Intraepithelial Papillary Capillary Loop Research Articles

Clinical significance of type IV vascularization of laryngeal lesions according to the Ni classification

BackgroundScattered, small, dot-like intraepithelial papillary capillary loops (IPCLs) represent type IV epithelial vascularization according to “Ni classification” and are considered to be nonmalignant. According to the European Laryngological Society classification, these loops are malignant vascular changes. This contradiction has high clinical importance; therefore, clarification of the clinical significance of type IV vascularization according to the Ni classification is needed.MethodsThe study was performed between June 2015 and December 2022. All recruited patients (n = 434) were symptomatic, with macroscopic laryngeal lesions (n = 674). Patients were investigated using the enhanced endoscopic methods of narrow band imaging (NBI) and the Storz Professional Image Enhancement System (IMAGE1 S). The microvascular patterns in the lesions were categorized according to Ni classification from 2011 and all lesions were examined histologically.ResultsA total of 674 lesions (434 patients) were investigated using flexible NBI endoscopy and IMAGE1 S endoscopy. Type IV vascularization was recognized in 293/674 (43.5%) lesions. Among these 293 lesions, 178 (60.7%) were benign (chronic laryngitis, hyperplasia, hyperkeratosis, polyps, cysts, granulomas, Reinkeho oedema and recurrent respiratory papillomatosis); 9 (3.1%) were squamous cell carcinoma; 61 (20.8%) were mildly dysplastic, 29 (9.9%) were moderately dysplastic, 14 (4.8%) were severe dysplastic and 2 (0.7%) were carcinoma in situ. The ability to recognize histologically benign lesions in group of nonmalignant vascular pattern according to Ni (vascularization type I-IV) and distinguish them from precancers and malignancies was with accuracy 75.5%, sensitivity 54.4%, specificity 94.4%, positive predictive value 89.6% and negative predictive value 69.9%.ConclusionLaryngeal lesions with type IV vascularization as defined by Ni present various histological findings, including precancerous and malignant lesions. Patients with type IV vascularization must be followed carefully and, in case of progression mucosal lesion microlaryngoscopy and excision are indicated.

The Effectiveness of White Light Endoscopy Combined With Narrow Band Imaging Technique Using Ni Classification in Detecting Early Laryngeal Carcinoma in 114 Patients: Our Clinical Experience

By displaying tumor-specific neoangiogenesis, narrow band imaging (NBI), a novel imaging approach, enhances the diagnosis of head and neck cancers and makes it more accurate OBJECTIVE: To determine the effect of NBI in combination with white light endoscopy (WLE) for diagnosis of preneoplastic or neoplastic laryngeal cancers according to Ni classification and to conclude if higher Ni classification and tumor stage are related. We enrolled 114 patients with various laryngeal cancer between December 2018 and June 2021. Patients were examined with WLE and NBI. Squamous cell carcinoma (SCC) accounted for 46 cases, benign lesions 30 cases, and nondysplastic, low-grade, and severe dysplasias for 38 cases. Based on characteristics of the intraepithelial papillary capillary loop (IPCL), endoscopic NBI results were divided into five categories (I, II, III, IV, and V). Type I-IV are regarded to be benign, while type V is considered to be cancerous. An incisional biopsy was conducted to assess histopathology, and the histopathology was compared to the NBI results. We assessed the negative predictive value (NPV), positive predictive value (PPV), specificity, and sensitivity for WLE alone and WLE combined with NBI. Analyses were conducted using SPSS software version 26. The WLE combined with NBI showed excellent sensitivity (96%) compared to WLE (86.4%). Specificity was higher in the WLE combined with NBI (96.4%) than WLE alone (91.7%). WLE combined with NBI saw a NPV of 89% as compared with WLE with 88%. WLE and WLEin combination with NBI, recorded a PPV of 90% and 98%, respectively. The accuracy of detecting laryngeal cancer increases when WLE and NBI are combined. Combined NBI with WLE remains highly sensitive to early glottis cancer. Accuracy of preoperative NBI was high. In the diagnosis of laryngeal cancer, a higher Ni classification closely correlates with the late stages of the glottis tumor.

