Evaluation of Vascular Patterns Using Contact Endoscopy and Narrow-Band Imaging (CE-NBI) for the Diagnosis of Vocal Fold Malignancy

The endoscopic detection of perpendicular vascular changes (PVC) of the vocal folds has been associated with vocal fold cancer, dysplastic lesions, and papillomatosis, according to a classification proposed by the European Laryngological Society (ELS). The combination of contact endoscopy with narrow-band imaging (NBI-CE) allows intraoperatively a highly contrasted, real-time visualization of vascular changes of the vocal folds. Aim of the present study was to determine the association of PVC to specific histological diagnoses, the level of interobserver agreement in the detection of PVC, and their diagnostic effectiveness in diagnosing laryngeal malignancy. The evaluation of our data confirmed the association of PVC to vocal fold cancer, dysplastic lesions, and papillomatosis. The level of agreement between the observers in the identification of PVC was moderate for the less-experienced observers and almost perfect for the experienced observers. The identification of PVC during NBI-CE proved to be a valuable indicator for diagnosing malignant and premalignant lesions.

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Validation of the European Laryngological Society classification of glottic vascular changes as seen by narrow band imaging in the optical biopsy setting

European Archives of Oto-Rhino-Laryngology ◽

10.1007/s00405-021-06723-7 ◽

2021 ◽

Author(s):

Francesco Missale ◽

Stefano Taboni ◽

Andrea Luigi Camillo Carobbio ◽

Francesco Mazzola ◽

Giulia Berretti ◽

...

Keyword(s):

Test Performance ◽

Predictive Value ◽

Interobserver Agreement ◽

Narrow Band ◽

Narrow Band Imaging ◽

Intraepithelial Neoplasia ◽

Optical Biopsy ◽

Vascular Changes ◽

Laryngeal Lesions ◽

European Laryngological Society

Abstract Purpose In 2016, the European Laryngological Society (ELS) proposed a classification for vascular changes occurring in glottic lesions as visible by narrow band imaging (NBI), based on the dichotomic distinction between longitudinal vessels (not suspicious) and perpendicular ones (suspicious). The aim of our study was to validate this classification assessing the interobserver agreement and diagnostic test performance in detecting the final histopathology. Methods A retrospective study was carried out by reviewing clinical charts, preoperative videos, and final pathologic diagnosis of patients submitted to transoral microsurgery for laryngeal lesions in two Italian referral centers. In each institution, two physicians, independently re-assessed each case applying the ELS classification. Results The cohort was composed of 707 patients. The pathologic report showed benign lesions in 208 (29.5%) cases, papillomatosis in 34 (4.8%), squamous intraepithelial neoplasia (SIN) up to carcinoma in situ in 200 (28.2%), and squamous cell carcinoma (SCC) in 265 (37.5%). The interobserver agreement was extremely high in both institutions (k = 0.954, p < 0.001 and k = 0.880, p < 0.001). Considering the diagnostic performance for identification of at least SIN or SCC, the sensitivity was 0.804 and 0.902, the specificity 0.793 and 0.581, the positive predictive value 0.882 and 0.564, and the negative predictive value 0.678 and 0.908, respectively. Conclusion The ELS classification for NBI vascular changes of glottic lesions is a highly reliable tool whose systematic use allows a better diagnostic evaluation of suspicious laryngeal lesions, reliably distinguishing benign ones from those with a diagnosis of papillomatosis, SIN or SCC, thus paving the way towards confirmation of the optical biopsy concept.

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Laryngeal Lesion Classification Based on Vascular Patterns in Contact Endoscopy and Narrow Band Imaging: Manual Versus Automatic Approach

Sensors ◽

10.3390/s20144018 ◽

2020 ◽

Vol 20 (14) ◽

pp. 4018

Author(s):

Nazila Esmaeili ◽

Alfredo Illanes ◽

Axel Boese ◽

Nikolaos Davaris ◽

Christoph Arens ◽

...

