A meta-analysis of narrow-band imaging for the diagnosis of primary nasopharyngeal carcinoma.

David Cm Yeung,Michael Cf Tong,Eddy Wy Wong,Alexander C Vlantis,Jason Yk Chan

doi:10.12688/f1000research.15183.1

Abstract

Background: Narrow band imaging (NBI), an endoscopic technique featuring an augmented definition of microvasculature and mucosal patterns. NBI is increasingly advocated as a tool to characterize neoplasia and intestinal metaplasia in endoscopic standards, such as for colorectal polyps and tumors. Recently NBI has also been studied in the detection of Nasopharyngeal Carcinoma (NPC). Here we aimed to assess the diagnostic utility of NBI for the diagnosis of NPC. Methods: A meta-analysis of studies comparing narrow-band imaging and white light endoscopy in the diagnosis of primary nasopharyngeal carcinoma was performed. The review process involved two independent investigators. The databases used were MEDLINE, PubMed, the Cochrane library, Embase, and the Web of Science. Statistical analysis was performed with OpenMetaAnalyst, MetaDiSc version 1.4, and Medcalc version 17.9.7. Results: Five studies including 2480 patients were included. The sensitivity and specificity for narrow-band imaging were 0.90 (0.73-0.97) and 0.95 (0.81-0.99) respectively. The positive likelihood ratio and negative likelihood ratio were 18.82 (0.31-82.1) and 0.08 (0.02-0.31). For white light endoscopy, the sensitivity and specificity were 0.77 (0.58-0.89) and 0.91 (0.79-0.96). The positive likelihood ratio was 7.61 (3.61-16.04), and the negative likelihood ratio was 0.21 (0.11-0.39). The odds ratio for detection rates between narrow-band imaging and white light endoscopy was 4.29 (0.56-33.03, p = 0.16). Area under the curve for narrow-band imaging was 0.98 (SE: 0.02), and for white light it was 0.93 (SE: 0.03). There was no significant difference in the receiver operating characteristic curves between the two modalities (p = 0.14). Conclusion: Narrow-band imaging showed a higher sensitivity and positive likelihood ratio for the diagnosis of nasopharyngeal carcinoma. However, there was no significant difference in detection rates compared to white light endoscopy. Further investigation with a uniform diagnostic criteria and terminology is needed for narrow-band imaging in the diagnosis of nasopharyngeal carcinoma.

Highlights

Nasopharyngeal carcinoma (NPC) is a common head and neck cancer in the southeast Asia[1]
The current standard for Nasopharyngeal Carcinoma (NPC) diagnosis is histological from a white light endoscopy (WL) directed biopsy[3]
This technique, which has been used for the detection of adenomas in the gastrointestinal tract, has the potential to reduce the false negative rates associated with conventional white light endoscopy[6]

Summary

Introduction

Nasopharyngeal carcinoma (NPC) is a common head and neck cancer in the southeast Asia[1]. Narrow-band imaging (NBI) is an imaging technique that uses two specific wavelengths of light that are strongly absorbed by hemoglobin, allowing improved visualization and delineation of mucosal microvascular patterns[5]. This technique, which has been used for the detection of adenomas in the gastrointestinal tract, has the potential to reduce the false negative rates associated with conventional white light endoscopy[6]. Methods: A meta-analysis of studies comparing narrow-band imaging and white light endoscopy in the diagnosis of primary nasopharyngeal carcinoma was performed. Conclusion: Narrow-band imaging showed a higher sensitivity and positive likelihood ratio for the diagnosis of nasopharyngeal carcinoma.

Objectives

Methods

Results

Discussion

Conclusion