Narrow Band Imaging Endoscopy Research Articles

A protocol of systematic review and meta-analysis of narrow band imaging endoscopy in detection of early gastric cancer.

Background:Early gastric cancer is the fifth common malignancy and the third leading cause of cancer death throughout the world. However, it is not clear how endoscopic screening for early gastric cancer affects incidence or mortality. We performed a systematic review and meta-analysis to evaluate the relationship between endoscopic screening for the mortality and incidence of early gastric cancer.Materials and methods:This protocol established in this study has been reported following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. Web of Science, PubMed, EMBASE, and the Cochrane Library were searched for cohort and case-control studies in cases without early gastric cancer until March 31, 2020. We will use a combination of Medical Subject Heading and free-text terms with various synonyms to search based on the Eligibility criteria. Two investigators independently reviewed the included studies and extracted relevant data. The relative risk and 95% confidence intervals were used as effect estimate. I-square test, substantial heterogeneity, sensitivity analysis, and publication bias assessment will be performed accordingly. Stata 15.0 and Review Manger 5.3 are used for meta-analysis and systematic review.Results:The results will be published in a peer-reviewed journal.Conclusion:The results of this review will be widely disseminated through peer-reviewed publications and conference presentations. This evidence may also provide helpful evidence of whether endoscopic screening would reduce the mortality and incidence of early gastric cancer.PROSPERO registration number:CRD42020171053

Clinical applicability of gastroscopy with narrow-band imaging for the diagnosis of Helicobacter pylori gastritis, precancerous gastric lesion, and neoplasia.

Premalignant gastric lesions such as atrophic gastritis and intestinal metaplasia frequently occur in subjects with long-term Helicobacter pylori (H. pylori) infection. The regular arrangement of collecting venules (RAC) is seen in the normal gastric corpus, whereas mucosal swelling and redness without RAC are observed in H. pylori-infected mucosa. Despite successful H. pylori eradication, the presence of atrophic gastritis and/or gastric intestinal metaplasia (GIM) is a risk factor for gastric cancer. With the development of advanced imaging technologies, recent studies have reported the usefulness of narrow-band imaging (NBI) for endoscopic diagnosis of atrophic gastritis and GIM. Using NBI endoscopy with magnification (M-NBI), atrophic gastritis is presented as irregular coiled microvessels and loss of gastric pits. Typical M-NBI endoscopic findings of GIM are a light blue crest and a white opaque substance. Based on the microvascular patterns, fine network, core vascular, and unclear patterns are useful for predicting gastric dysplasia in polypoid lesions. For diagnosis of early gastric cancer (EGC), a systematic classification using M-NBI endoscopy has been proposed on the basis of the presence of a demarcation line and an irregular microvascular/microsurface pattern. Furthermore, M-NBI endoscopy has been found to be more accurate for determining the horizontal margin of EGC compared to conventional endoscopy. In this review, we present up-to-date results on the clinical usefulness of gastroscopy with NBI for the diagnosis of H. pylori gastritis, precancerous gastric lesion, and neoplasia.

A protocol of systematic review and meta-analysis of narrow band imaging endoscopy in detection of early gastric cancer.

Background:Although previous studies have utilized narrow band imaging endoscopy diagnosis (NBIED) in detection of patients with early gastric cancer (EGC), there are still inconsistent results. Thus, this study will explore the accuracy of NBIED in detection of patients with EGC.Methods:We propose to perform literature search of potential studies investigating the accuracy of NBIED in detection of patients with EGC in MEDLINE, EMBASE, Cochrane Library, Web of Science, WANGFANG, VIP database and China National Knowledge Infrastructure from the beginning of each database to January 31, 2020 without restrictions to language and publication time. Two authors will independently scrutinize these databases to identify studies that satisfy all predefined eligibility criteria. We will check study quality and analyze outcome data using Quality Assessment of Diagnostic Accuracy Studies tool, and RevMan 5.3 software respectively.Results:We anticipate the results of this study will afford additional insight into the appraising of the accuracy of NBIED in patients with EGC.Conclusion:The findings of this study will be useful informing diagnostic decisions for the diagnosis of patients with EGC.PROSPERO registration number: PROSPERO CRD42020171053.

