Sensitivity Of Narrow Band Imaging Research Articles

Utility of Narrow-band Imaging Bronchoscopy in the Diagnosis of Endobronchial Sarcoidosis.

There are few reports on the utility of bronchoscopic narrow-band imaging (NBI) for visualizing endobronchial abnormalities in sarcoidosis. Our primary objective was to compare the sensitivity of finding endobronchial abnormality using NBI versus white light bronchoscopy (WLB) in patients with sarcoidosis. The secondary aim was to evaluate the sensitivity of NBI in diagnosing endobronchial sarcoidosis against a reference standard of positive endobronchial biopsy (EBB). We retrospectively included subjects with sarcoidosis, where we sequentially recorded WLB and NBI videos to visualize the endobronchial mucosa. We collected data on the demographic findings, sarcoidosis stage, and the histopathological findings of transbronchial needle aspiration, EBB, and transbronchial lung biopsy. Three experienced bronchoscopists viewed the video recordings and noted the abnormalities of the airway mucosa separately on WLB and NBI. We included 28 subjects (mean age, 42.9y; 53.6% men; 14 each, stages 1 and 2) with a final diagnosis of sarcoidosis. Granulomas were detected on EBB in 11 (39.3%) subjects. We identified endobronchial nodules in 10 and 15 subjects on WLB and NBI. The sensitivity of finding endobronchial abnormality using WLB and NBI was 35.7% (10/28) and 53.6% (15/28), respectively (χ2=1.77, df=1, P=0.18). The sensitivity of NBI in diagnosing endobronchial sarcoidosis against a positive EBB was 63.6% (7/11 subjects). There was excellent agreement (Κ=0.86) for detecting nodules on NBI among the 3 observers. NBI might allow the identification of additional abnormalities not detected on WLB in sarcoidosis. Larger studies are required to confirm our observations.

Narrow band imaging in early diagnosis of laryngopharyngeal malignant and premalignant lesions

Objectives: (1) To assess the diagnostic accuracy of narrow-band imaging (NBI) in the assessment of benign, premalignant, and malignant vocal fold lesions. (2) To evaluate the diagnostic value of NBI in detection of recurrence in upper aero-digestive tract malignancy.Methods: This was a prospective, observational study done between December 2018- November 2019 in the Department of Otolaryngology. One hundred six patients of suspected benign, premalignant, malignant lesions of larynx and hypopharynx along with recurrence cases of upper aerodigestive tract malignancy who have completed chemoradiation therapy. All patients were subjected to white light endoscopy (WLE), NBI, and biopsy for histopathological diagnosis. In WLE, laryngeal lesions were classified into three types: malignant, suspected malignant, and benign. NBI images were classified into 5 types based on the intrapapillary capillary loop (IPCL) patterns: Type I-IV were considered benign and Type V lesion was considered malignant. At the end, WLE and NBI findings were correlated with histopathological reports.Results: The diagnostic accuracy of NBI in diagnosing benign, premalignant, and malignant lesions is significantly better than WLE. The sensitivity of NBI in detecting malignant lesions is significantly greater than WLE. NBI has proved to be of great value in identifying lesions that could be missed by WLE alone, as combined sensitivity of NBI and WLE is significantly higher than WLE alone.Conclusion: NBI is an excellent technique for early detection of laryngopharyngeal malignancies with significantly higher sensitivity than WLE alone.

Comparison of the diagnostic efficacy of blue laser imaging with narrow band imaging for gastric cancer and precancerous lesions: a meta-analysis.

novel endoscopic techniques including narrowband imaging (NBI) and blue laser imaging (BLI) have led to the improved detection of early stage gastric cancer and precancerous lesions. However, these techniques are not generally thought to be equivalent at present and BLI is generally considered as superior to NBI. Therefore, this comprehensive meta-analysis aimed to definitively compare the diagnostic efficacy of NBI and BLI for the diagnosis of gastric cancer and precancerous lesions. relevant articles were identified via searches of the PubMed, Web of Science, Embase and Cochrane Library databases from their inception until October 2019. In total, 28 relevant studies were identified and incorporated into the meta-analysis. RevMan5.3 was used to assess the relative diagnostic efficacy of these two imaging modalities in these studies. The threshold was assessed using Meta-DiSc 1.4 and STATA 14.0 for bivariate regression modeling of pooled studies. the pooled sensitivity of BLI for gastric cancer was 0.89 (0.80, 0.95) and the specificity was 0.92 (0.76, 0.98). The pooled sensitivity of NBI for gastric cancer was 0.83 (0.75, 0.89) and the specificity was 0.95 (0.91, 0.97). The pooled sensitivity of BLI for precancerous lesions was 0.81 (0.71, 0.87) and the specificity was 0.90 (0.80, 0.96). The pooled sensitivity of NBI for precancerous lesions was 0.80 (0.75, 0.85) and the specificity was 0.88 (0.77, 0.94). this study showed that both BLI and NBI have a very high diagnostic efficacy for the detection of gastric cancer and precancerous lesions, the sensitivity and specificity of these two approaches were similar.