Contact Endoscopic Surface Vascular and Epithelial Morphology in Leukoplakia and Carcinoma of the Vocal Cords

Purpose Leukoplakia is a macroscopic morphological term for thick white or grey mucosal patches that can represent various histologic diagnostic entities ranging from hyperplasia to malignancy. Aim was the study morphology of the superficial mucosa and microvascular network of the vocal cords in patients with suspected glottic squamous cell carcinoma (SCC) using contact endoscopy (CE). Material and Methods Seventy-nine patients (21 female, 58 male), with a mean age of 57.5 years ± 7.12 (range, 32–73 years), were prospectively enrolled and evaluated. Of these patients, 58 had leukoplakia (Group A/41 males and 17 females, with a mean age of 53.7 years ± 6.65), and 21 (Group B/ 17males and 4 females/ with a mean age of 60.5 years ± 6.04) had malignant lesions (pT1, n = 6; p T2, n = 8; pT3, n = 8; Group B), as proven by the results of the histological examination. Further, 79 non-smokers (control group—group C) were studied. CE imaging findings were classified into five types (I to V) based on the features of the mucosal intra-epithelial capillary loops. CE findings were correlated to the histologic findings. A separate analysis involving smoking status was done. Results The CE-based intraepithelial papillary capillary loop classification score was strongly correlated with the histological findings. Age was strongly associated with both malignancy and bilateral involvement. Smoking habits didn’t significantly differ between patients with unilateral and bilateral SCC. Conclusions CE imaging of the vocal cord mucosal capillaries may be useful for the early detection of glottic SCC and pre-cancerous lesions.

Accuracy of narrow band imaging for detecting the malignant transformation of oral potentially malignant disorders: A systematic review and meta-analysis.

Oral potentially malignant disorders (OPMDs) are a spectrum of diseases that harbor the potential of malignant transformation and developing into oral squamous cell carcinoma (OSCC). Narrow band imaging (NBI) has been clinically utilized for the adjuvant diagnosis of OPMD and OSCC. This study aimed to comprehensively evaluate the diagnostic accuracy of NBI for malignant transformations of OPMD by applying the intraepithelial papillary capillary loop (IPCL) classification approach. Studies reporting the diagnostic validity of NBI in the detection of OPMD/OSCC were selected. Four databases were searched and 11 articles were included in the meta-analysis. We performed four subgroup analyses by defining IPCL I/II as negative diagnostic results and no/mild dysplasia as negative pathological outcome. Pooled data were analyzed using random-effects models. Meta-regression analysis was performed to explore heterogeneity. After pooled analysis of the four subgroups, we found that subgroup 1, defining IPCL II and above as a clinically positive result, demonstrated the most optimal overall diagnostic accuracy for the malignant transformation of OPMDs, with a sensitivity and specificity of NBI of 0.87 (95% confidence interval (CI) [0.67, 0.96], p < 0.001) and 0.83 [95% CI (0.56, 0.95), p < 0.001], respectively; while the other 3 subgroups displayed relatively low sensitivity or specificity. NBI is a promising and non-invasive adjunctive tool for identifying malignant transformations of OPMDs. The IPCL grading is currently a sound criterion for the clinical application of NBI. After excluding potentially false positive results, these oral lesions classified as IPCL II or above are suggested to undergo biopsy for early and accurate diagnosis as well as management.

NBI and Laryngeal Papillomatosis: A Diagnostic Challenge: A Systematic Review.