The role of Narrow Band Imaging (NBI) in the diagnosis of sinonasal diseases.

Narrow band imaging (NBI) endoscopy is an optical method that helps to characterise tissue vasculature. Its appli- cation in sinonasal pathology remains scarce and a systematic study of its application to rhinology is lacking. The aim of this study is to analyse and describe the normal sinonasal mucosa under NBI light and to characterise the microvascular features of various sinonasal pathologies. We also want to suggest a classification of the patterns, peculiar to this district, and to evaluate whether they can be indicative of a specific physiological or pathological condition. Digital videos and images under white light and NBI of 103 patients (82 evaluated) with 29 sinonasal pathologies and 55 controls (33 evaluated). were independently analysed by three otolaryngologists and the final pattern was then arranged for each image, reaching an agreement between the individual evaluations. Once the appearance of normal sinonasal (SN) mucosa was established (SN1), four patterns for the pathological mucosa were described and a working classification was proposed (SN2, SN3, SN4, SN5). We calculated specificity (80.6% vs 90.6%), sensi- tivity (20% vs 38.5%), PPV (46.1% vs 50%), NPV (54.7% vs 85.7%) and accuracy (53% vs 80.3%) of the ability of SN4 and SN5 pattern to discriminate between benign and malignant nasal neoformations. This is the first study to propose a systematic NBI description and a classification of the vasculature of healthy and pathological mucosa in the sinonasal tract. Our preliminary results show that this technique can help in the workup of several rhinologic conditions and especially in distinguishing benign from malignant tumors.

Narrow band imaging characteristics of gastric polypoid lesions: a single-center prospective pilot study.

Gastric polypoid lesions (GPL) are endoscopic findings whose histological nature is difficult to determine with white-light endoscopy. Hyperplastic polyps (HP), type-1 gastric carcinoids (T1-GC) and adenomas are the most frequent GPL needing different management. Narrow-band imaging (NBI) has high accuracy for gastric malignant lesions but few studies assessed whether GPL display specific NBI characteristics. We aimed to investigate the endoscopic NBI appearances of GPL. During gastroscopies, images of GPL were recorded, and lesions were removed for histological evaluation. Two endoscopists blindly reviewed the digital images and registered the endoscopic NBI appearances on a specific check-list. GPL were categorized in HP, adenomas and T1-GC using histology as gold standard. Overall 52 GPL, observed in 40 patients [F55%; age 63 (36-85) years], were included: 29 (55.8%) HP; 18 (34.6%) T1-GC; 5 (9.6%) adenomas. The median size was seven (2-35) mm. A regular circular mucosal pattern was more frequently observed in HP and T1-GC compared to adenomas (P < 0.001). T1-GC showed a central erosion in 77.8% (P < 0.001 versus HP) with a clear demarcation line in 33.3%. Adenomas had tubule-villous mucosal pattern in 80% (P = 0.01 versus other lesions). NBI analysis of the mucosal pattern seems to be effective to endoscopically discriminate between adenomas and HP while the main characteristic of T1-GC seems to be the presence of a central erosion, sometimes with demarcation line. The endoscopic NBI characterization of GPL may contribute to optimize the management of these lesions.

