Narrow-Band Imaging in Laparoscopic Management of Cervical Carcinoma

Abstract

Peritoneal metastasis detected at initial diagnosis of squamous cell carcinoma of the uterine cervix is extremely rare [1,2]. The presence of peritoneal implants is crucial in the clinical management of cervical carcinoma because it identifies patients suitable to receive systemic chemotherapy. Surgical identification of lesions suspicious for peritoneal implants and histologic confirmation depend on the surgeon’s level of skill and structural characteristics of the implants. Endoscopic biopsy is considered the criterion standard for diagnosis. One method of increasing the predictive value of identified lesions is to enhance the visual markers of neoplastic implants. The neovascularization that is inherent in the pathologic features of neoplastic lesions may be used to enable identification of implants not usually observed using narrow-band imaging (NBI). The NBI system (Olympus Winter & Ibe GmbH, Hamburg, Germany) uses optic image enhancement technology that emphasizes capillary blood vessels and microstructures containing hemoglobin on the mucosal surface. Compared with conventional light of 300 to 700 nm, narrow bands at 415 and 540 nm are strongly absorbed by hemoglobin, which increases the contrast of blood vessels. Thus, microscopic blood vessels not clearly seen under conventional light can be observed. In several studies of gastroscopy, colonoscopy, and bronchoscopy, NBI has been reported as a possible tool for detection of irregular vascular patterns indicative of malignant lesions in the early diagnosis of cancer [3,4]. A recent pilot study described a series of 20 consecutive