Highlights▪Laryngeal papillomatosis (LP) is considered a benign lesion, caused by HPV low-risk subtypes 6 and 11.▪Narrow-band imaging (NBI) endoscopy is a useful diagnostic tool for distinguishing between benign and malignant laryngeal lesions.▪Laryngeal squamous cell carcinoma (LSCC) and LP show the same type V pattern according to Ni classification on NBI.▪Epithelial surface and clinical features of LP should be researched to determine a correct differential diagnosis between LP and LSCC.Narrow-band imaging (NBI) represents a valid aid in laryngeal squamous cell carcinoma (LSCC) diagnosis for detecting vascular changes. However, LSCC and laryngeal papillomatosis (LP) show similar vascular patterns that may lead to misdiagnosis and improper treatment. This review aims to deepen this NBI limit in order to stress a careful preoperative evaluation of laryngeal lesions. The research was carried out on PubMed, Web of Science and Scopus databases using specific keywords. The topic of research was assessed by these parameters: accuracy, sensitivity, specificity, and positive and negative predictive values. This review included only five articles: they demonstrated that NBI is better than white-light endoscopy in detecting LSCC and LP. They also reported that LP is frequently mistaken for LSCC, resulting in high rates of false positives using NBI. This is the first review that emphasized this NBI limitation in distinguishing between LP and LSCC in cases of a type V pattern of intraepithelial papillary capillary loop. Although NBI application increased the rate of early cancer detection, LP reduces NBI accuracy. This drawback may lead to misdiagnosis and improper treatment. Our advice is to be careful in cases of type V pattern on NBI and to research LP epithelial and clinical features because it could be a pitfall.

Diagnostic Accuracy of High-Grade Intraepithelial Papillary Capillary Loops by Narrow Band Imaging for Early Detection of Oral Malignancy: A Cross-Sectional Clinicopathological Imaging Study.

Simple SummaryThis study aimed to clarify the advantages and disadvantages of conventional visual inspection (CVI), endoscopic white light imaging (WLI), and narrow-band imaging (NBI) and to examine the diagnostic accuracy of intraepithelial papillary capillary loops (IPCL) for the detection of oral squamous cell carcinoma (OSCC). All OSCC cases showed high-grade (Type III–IV) IPCL. A non-homogeneous lesion with high-grade IPCL strongly suggested malignancy. Our results indicate that WLI and NBI are powerful tools for detecting precancerous and cancerous lesions using IPCL. However, NBI is influenced by mucosal thickness; therefore, image interpretation is important.This study aimed to clarify the advantages and disadvantages of conventional visual inspection (CVI), endoscopic white light imaging (WLI), and narrow-band imaging (NBI) and to examine the diagnostic accuracy of intraepithelial papillary capillary loops (IPCL) for the detection of oral squamous cell carcinoma (OSCC). This cross-sectional study included 60 participants with oral mucosal diseases suspected of having oral potentially malignant disorders (OPMDs) or OSCC. The patients underwent CVI, WLI, NBI, and incisional biopsy. Images were evaluated to assess the lesion size, color, texture, and IPCL. Oral lichen planus (OLP) and oral leukoplakia lesions were observed in larger areas with NBI than with WLI; 75.0% were associated with low-grade (Type 0–II) IPCL. Various types of oral leukoplakia were seen; however, all OSCC cases showed high-grade (Type III–IV) IPCL. The diagnostic accuracy of high-grade IPCL for OSCC showed a sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 100%, 80.9%, 59.1%, 100%, and 85.0%, respectively. A non-homogeneous lesion with high-grade IPCL strongly suggested malignancy. Overall, our results indicate that WLI and NBI are powerful tools for detecting precancerous and cancerous lesions using IPCL. However, NBI is influenced by mucosal thickness; therefore, image interpretation is important for accurate diagnosis.