Keyword(s):

Narrow Band ◽

Narrow Band Imaging ◽

Subjective Evaluation ◽

Vascular Changes ◽

Visual Evaluation ◽

Laryngeal Lesion ◽

Laryngeal Mucosa ◽

Supervised Classifiers ◽

Real Time Visualization ◽

Computer Based

Longitudinal and perpendicular changes in the vocal fold’s blood vessels are associated with the development of benign and malignant laryngeal lesions. The combination of Contact Endoscopy (CE) and Narrow Band Imaging (NBI) can provide intraoperative real-time visualization of the vascular changes in the laryngeal mucosa. However, the visual evaluation of vascular patterns in CE-NBI images is challenging and highly depends on the clinicians’ experience. The current study aims to evaluate and compare the performance of a manual and an automatic approach for laryngeal lesion’s classification based on vascular patterns in CE-NBI images. In the manual approach, six observers visually evaluated a series of CE+NBI images that belong to a patient and then classified the patient as benign or malignant. For the automatic classification, an algorithm based on characterizing the level of the vessel’s disorder in combination with four supervised classifiers was used to classify CE-NBI images. The results showed that the manual approach’s subjective evaluation could be reduced by using a computer-based approach. Moreover, the automatic approach showed the potential to work as an assistant system in case of disagreements among clinicians and to reduce the manual approach’s misclassification issue.

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Manual versus Automatic Classification of Laryngeal Lesions based on Vascular Patterns in CE+NBI Images

Current Directions in Biomedical Engineering ◽

10.1515/cdbme-2020-3018 ◽

2020 ◽

Vol 6 (3) ◽

pp. 70-73

Author(s):

Nazila Esmaeili ◽

Alfredo Illanes ◽

Axel Boese ◽

Nikolaos Davaris ◽

Christoph Arens ◽

...

Keyword(s):

Vocal Fold ◽

Narrow Band ◽

Narrow Band Imaging ◽

Automatic Classification ◽

Vascular Pattern ◽

Objective Interpretation ◽

Laryngeal Lesions ◽

Malignant Lesions ◽

Manual Classification

AbstractLongitudinal and perpendicular changes in the blood vessels of the vocal fold have been related to the advancement from benign to malignant laryngeal cancer stages. The combination of Contact Endoscopy (CE) and Narrow Band Imaging (NBI) provides intraoperative realtime visualization of vascular pattern in Larynx. The evaluation of these vascular patterns in CE+NBI images is a subjective process leading to differentiation difficulty and subjectivity between benign and malignant lesions. The main objective of this work is to compare multi-observer classification versus automatic classification of laryngeal lesions. Six clinicians visually classified CE+NBI images into benign and malignant lesions. For the automatic classification of CE+NBI images, we used an algorithm based on characterizing the level of the vessel’s disorder. The results of the manual classification showed that there is no objective interpretation, leading to difficulties to visually distinguish between benign and malignant lesions. The results of the automatic classification of CE+NBI images on the other hand showed the capability of the algorithm to solve these issues. Based on the observed results we believe that, the automatic approach could be a valuable tool to assist clinicians to classifying laryngeal lesions.

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Diagnosis of Laryngeal Pemphigus Vulgaris Can Be Facilitated Using Advanced Endoscopic Methods

Medicina ◽

10.3390/medicina57070686 ◽

2021 ◽

Vol 57 (7) ◽

pp. 686

Author(s):

Lucia Staníková ◽

Martin Formánek ◽

Pavel Hurník ◽

Peter Kántor ◽

Pavel Komínek ◽

...

