Abstract
PurposeFlexible transnasal endoscopy is a common examination technique for the evaluation of laryngeal lesions, while the use of narrow band imaging (NBI) has been reported to enhance the diagnostic value of white light endoscopy (WLE). The purpose of this study is to assess observer variability and diagnostic value of both modalities and investigate the possible influence of previous laryngeal surgery on the detection rates of laryngeal malignancy.MethodsThe study was based on the retrospective evaluation of 170 WLE and NBI images of laryngeal lesions by three observers in a random order. The histopathological diagnoses serve as the gold standard.ResultsIn identifying laryngeal malignancy, the sensitivity of NBI proved to be higher than that of WLE (93.3% vs. 77.0%). NBI was also superior to WLE in terms of accuracy (96.3% vs. 92%) and diagnostic odds ratio (501.83 vs. 120.65). Both modalities had a specificity of 97.3%. The inter-observer agreement was substantial (kappa = 0.661) for WLE and almost perfect (kappa = 0.849) for NBI. Both WLE and NBI showed a high level of intra-observer agreement. The sensitivity was significantly lower in images with history of previous laryngeal surgery compared to those without.ConclusionsFlexible transnasal endoscopy has been proved to be a valuable tool in the diagnosis of laryngeal malignancy. The use of NBI can increase the sensitivity and observer reliability in that context and can also provide a diagnostic gain in cases with previous laryngeal surgery
Highlights
The endoscopic diagnosis of laryngeal lesions has substantially evolved in recent years due to various technological developments, such as improvements in image resolution and the introduction of optical image-enhancement modalities
Narrow Band Imaging (NBI) is an optical modality based on the use of narrow band optical filters corresponding to the absorption peaks of haemoglobin
It allows better visualization of mucosal and submucosal vessels and clearer demarcation of mucosal abnormalities compared to standard white light endoscopy (WLE) without the use of dyes, as in optical chromoendoscopy [1,2,3]
Summary
The endoscopic diagnosis of laryngeal lesions has substantially evolved in recent years due to various technological developments, such as improvements in image resolution and the introduction of optical image-enhancement modalities. The use of flexible transnasal endoscopy can provide important clinical benefits in that context as it is timesaving, well tolerated by patients, requires no general anesthesia, and allows close examination of the laryngeal mucosa. Narrow Band Imaging (NBI) is an optical modality based on the use of narrow band optical filters (wavelengths with peaks at 415 nm and 540 nm) corresponding to the absorption peaks of haemoglobin. It allows better visualization of mucosal and submucosal vessels and clearer demarcation of mucosal abnormalities compared to standard white light endoscopy (WLE) without the use of dyes, as in optical chromoendoscopy [1,2,3]. Since its introduction to otorhinolaryngology by Muto in [4,5,6], NBI has continuously provided promising results in various clinical fields, including the diagnosis of laryngeal lesions.
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