Tu1514 ANALYSIS OF METACHRONOUS GASTRIC CANCER AFTER ENDOSCOPIC SUBMUCOSAL DISSECTION FOR EARLY GASTRIC CANER

Progression of endoscopic diagnosis contributes improvement of detecting early gastric cancer (EGC). Endoscopic resection like endoscopic submucosal dissection (ESD) achieves surefire treatment of EGC. Now metachronous gastric cancer (MGC) after ESD becomes a problem. We analyzed the patients who had MGC after ESD to clarify the feature of MGC. We conducted retrospective analysis of EGC cases resected by ESD in our institution. From April 2014 through August 2019, 393 patients were performed ESD and 38 cases (9.7%) were MGC including 10 synchronous (within 1 year after ESD). We analyzed age, sex, interval of recurrence, location, macroscopic type, histological type, size of tumor, depth of invasion, history of eradication of Helicobacter Pylori (HP), detecting method and curative ratio by ESD. The study was approved by IRB. The outcomes were as follows: MGC including synchronous was 9.7% (38/393) during this surveillance. Sex: male/female ratio was 35/3. Average age: 74.0±4.7 years old (61-86, median 74). Average interval of recurrence: 45.7±41.6 months (2-168, median 33.5). 68% (26/38) of cases experienced a recurrence within 5 years after previous ESD. The maximum recurrence was 3 times. Location: Upper 19, Middle 4, Lower 15. 76% (29/38) of cases arose from different location from the previous one. Macroscopic type: 0-IIa 12, 0-IIb 4, 0-IIc 22. 42% of cases were same type as previous one. Histological type: 37 tubular adenocarcinoma and 1 poorly differentiated adenocarcinoma. Average size: 11.4±7.8 mm (1.5-37, median 10). Depth of invasion: M 36, SM 2. History of eradication of HP: 53% (20/38). In those cases, the longest interval of recurrence was 12 years and the shortest one was 2 years. Detecting method: white-light imaging 74%, indigo carmine dye 26%. Narrow-band imaging (NBI) or magnifying endoscopy with NBI was not used at the first detection of EGC. Curative ratio by ESD: 97% (37/38). Almost cases were less than 30mm tubular adenocarcinoma existed in mucosal layer, therefore, they were curative. Just one case (por, SM1) was not curative by ESD. In our analysis, MGC after ESD was 9.7%. The majority of cases were curative by ESD. 53% of cases had history of eradication of HP. They had severe atrophic gastritis and metaplasia. Even after eradication of HP, the patients performed ESD for EGC also still need continuous periodic endoscopic examination. To make sure effectivity of eradication of HP after ESD for EGC, additional prospective analysis is necessary.

Endoscopy-Driven Pretraining for Classification of Dysplasia in Barrett’s Esophagus with Endoscopic Narrow-Band Imaging Zoom Videos

Endoscopic diagnosis of early neoplasia in Barrett’s Esophagus is generally a two-step process of primary detection in overview, followed by detailed inspection of any visible abnormalities using Narrow Band Imaging (NBI). However, endoscopists struggle with evaluating NBI-zoom imagery of subtle abnormalities. In this work, we propose the first results of a deep learning system for the characterization of NBI-zoom imagery of Barrett’s Esophagus with an accuracy, sensitivity, and specificity of 83.6%, 83.1%, and 84.0%, respectively. We also show that endoscopy-driven pretraining outperforms two models, one without pretraining as well as a model with ImageNet initialization. The final model outperforms absence of pretraining by approximately 10% and the performance is 2% higher in terms of accuracy compared to ImageNet pretraining. Furthermore, the practical deployment of our model is not hampered by ImageNet licensing, thereby paving the way for clinical application.

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.

Endoscopic narrow-band imaging for the diagnostic workup of intraductal papillary mucinous neoplasm with duodenal fistula.

Endoscopic narrow-band imaging for the diagnostic workup of intraductal papillary mucinous neoplasm with duodenal fistula.

Narrow-band imaging and high-definition white-light endoscopy in patients with serrated lesions not fulfilling criteria for serrated polyposis syndrome: a randomized controlled trial with tandem colonoscopy

BackgroundIt is unknown whether narrow-band imaging (NBI) could be more effective than high-definition white-light endoscopy (HD-WLE) in detecting serrated lesions in patients with prior serrated lesions > 5 mm not completely fulfilling serrated polyposis syndrome (SPS) criteria.MethodsWe conducted a randomized, cross-over trial in consecutive patients with prior detection of at least one serrated polyp ≥10 mm or ≥ 3 serrated polyps larger than 5 mm, both proximal to the sigmoid colon. Five experienced endoscopists performed same-day tandem colonoscopies, with the order being randomized 1:1 to NBI—HD-WLE or HD-WLE—NBI. All tandem colonoscopies were performed by the same endoscopist.ResultsWe included 41 patients. Baseline characteristics were similar in the two cohorts: NBI—HD-WLE (n = 21) and HD-WLE—NBI (n = 20). No differences were observed in the serrated lesion detection rate of NBI versus HD-WLE: 47.4% versus 51.9% (OR 0.84, 95% CI: 0.37–1.91) for the first and second withdrawal, respectively. Equally, no differences were found in the polyp miss rate of NBI versus HD-WLE: 21.3% versus 26.1% (OR 0.77, 95% CI: 0.43–1.38). Follow-up colonoscopy in nine patients (22%) allowed them to be reclassified as having SPS.ConclusionsIn patients with previous serrated lesions, the serrated lesion detection rate was similar with NBI and HD-WLE. A shorter surveillance colonoscopy interval increases the detection of missed serrated polyps and could change the diagnosis of SPS in approximately one in every five patients.Trial registrationClinicalTrials.gov NCT02406547, registered on April 2, 2015.