Vocal fold fibroblasts promote angiogenesis in vocal fold leukoplakia by secreting pro-angiogenic factors

ObjectiveCancer-associated fibroblasts (CAFs) have been reported to play an essential role in tumor angiogenesis and progression. In this study, we aimed to investigate the impact of vocal fold leukoplakia-associated fibroblasts (VFLFs) on the angiogenesis process in vocal fold leukoplakia (VFL) and their potential secretions of proangiogenic factors. MethodsA total of 160 lesions (86 laryngeal carcinoma, 67 vocal fold leukoplakia, 7 vocal fold polyp) were detected under narrow band imaging (NBI) mode to evaluate the relationship between pathology and intraepithelial papillary capillary loop (IPCL) grades. We characterized immortalized vocal fold CAFs, VFLFs, normal fibroblasts (NFs) cell lines using immunofluorescence cytochemistry and real-time quantitative polymerase chain reaction (RT-qPCR). The effects of fibroblast conditioned media (CM) on the proliferative, migrating and tube formation capacity of human umbilical vein endothelial cells (HUVEC) were investigated using the cell counting kit-8 (CCK-8) assay, wound healing assay, transwell migration experiment and Matrigel tube formation experiment. The expression levels of proangiogenic factors in CAFs, VFLFs, and NFs were evaluated by antibody microarray and RT-qPCR. ResultsNBI images depicted that angiogenesis was abnormally activated during laryngeal tumorigenesis. Both CAF and VFLF expressed Vimentin, alpha-smooth muscle actin (α-SMA) and fibroblast activation protein (FAP). NF expressed Vimentin and α-SMA, but not FAP. The PCR results showed that mRNA expression levels of Vimentin, α-SMA and FAP in CAFs and VFLFs were significantly increased than those in NFs. CAF-CM and VFLF-CM promoted the proliferative, migrating, and tube formation ability of HUVECs. Secretome profiling of fibroblasts by antibody microarray demonstrated that VFLFs secreted significantly more vascular endothelial growth factor (VEGF), angiogenin, bFGF and HGF than NFs. ConclusionsOverall, we demonstrated that VEGF, angiogenin, bFGF and HGF derived from VFLFs may play crucial roles in the angiogenesis process of laryngeal premalignant and malignant lesions. This may contribute to the exploitation of novel therapeutic strategies for VFL.

Correlating intraepithelial papillary capillary loops of vocal cord leukoplakia with histopathology

Background The pathology of vocal fold leukoplakia (VFL) was hard to predict before surgery. Objectives To investigate the correlation of intraepithelial papillary capillary loops (IPCLs) with the malignant transformation in VFL. Materials and Methods The IPCLs in 90 patients were classified according to 2019 Ni classification. Type I–III represented to non- to moderate dysplasia in pathology being viewed as ‘benign leukoplasia’, type IV–VI represented to severe dysplasia/cancer in situ, cancerization being viewed as ‘malignant leukoplasia’. The corresponding relationship of IPCLs with pathology was calculated. Results Forty-one cases were classified as type I–III, the consistency of type I–III with pathology was 61.0%, with 100.0% of type I, 47.1% of type II and 30.0% of type III. 49 cases were classified as type IV–VI, all were ‘malignant leukoplasia’, the consistency of type IV–VI and pathology was 100.0%. The accuracy of type I–III, IV–VI to predict pathology were 61.0, 100.0%. The sensitivity, specificity, accuracy, positive predictive value, negative predictive value of Ni classification corresponding to ‘benign/malignant leukoplasia’ was 75.8, 100.0, 82.2, 100.0, 60.0%, respectively. Conclusions and Significance IPCLs of type IV–VI in vocal cord leukoplasia had a close correlation with pathology. The degree of dysplasia was underestimated in type II and type III.

