Abstract
Objectives/HypothesisRecurrent respiratory papillomatosis (RRP) is a benign disease caused by human papillomavirus 6 and 11. The characteristic feature of this disease are wart-like lesions covering the respiratory epithelium with a predilection for the larynx. There is no curative treatment for the disease. The goal of the treatment is a total surgical removal of the papillomatous lesions in order to reduce the number of relapses. Therefore, a good visualization method of papillomas is crucial during surgery. The aim of the study was to compare the accuracy of narrow band imaging (NBI) to the use of white light alone in detecting RRP.MethodsThe study was carried out between April 2013 and November 2015 at Poznan University of Medical Sciences, Department of Otolaryngology, Poland. Rigid endoscopy with conventional white light (WL) and NBI (CV-260SL processor and CLV- 260SL light source, Olympus Optical Co. Ltd, Tokyo, Japan) was performed in all patients during direct laryngoscopy. All anatomical sites of the larynx and trachea were assessed using the Dikkers scale and Derkay total site scoring system with WL and NBI. The consensus was reached as to the number of lesions seen in WL compared to NBI.ResultsDuring 36 microlaryngoscopies, the number of papillomas detected in the larynx (by Derkay total site score) differed significantly between white light endoscopy and NBI (Wilcoxon test p = 0.000655). In endoscopy with NBI, a mean of 1.3 more papillomas in Derkay total site score was detected in comparison to white light endoscopy NBI showed additional areas of diseased tissue in 15/36 (41.67%) patients.ConclusionsNBI as an additional tool during microlaryngoscopy can improve the detection of papillomatous lesions.
Highlights
Recurrent respiratory papillomatosis (RRP) is a benign disease caused by human papillomavirus 6 and 11
During 36 microlaryngoscopies, the number of papillomas detected in the larynx differed significantly between white light endoscopy and narrow band imaging (NBI) (Wilcoxon test p = 0.000655)
In endoscopy with NBI, a mean of 1.3 more papillomas in Derkay total site score was detected in comparison to white light endoscopy NBI showed additional areas of diseased tissue in 15/36 (41.67%) patients
Summary
Recurrent respiratory papillomatosis (RRP) is a rare (with an incidence of 4.3 per 100 000 among children and 1.8 per 100 000 among adults [1]), benign disease caused by human papillomavirus (HPV) 6 and 11[2]. Surgical removal remains the first-line treatment method. The goal of RRP therapy is a precise surgical removal of every single lesion. Even despite a positive outcome of the surgery, laryngeal papillomatosis has a high rate of recurrence and currently, there is no curative treatment for the disease. Some patients may require over 100 surgeries for complete removal of papillomata [3]. Patients may suffer from lower voice quality. According to Loizu et al 68 to 78% of adult patients suffering from RRP experience voice dysfunction [4]
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