Role of narrow band imaging in the diagnosis of premalignant and malignant lesions of oral cavity

Objective: To investigate the role of narrow band imaging (NBI) endoscopy in diagnosing oral premalignant and malignant lesions. Methods: NBI and white light (WLI) endoscopy were performed on 85 patients (47 females, 38 males, aged from 12 to 83 years old, the medium age was 58 years) with 144 oral lesions from July 2016 to October 2017 in the First Affiliated Hospital of Xiamen University. NBI findings were classified into 5 types according to the Ni's classification and compared with histopathological results. Sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of NBI and WLI were calculated. Accuracy of NBI on premalignant and malignant lesions were compared with that of WLI. The connection between NBI findings and pathological results were investigated. SPSS 22.0 software was used to analyze the data. Results: Sensitivity, specificity, PPV, and NPV of NBI vs WLI were 96.5% vs 81.2%, 98.3% vs 98.3%, 98.8% vs 98.6%, and 95.1% vs 78.4%, respectively. NBI findings showed high accordance with the phathological results (kappa=0.943,P<0.01). However, consistency between WLI findings and the phathological results was relatively low (kappa=0.765, P<0.01). NBI was more accurate in diagnosing both premalignant (P<0.01) and malignant lesions (especially for high-grade intraepithelial neoplasia, P<0.01) than WLI. There was remarkable correlation between NBI findings and the phathological results (r=0.836, P<0.01). Conclusions: NBI shows high accuracy in detecting premalignant and malignant lesions of oral cavity. Ni's NBI classification is helpful to diagnose the premalignant and early malignant lesions as well as to evaluate tumor invasion. Thus, NBI can contribute more to early diagnosis and therapy of premalignant and malignant lesions of oral cavity.

Superiority of NBI endoscopy to PET/CT scan in detecting esophageal cancer among head and neck cancer patients: a retrospective cohort analysis

BackgroundSecond primary cancer of the esophagus is frequent in head and neck patients, especially in high-risk populations, and has a great impact on the prognosis. Although Positron emission tomography (PET)/computed tomography (CT) scan is commonly conducted in head and neck patients, its ability to detect early esophageal cancer is limited. Narrow-band imaging endoscopy is an accurate and convenient technique for esophageal examination. We aimed to compare PET/CT scan and narrow-band imaging endoscopy for the detection of esophageal cancer in head and neck cancer patients.MethodsFrom November 2015 to November 2018, all head and neck cancer patients who underwent both PET/CT scan and narrow-band imaging endoscopy at Changhua Christian Hospital were retrospectively enrolled. Descriptive statistics, receiver operating characteristic curve analysis, logistic regression analysis, independent Student’s t-test, and Kaplan–Meier survival analysis were conducted with MedCalc Statistical Software.ResultsA total of 147 subjects were included in the analysis; suspicious esophageal lesions were identified by PET/CT scan in 8 (5.44%) and by narrow-band imaging in 35 (23.81%). The final pathologic diagnoses were esophageal squamous cell carcinoma in 10 and high-grade dysplasia in 5. The respective sensitivity, specificity, and area under the curve for detecting suspicious esophageal lesions were 33.33, 97.73%, and 0.655 for PET/CT scan, and 100.0, 84.85%, and 0.924 for narrow-band imaging endoscopy. Hypopharyngeal or laryngeal location of the primary head and neck cancer was the only risk factor for developing second primary esophageal cancer.ConclusionsPET/CT scan was inferior to narrow-band imaging endoscopy in detecting second primary esophageal cancer in head and neck cancer patients. In addition to PET/CT scan, narrow-band imaging endoscopy should be considered in head and neck patients at high risk for developing second primary esophageal cancer.

Narrow band imaging might contribute to the diagnosis of laryngopharyngeal reflux.