Význam flexibilní endoskopie s Narrow Band Imaging pro hodnocení recidivy nádorů hrtanu a hypofaryngu po radioterapii

Background: The dia­gnosis of recurrent upper aerodigestive tumours is difficult, especially in the case of previous curative radiotherapy (RT) or chemoradiotherapy (CRT). Progress in the dia­gnostics of head and neck cancer came with the development of optical endoscopic imaging methods. The aim of this study was to analyse the benefits of flexible Narrow Band Imaging (NBI) in the visualization of suspected recurrence of malignancy in patients after curative RT (CRT). Methods: A total of 58 examined patients in follow-up after curative RT or CRT for laryngeal and hypopharyngeal squamous cell carcinoma were enrolled in the study. All patients underwent transnasal flexible endoscopy in conventional white light and NBI in local anaesthesia. Changes in microvascular architecture (intraepithelial papillary capillary loops – IPCL) have been classified according to Ni. IPCL I–III were considered to be non-suspicious, and therefore no histopathological examination was indicated. IV and V type findings were verified using HDTV NBI intraoperatively with bio­psy sampling and subsequent histopathological correlation was performed. Results: Transnasal videoendoscopic examination with NBI revealed a suspicious finding (IPCL type IV and V) in 23/58 (39.7%) patients, non-suspicious finding (IPCL I–III) in 35/58 (60.3%). Histopathological examination verified the positive finding (precancerous or malignant changes) in 12/23 (52.2%) and negative finding in 11/23 (47.8%) cases. The sensitivity, specificity, positive and negative predictive value of flexible NBI endoscopy were 100%, 76.1%, 52.2% and 100% respectively. According to the Kappa index (K = 0.568), we proved a moderate concordance between flexible NBI endoscopy and histopathological results. Conclusions: Transnasal flexible endoscopy with NBI in outpatient settings contributes to an early detection of pathological changes also in post-radiation altered mucosa of the larynx and hypopharynx, while a correct interpretation of in NBI findings is required to reduce the incidence of false positive results. Keywords: squamous cell carcinoma – Larynx – radiotherapy – narrow band imaging – Ni classification – hypopharynx

Role of Narrow Band Imaging in Laryngeal Lesions: A Prospective Study from Southern India.

To assess the utility of Narrow Band Imaging (NBI) as a diagnostic tool in evaluating laryngeal pathology in patients presenting with hoarseness. Study design: Prospective cross sectional diagnostic study. Methods: 200 patients with voice change were recruited and laryngeal findings documented with high definition flexible endoscopy with both white light and narrow band light and the representative still images recorded for analysis. The NBI intraepithelial papillary capillary loop (IPCL) patterns was compared with the histopathology report. Of the 200 patients evaluated, 84 lesions were biopsied which included both benign and malignant lesions. The sensitivity obtained was 73.3% [54.1-87.7% with 95% CI] and the specificity was 87% [75.1-94.6% with 95% CI] for detecting malignant lesions. NBI can be considered as a useful diagnostic tool in evaluating laryngeal pathology and can be used to detect early premalignant and malignant lesions.

Diagnosis of Laryngeal Pemphigus Vulgaris Can Be Facilitated Using Advanced 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.

Endoscopic diagnosis value of narrow band imaging Ni classification in vocal fold leukoplakia and early glottic cancer

