patient to swallow sip of water or saliva, the lumen of esophagus cleared and enlarged. This makes to observe esophagus easily without any air supply. The esophagus is completely normal except glycogenic acanthosis with tone enhancement scan. Conclusions: The advance point of this examination is easily able to perform in sitting position without anesthesia, also takes only a minute and minimum invasive to observe the physiologically natural swallowing. It is also possible without anesthesia until esophagogastric junction using with a thin type flexible bronchoscopy. In the future, diameter of gastric fiberscope even with narrow band imaging (NBI) function might be gradually getting thinner. Before that time every physician should know this technique. Just insert along the bottom of nose.

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