Laryngopharyngeal reflux (LPR) accounts for 4-10% of outpatient visits. The standard domestic LPR diagnostic tools are the reflux finding score (RFS) and reflux symptom index (RSI). Narrow band imaging (NBI) can identify previously unknown characteristic microvessel features. Our aim was to explore the role of NBI in LPR diagnosis. We recruited 56 LPR outpatients and 41 symptom-negative controls. All individuals received RSI and RFS scores and underwent 24-hour multichannel intraluminal impedance-PH (MII-pH) monitoring and endoscopic NBI before and after treatment. The positivity rates in the study and control groups, before and after treatment, and using NBI and the conventional method were evaluated. Fifty-one LPR and six control patients had sparse light brownish dots or tufted light brownish dots in the postcricoid region. The RSI and RFS positivity rates were 31.3% and 87.1%, respectively. NBI is as effective as the RFS (P<0.05), and has poor consistency with the RSI (P<0.05). Fifty-three LPR patients underwent posttreatment laryngoscopy. The positivity rate decreased to 17.0% (P<0.05). NBI has good value for LPR diagnosis.

The Comparison of Diagnostic Significance of Narrow Band Imaging in Contrast of White Light Endoscopy in the Assessment of Nasopharyngeal Cancer

Background: Narrow band imaging (NBI) is reported to improve the diagnostic importance of nasopharyngeal cancer. The purpose of this review was to evaluate the diagnostic significance of NBI in the literature and compare it to the conventional white light endoscopy. The use of narrow band imaging (NBI) and further technological achievements concerning the resolution and magnification of endoscopic images have in the past 15 years. With the use of NBI, superficial mucosal lesions, which may be missed by standard WLI endoscopy, can be identified easily by their neoangiogenic pattern. Objective: To assess diagnostic value of the narrow band imaging and white light endoscopy in nasopharyngeal carcinoma and compare diagnostic values (sensitivity, specificity, positive predictive value and negative predictive value) with white light endoscopy. Search Methods: From 2010 to 2020, data was searched from electronic databases such as PubMed, web of science. We used narrow band imaging as a key word accordance with diagnostic modalities such as sensitivity, specificity, PPV and NPV and data were collected. Results: We have found mainly 6 studies have discussed about diagnostic value of endoscopy in nasopharyngeal carcinoma in the total of 2746 suspected patients. Among them, 5 studies have compared diagnostic values such as sensitivity, specificity, positive predictive value and negative predictive value between NBI and WLE. Among 5 studies, 4 studies have found higher sensitivity in NBI, 2 studies found higher 1 equal to WLE specificity in NBI. 3 studies have compared PPV and NPV between NBI and WLE. Among them, all the studies found higher PPV and NPV in NBI than WLE. Conclusion: Recently developed narrow band imaging has a great significance in the diagnosis of nasopharyngeal carcinoma. Although NBI has also encountered some problem such as contact bleeding and darker image. So, further evaluation should be done.

Distribution of lanthanum carbonate in the gastric mucosa confirmed by electron microscopy with a magnified endoscopy: a case report and literature review

We describe the case of a 70-year-old man with diabetic nephropathy undergoing hemodialysis. Four years following hemodialysis, he started taking lanthanum carbonate 1500 mg/day and lansoprazole 30 mg/day. Nine years following hemodialysis, he underwent screening esophagogastroduodenoscopy, which demonstrated the presence of the whitish cobblestone-like mucosa in the gastric corpus and multiple reddish depressed lesions with annular whitish mucosa in the antrum. With magnified narrow-band imaging endoscopy, a yellowish–white substance was observed in the villous structure, and subepithelial vessels were observed on the yellowish–white substance. Biopsies were taken from the whitish cobblestone-like mucosa of the upper corpus, a reddish depressed part of the antrum. Histologically, aggregates of cells containing amphophilic fine granular material were found in the mucosal interstitium. These cells stained positive for CD68 and were identified as histiocytes. Since he had been taking lanthanum carbonate for 5 years, we considered the possibility of histiocyte-mediated phagocytosis of lanthanum. Digital mapping via scanning electron microscopy with energy-dispersive X-ray spectrometry showed the presence of lanthanum and phosphorus in the interstitium and cytoplasm of histiocytes. The white, rough mucosa in the gastric body appeared 6 months following the commencement of lanthanum administration and still exists 3 years and 5 months after discontinuation of lanthanum.