ObjectivesTo explore the diagnostic value and the correlation between histological diagnosis and the Ni classification under narrow band imaging (NBI) for vocal fold leukoplakia (VFL) and early glottic cancer. MethodsA total of 91 patients with 119 vocal fold lesions were selected from January 2017 to May 2020. All these patients were subsequently examined by white light imaging (WLI) and NBI endoscopy, and then all lesions were classified by the Ni classification according to the characteristics of intraepithelial papillary capillary loop (IPCL) observed. The gold standard of diagnosis was histopathological results. Eventually, the chi-square and kappa test were applied, respectively, to evaluate the diagnostic value of NBI endoscopy and the consistency of Ni classification and pathological results. ResultsThe accuracy and sensitivity of NBI endoscopy were significantly higher than that of WLI endoscopy (P < 0.05). For the diagnosis of precancerous lesions under the NBI, the sensitivity, specificity, positive and negative predictive value were 69.6% (16/23), 90.6% (87/96), 64.0% (16/25) and 92.6% (87/94), which for malignant lesions were 84.4% (65/77), 92.9% (39/42), 95.6% (65/68) and 76.5% (39/51). Moreover, for patients with low-grade intraepithelial neoplasia (mild and moderate dysplasia), type IV lesions accounted for the most (69.6 vs 30.4%; χ2 = 36.961, P < 0.001). For high-grade intraepithelial neoplasia or carcinoma in situ, type Va lesions were predominant (χ2 = 30.526, P < 0.001), while type Vb and Vc lesions were dominant in invasive carcinoma (χ2 = 64.373, P < 0.001). Besides, the kappa test revealed that there was a high consistency between Ni classification and pathological diagnosis (Kappa = 0.667, P < 0.001). ConclusionsThe Ni classification can improve the diagnosis accuracy of vocal fold lesions which enables clear visualization of mucosal microvasculature. This is essential for the early diagnosis of VFL and early glottic cancer during routine endoscopic examination.

Diagnostic Value and Pathological Correlation of Narrow Band Imaging Classification in Laryngeal Lesions.

To explore the diagnostic value and pathological correlation of narrow band imaging (NBI) classification in laryngeal lesions. A total of 112 patients (123 lesions) with laryngeal lesions from July 2018 to May 2019 were selected in this study. All patients were examined by NBI and white light imaging endoscopy. The NBI endoscopy was applied to classify the observed lesion sites according to intraepithelial papillary capillary loop pattern. The gold standard of diagnosis was pathological results. To evaluate the consistency of NBI classification and pathological results. The sensitivity, specificity, positive predictive value, and negative predictive value of the diagnosis for benign, precancerous, and malignant lesions under the NBI endoscopy were 90.91%, 81.19%, 74.07%, 85.42%; 41.67%, 92.93%, 58.82%, 86.79%; and 93.51%, 65.22%, 91.14%, 68.18%, respectively. There was a high consistency between NBI classification and pathological results (κ = 0.679, P < .001). The NBI classification can improve the accuracy of the diagnosis of laryngeal lesions. It is important for early diagnosis and treatment of vocal cord leukoplakia and laryngeal cancer.

Quantification of structural and microvascular changes for diagnosing early-stage oral cancer.

Changes in mucosal microvascular networks, called intraepithelial papillary capillary loops (IPCL), are an important key factor for diagnosing early-stage oral cancer in vivo. Nevertheless, there are a lack of tools to quantify these changes objectively. This is the first study to quantify the IPCL changes in vivo to differentiate benign or malignant oral lesions by the optical coherence tomography (OCT) technique. K14-EGFP-miR-211-GFP transgenic mice were inducted by 4-Nitroquinoline-1-oxide to produce oral carcinogenesis in different stages, including normal, premalignancy and cancer. The results showed significant differentiation between benign or malignant lesions by OCT quantitative parameters, including epithelial thickness, IPCL density, radius and tortuosity.

The progress of narrow band imaging endoscopy in diagnosis of vocal cord leukoplakia

SummaryThe appearances of vocal cord leukoplakia are largely identical in the macroscopic examination even though the pathological character may differ. This makes it difficult for physicians to evaluate the extent of dysplasia of vocal cord leukoplakia and detect the occurrence of canceration using the conventional laryngoscopy, which might result in overtreatment or undertreatment of vocal cord leukoplakia in different patients. Therefore, an accurate preoperative assessment of the pathological character of vocal cord leukoplakia shows clinical significance in the selection of an appropriate treatment plan and predicting the prognosis of a patient. Recent studies have found that narrow band imaging（NBI） endoscopy can facilitate the early and differential diagnosis of head and neck cancers by observing the intraepithelial papillary capillary loop（IPCL） patterns at the mucosal surfaces. In this paper, the recent progress of NBI endoscopy in the diagnosis of vocal cord leukoplakia is reviewed.