Keyword(s):

Early Diagnosis ◽

Retrospective Analysis ◽

Narrow Band ◽

Narrow Band Imaging ◽

Pemphigus Vulgaris ◽

Tertiary Hospital ◽

Specific Pattern ◽

Vascular Changes ◽

Mucosal Lesions ◽

Endoscopic Methods

Background: Isolated laryngeal pemphigus vulgaris (LPV) is rare; however, early diagnosis is crucial in determining its course and prognosis. This paper aims to describe mucosal vascular changes typical for LPV using advanced endoscopic methods, which include Narrow Band Imaging (NBI), IMAGE1-S video-endoscopy and enhanced contact endoscopy (ECE). Materials and Methods: Retrospective analysis of all laryngeal mucosal lesion examined using advanced endoscopic methods during 2018–2020 at tertiary hospital was performed. Results: Videolaryngoscopy examination records of 278 patients with laryngeal mucosal lesions were analyzed; three of them were diagnosed with LPV. Epithelial vascularization of LPV included specific pattern. Intraepithelial papillary capillary loops were symmetrically stratified and were organized into “contour-like lines”. This specific vascularization associated with LPV were different from other laryngeal mucosal pathologies. Conclusions: Using advanced endoscopic methods supports early diagnosis of LPV and accelerate the diagnosis and treatment.

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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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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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Narrow band imaging in early diagnosis of laryngopharyngeal malignant and premalignant lesions

Auris Nasus Larynx ◽

10.1016/j.anl.2021.11.008 ◽

2021 ◽

Author(s):

Mohabbat Ali ◽

Gaurav Gupta ◽

Manju Silu ◽

Deep Chand ◽

Vivek Samor

Keyword(s):

Early Diagnosis ◽

Narrow Band ◽

Narrow Band Imaging ◽

Premalignant Lesions

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The predictive value of videostroboscopy in the assessment of premalignant lesions and early glottis cancers

Otolaryngologia Polska ◽

10.5604/01.3001.0010.2243 ◽

2017 ◽

Vol 71 (4) ◽

pp. 14-18 ◽

Cited By ~ 1

Author(s):

Anna Rzepakowska ◽

Ewelina Sielska-Badurek ◽

Ewa Osuch-Wójcikiewicz ◽

Michał Sobol ◽

Kazimierz Niemczyk

Keyword(s):

Predictive Value ◽

Vocal Fold ◽

Histopathological Examination ◽

High Sensitivity ◽

Vocal Folds ◽

Invasive Cancer ◽

Premalignant Lesions ◽

Good Tool ◽

Malignant Lesions ◽

Sensitivity Specificity

Objective: To assess the sensitivity and specificity of larngovideostroboscopy (LVS) in the diagnosis of precancerous and malignant lesions of the vocal folds. Material and methods: In 175 patients (128 men and 47 women), aged 19-88 years, mean age 61.5, who were admitted to the clinic with diagnosed premalignant conditions of vocal fold mucosa (leukoplakia, chronic hypertrophic inflammatory lesions) and thickening or tumor on the vocal fold, there was performed LVS before the laryngeal microsurgery. The LVS study included: localization of the leasion, movement of the vocal folds, mucosal wave, shape of glottis clousure, amplitude and symmetry of vocal fold vibration. In the evaluation, a point scale was applied for the individual functional parameters. The scale ranged from 0 to 14. Patients with impaired vocal fold motion or absent mucosal wave were positive on LVS for malignant lesions. Those with limitted mucosal wave were positive on LVS for dysplastic lesions. The results were compared with the final histopathological examination and the sensitivity, specificity, accuracy, positive (PPV) and negative (NPV) predictive value were calculated. Results: On the basis of histopathological examination, benign lesions (normal or inflammatory mucosa) accounted for 20% of diagnoses, hypertrophy and parakeratosis for 28%, low and middle grade dysplasia accounted for 10% and malignant lesions (high-grade dysplasia, pre-invasive cancer, Invasive cancer) was diagnosed in 42% of patients. The overall mean score for LVS was 4.5 and 8.0, respectively for benign and malignant lesions. Sensitivity, specificity, accuracy, PPV and NPV of LVS in detecting malignant lesions were respectively - 95.6%, 23.8%, 61.1%, 57.6% and 83.3% and in detecting both premalignant and malignant lesions were respectively – 90.7%, 31.4%, 78.9%, 84.1% and 45.8%. Conclusions: Because of the high sensitivity of LVS in detecting precancerous and malignant lesions, this method is a very good tool for screening of pathology within the larynx.

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