Microvascular density under magnifying narrow-band imaging endoscopy in colorectal epithelial neoplasms.

Background/AimsMagnifying endoscopic classification systems, such as the Japan narrow-band imaging (NBI) Expert Team (JNET) classification, have been widely used for predicting the histologic diagnosis and invasion depth of colorectal epithelial tumors. However, disagreement exists among observers regarding magnifying endoscopic diagnosis, because these classification systems are subjective. We herein investigated the utility of endoscopic microvascular density (eMVD) calculated from magnifying NBI endoscopic images in colorectal tumors.MethodsWe reviewed magnifying NBI endoscopic images from 169 colorectal epithelial tumors (97 adenomas, 72 carcinomas/high-grade dysplasias) resected endoscopically or surgically. The eMVD on magnifying NBI endoscopic images was evaluated using image-editing software, and relationships between eMVD and clinical, endoscopic, and pathological findings were retrospectively analyzed.ResultsThe eMVD in carcinomas (0.152 ± 0.079) was significantly higher than that in adenomas (0.119 ± 0.059, P<0.05). The best cutoff value for distinguishing carcinoma from adenoma was 0.133. Sensitivity, specificity, and accuracy were 56.9%, 67.0%, and 62.7%, respectively. In addition, JNET type 2B tumors showed significantly higher eMVD (0.162 ± 0.079) compared to type 2A tumors (0.111 ± 0.050, P<0.05).ConclusionsThe eMVD as determined by magnifying NBI endoscopy is considered to be a possible objective indicator for differentiating colorectal carcinomas from adenomas.

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.

Use OF NBI for the assessment of clinical signs of rhino-pharyngo-laryngeal reflux in pediatric age: Preliminary results

ObjectivesLaryngopharyngeal reflux (LPR) is a complex problem in pediatric population: diagnosis and clinical presentation are still controversial.Classic white light endoscopy shows some pathognomonic signs of LPR in children, such as thickening of pharyngo-laryngeal mucus, the cobblestoning aspect of pharyngeal mucosa, arytenoid edema/hyperemia, nodular thickening/true vocal cord edema, hypertrophy of the posterior commissure, subglottic edema.The NBI (Narrow Band Imaging) technology, generally used in oncology, allows to study neoangiogenesis and hypervascularization of the mucosa, common aspects in both chronic inflammation and neoplastic transformation. The aim of our study was to evaluate the added value of this technology in identifying the main laryngopharyngeal reflux sign in a pediatric population. MethodsWe evaluated at the Otolaryngology Unit of the “Fondazione Policlinico A. Gemelli” hospital and the Airway Surgery Unit of the “Bambino Gesù” Children's Hospital 35 patients aged from 2 months to 16 years divided into two groups in the period between November 2017 and May 2018. Group A included patients with clinical suspicion of LPR after gastroenterologist evaluation and Group B included patients who underwent an endoscopic evaluation for the assessment of recurrent respiratory symptoms such as stridor, recurrent croup, wheezing and persistent cough. We performed an endoscopic evaluation by white light and NBI for each patient, comparing the results of both methods to evaluate signs of pharyngo-laryngeal reflux and to calculate the value of reflux finding score (RFS). ResultsThe analysis of the data showed: for Group A an average value of RFS with white light of 11,84 (range 8–17, standard deviation 2,52 ± 0,57) and with NBI of 13,63 (range 10–17, standard deviation 2,13 ± 0,49); for Group B the analysis of the data showed an average value of RFS with white light of 10,06 (range 8–14, standard deviation 2,32 ± 0,58) and with NBI of 12,50 (range 9–18, standard deviation 2,63 ± 0,65). The comparison between the two methods resulted significant.Furthermore evaluation by NBI allowed to highlight other signs of pharyngo-laryngeal reflux, characteristic of pediatric age and not included in RFS, in particular cobblestone aspect of the hypopharingeal mucosa, phlogosis of the tonsillar crypts and adenoid surface, hyperemia and hypervascularization of subglottic and tracheal mucosa. ConclusionAlthough still preliminary our results represent an interesting starting point for further studies, because they underline the potentiality of NBI endoscopy in LPR evaluation and how this technology could improve the identification of reflux signs.