Clinicopathological features and outcomes of esophageal lesions containing a basal layer type squamous cell carcinoma component.

PurposeBasal layer type squamous cell carcinoma (BLSCC) is a unique type of squamous cell carcinoma (SCC), characterized by high-grade dysplastic cells occupying the lower half of the epithelium. So far, such special lesions do not seem to attract much attention. The aim of this study was to investigate the clinicopathological features and prognosis of esophageal squamous carcinoma lesions with a BLSCC component.Materials and methodsBetween January 2011 and January 2018, 96 patients with esophageal squamous cell carcinoma underwent endoscopic submucosal resection in our hospital were retrospectively analyzed. Patients were divided into BLSCC or typical SCC groups according to the presence or absence of a BLSCC component. The endoscopic findings were compared between the two groups. Furthermore, patients were followed up until October 2018 to compare recurrence rates.ResultsBLSCC components were detected in 32 (33.3%, 32/96) lesions. Among them, 13 (40.62%, 13/32) were BLSCC predominant. The intraepithelial papillary capillary loops of 7 pure BLSCC showed type B1 under narrow-band imaging. Single-factor and multivariate analyses indicated that five or more independently scattered, deep-stained spots in iodine-unstained areas were significantly predictive of the presence of BLSCC components (OR=4.837, P=0.015). All patients of typical SCC group survived, but one of BLSCC group died for distant metastases during the follow-up period. The 1-year cumulative recurrence rate (CRR) of BLSCC group were 3.4%, lower than that of typical SCC group (7.1%). Although no significant difference of CRR was seen between the two groups (P>0.05), the 2-year CRR of BLSCC group increased to 11.9%, being higher than that of typical SCC group (7.1%).ConclusionThe presence of multiple, scattered stained spots in iodine-unstained areas was predictive of BLSCC components. Such lesion should be treated actively and subject to a more rigorous follow-up protocol due to a higher likelihood of late recurrence.

Narrow-band imaging for overcoming the microvascular pattern hidden under the plaque of the vocal fold leukoplakia

Objective:To explore the application of narrowband imaging (NBI) in overcoming the microvascular pattern hidden under the plaque of vocal fold leukoplakia. Method:According to the morphology of intraepithelial papillary capillary loops (IPCL) around the plaque of vocal cord leukoplakia under NBI endoscopy,89 patients with microvascular morphology covered by plaque were divided into different groups. Subepithelial cordectomy was performed in 20 cases of benign group, subligamental cordectomy was performed in 45 cases of suspected malignant group, and transmuscular cordectomy was performed in 24 cases of malignant group, respectively. The lesions of vocal fold were biopsied with suspension micro-laryngoscope, and pathological examinations were also observed. Result:Pathological diagnoses showed that there were 10 cases of squamous epithelial hyperplasia, 8 cases of mild dysplasia, 21 cases of moderate dysplasia, 41 cases of severe dysplasia and carcinoma in situ, and 9 cases of invasive cancer, respectively. Spearman's analysis showed that there was a stronge positive correlation between the microvascular pattern of peripheral regions surrounding the plaque by NBI endoscopy and malignant degree of pathological classification(r=0.725, P<0.01). Conclusion:NBI endoscopy can overcome the "umbrella effect" of vocal cord leukoplakia. The microvascular morphology of the mucosa around the leukoplakia has a good correlation with final pathological diagnoses, and NBI endoscopy is helpful to determine the biopsy depth of the vocal cord leukoplakia.