136 Usefulness of Magnifying Narrow-Band Imaging Endoscopy for the Diagnosis of Sessile Serrated Adenoma/Polyp With Dysplasia/Carcinoma

INTRODUCTION: Sessile serrated adenoma/polyp (SSA/P) is an early precursor lesion in the serrated neoplasia pathway, which results in BRAF-mutated colorectal carcinomas with high levels of microsatellite instability. Therefore, accurate diagnosis of SSA/P and its dysplastic components is endoscopically important. However, the usefulness of magnifying narrow-band imaging (NBI) endoscopy for SSA/Ps with dysplastic change has not yet been fully elucidated. The aim of this study was to verify the usefulness of magnifying NBI endoscopy for the diagnosis of SSA/P with dysplasia/carcinoma. METHODS: Among 939 endoscopically or surgically resected lesions pathologically diagnosed as SSA/P with or without dysplasia/carcinoma at Juntendo University Hospital (Tokyo, Japan) between 2011 and 2018, a total of 709 lesions had images available. These SSA/P lesions included 647 with no dysplasia (ND), 37 with low-grade dysplasia (LGD), 15 with high-grade dysplasia (HGD), and 10 with submucosal invasive carcinoma (SIC). We retrospectively evaluated magnifying NBI endoscopic findings using the Japan NBI Expert Team (JNET) system. RESULTS: The clinicopathological and endoscopic characteristics of the studied lesions are summarized in Table 1. The HGD and SIC lesions were associated with advanced age. All the lesions were more frequently located in the proximal colon. The SIC lesions were significantly larger than the ND and LGD lesions. All the lesions frequently exhibited endoscopic findings characteristic of SSA/P, such as mucus cap and Type II-Open pit pattern. As for the JNET classification of magnifying NBI endoscopy findings, all 709 lesions were type 1. Six hundred and eighteen (96%) ND lesions exhibited type 1 only, whereas 52 (84%) SSA/P with dysplasia/carcinoma lesions had a combination of type 1 and types 2A, 2B, or 3, corresponding to SSA/P and dysplasia/carcinoma, respectively (Figures 1 and 2). Furthermore, the JNET classification had high sensitivity (84%) and specificity (96%) for diagnosing SSA/P with dysplasia/carcinoma. CONCLUSION: Recently, the JNET was established and has proposed a universal NBI magnifying endoscopic classification of colorectal tumors. Our findings suggest that the use of magnifying NBI endoscopy using the JNET classification might be useful for the diagnosis of not only conventional colorectal tumors, but also SSA/P with dysplasia/carcinoma. This increased awareness may also improve the recognition of SSA/Ps with dysplasia or invasive carcinoma.

Correlation of narrow band imaging vascular patterns with immunohistological microvessel density in vocal fold lesions

IntroductionThe microarchitecture of the mucosal and submucosal vessels is crucial for diagnosis of vocal fold lesions. Neo-angiogenesis is a confirmed biological parameter that implicates progression and metastasis in laryngeal cancer. ObjectiveThis study investigates the correlation between vascular pattern classifications by narrow band imaging and immunohistological microvessel density in different types of intraepithelial vocal fold lesions. MethodsAnalysis of immunohistological microvessel density using CD31 and CD34 antibodies was performed in 77 lesions including: 20 non-dysplastic lesions, 20 with low-grade dysplasia, 17 with high-grade dysplasia and 20 invasive cancers. The evaluation of vascular patterns with narrow band imaging according to the Ni classification and European Laryngological Society guidelines was performed prior to surgical resection. ResultsThe mean value of CD31 microvessel density was the highest for Ni Type IV lesions (20.55), whereas for the longitudinal and perpendicular patterns according to the European Laryngological Society classification it was 12.50 and 19.45 respectively. The highest mean value of microvessel density with CD 34 was identified in Ni Type Va (35.43) lesions and in the longitudinal and perpendicular patterns according to the European Laryngological Society classification was 15.12 and 30.40 respectively. ConclusionsThe microvascular morphological changes of intraepithelial laryngeal lesions observed under narrow band imaging endoscopy are positively correlated with angiogenesis indexes of immunohistological evaluation.