Early identification of esophageal squamous neoplasm by hyperspectral endoscopic imaging

Esophageal squamous neoplasm presents a spectrum of different diatheses. A precise assessment for individualized treatment depends on the accuracy of the initial diagnosis. Detection relies on comprehensive and accurate white-light, iodine staining, and narrow-band imaging endoscopy. These methods have limitations in addition to its invasive nature and the potential risks related to the method. These limitations include difficulties in precise tumor delineation to enable complete resection, inflammation and malignancy differentiation, and stage determination. The resolution of these problems depends on the surgeon’s ability and experience with available technology for visualization and resection. We proposed a method for identifying early esophageal cancerous lesion by endoscopy and hyperspectral endoscopic imaging. Experimental result shows the characteristic spectrum of a normal esophagus, precancerous lesion, canceration, and intraepithelial papillary capillary loop can be identified through principal component score chart. The narrow-band imaging (NBI) image shows remarkable spectral characteristic distribution, and the sensitivity and specificity of the proposed method are higher than those of other methods by ~0.8 and ~0.88, respectively. The proposed method enables the accurate visualization of target organs, it may be useful to capsule endoscope and telemedicine, which requires highly precise images for diagnosis.

Narrow band imaging for risk stratification of glottic cancer within leukoplakia.

This study investigates relevance of narrow band imaging (NBI) in stratifying risk of malignant transformation within leukoplakia. We conducted a prospective analysis that included 62 patients with 91 changes of leukoplakia on vocal folds. The NBI was obtained before microsurgery. Categorization of the lesion as benign was made when vessels of surrounding epithelium were classified as type I, II, or IV according to Ni classification. If there were visualized intraepithelial papillary capillary loops of type V, the lesion was classified as malignant. Results were compared to the histopathological diagnosis. The NBI assessment classified 75 lesions (82.4%) as benign and 16 (17.6%) as malignant. Histopathological results revealed the diagnosis of no dysplastic changes or low grade dysplasia in 77 cases (84.6%). Another 14 cases (15.4%) occurred with high-grade dysplasia, carcinoma in situ, and invasive cancer. Sensitivity, specificity, and accuracy of NBI in predicting malignancy within leukoplakia were 100%, 97.4%, and 97.8%, respectively. The kappa index was 0.92 (95% confidence interval 81.1%-100%). The noninvasive procedure of an NBI endoscopy may be recommended as an accurate method in predicting the risk of malignant transformation within the vocal fold leukoplakia and, therefore, would be useful in the clinic for planning the patient's therapy.

Comparative histomorphometric study of intraepithelial papillary capillaries on leukoplakia with/without different dysplastic grading and squamous cell carcinoma of the oral mucosa

Tumor growth is closely related to the development of an intrinsic vascular network. However, microvascular appearance was not regarding highly to pathological diagnosis, though clinical applicability of endoscopic narrow-bad imaging (NBI) is developed in the oral cavity. To analyze changes of intraepithelial papillary capillary loop (IPCLs) patterns as the utility for pathological diagnosis, comparative histomorphometric analysis of IPCLs among squamous cell hyperplasia, leukoplakia with low- or high-grade dysplasia, and oral squamous cell carcinoma (OSCC) had performed. Subjects were 40 clinically hyperkeratosis, histologically consisted 5 groups; each 10 of squamous cell hyperplasia, low- or high-grade dysplasia, OSCC and normal mucosae. Sections with smooth muscle actin and CD34 immunoreactivities were used to examine comparative histomorphometric analysis on the basis of IPCL irregularities. The area, shortest diameter, proximity to the basement membrane and circularity were measured using Win Roof image analysis software. Statistical analyses were done by Kruskal–Wallis and Steel–Dwass tests. Values of p < 0.05 were considered significant. Larger vessel diameter/areas, more extension and smaller circularity with dysplastic grading, and OSCC showed the most prominent of them. In short, the changes in vessels of IPCLs in high-grade dysplasia and OSCC involve two factors: increased vessel diameter and prolongation of IPCLs toward the surface. The microvascular irregularity and proliferation composed by IPCLs and IPCL like abnormal capillaries were observed pathologically in squamous epithelial lesions of the oral cavity. The change of IPCLs patterns can be of help in detecting for high-grade dysplasia or OSCC.