Flexible transnasal endoscopy with white light or narrow band imaging for the diagnosis of laryngeal malignancy: diagnostic value, observer variability and influence of previous laryngeal surgery

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

Comparison of narrow-band imaging and confocal laser endomicroscopy for the detection of neoplasia in Barrett's esophagus: A meta-analysis

Barrett's esophagus (BE) predisposes to the development of esophageal neoplasia, including high-grade dysplasia (HGD) and esophageal adenocarcinoma (EAC). A systematic literature review and meta-analysis were performed to assess the accuracy of within-patient comparisons of narrow band imaging (NBI) and confocal laser endomicroscopy (CLE) for diagnosis of HGD/EAC in patients with BE. The following databases were examined up to April 2016 without language restriction: PubMed, Embase, Medline, Web of Science and the Cochrane Library. The QUADAS-2 tool for assessing the quality of included studies was used. The meta-analysis included pooled additional detection rate (ADR), diagnostic accuracy, and 95% confidence intervals (CI). The I2 and Q-test were used to determine study heterogeneity. Five studies involving 251 patients, reported within-patient comparisons of NBI and CLE, were eligible for meta-analysis. Compared with NBI, pooled ADR of CLE for per-lesion detection of neoplasia in patients with BE was 19.3% (95% CI: 0.05-0.33, I2=74.6%). The pooled sensitivity of NBI was 62.8% (95% CI: 0.56-0.69, I2=94.6%), which was lower (not significantly) than that of CLE (72.3%, 95% CI: 0.66-0.78, I2=89.3%). The pooled specificity of NBI and CLE were similar [85.3% (95% CI: 0.84-0.87, I2=92.1%) vs 83.8% (95% CI: 0.82-0.85, I2=96.8%)]. When compared with NBI, CLE significantly increased the per-lesion detection rate of esophageal neoplasia, HGD, and EAC in BE patients. Whether CLE is superior to NBI in neoplasia detection at per-patient level needs to be further investigated.

Follow-up of oral and oropharyngeal cancer using narrow-band imaging and high-definition television with rigid endoscope to obtain an early diagnosis of second primary tumors: a prospective study.

Narrow-band imaging (NBI) is an optical technique enhancing mucosal vasculature. The aim of this study is to assess the effectiveness of rigid NBI endoscopy in the early detection of second primaries or local recurrences after treatment for oral (OSCC) and oropharyngeal squamous cell carcinoma (OPSCC), its advantage over standard white-light (WL) endoscopy, and the influence of previous radiotherapy, the learning curve, and lesion site. Between January 2013 and June 2015, 195 patients treated for OSCC or OPSCC with surgery alone (group A) or radiotherapy with or without surgery and/or chemotherapy (group B) underwent additional follow-up assessments using NBI. Sensitivity, specificity, positive/negative predictive values (PPV and NPV), and accuracy for detecting second primaries or local recurrences were calculated for patients with at least two NBI assessments. The effect of previous radiotherapy was determined by test of proportions and that of the learning curve and lesion site with Fisher's exact test. 138/195 patients were included in the analysis. NBI sensitivity, specificity, PPV, NPV, and accuracy for groups A and B were 89.5 vs 100%, 85.2 vs 81.5%, 65.4 vs 69.7%, 96.3 vs 100%, and 86.3 vs 87%, respectively. The diagnostic gain of NBI was 88.2% in group A and 69.6% in group B. The learning curve was the main source of false positives (p = 0.025), whereas radiotherapy and lesion site were uninfluential (p = NS). NBI appears useful for follow-up after treatment for OSCC or OPSCC, its performance being affected only by the learning curve and not by previous treatment or lesion site.

A meta-analysis of narrow band imaging for the diagnosis and therapeutic outcome of non-muscle invasive bladder cancer.

ObjectivesTo assess the additional detection rate (ADR) of within-patient comparisons of Narrow band imaging (NBI) and white light cystoscopy (WLC) for non-muscle invasive bladder cancer (NMIBC) detection and compare the impact of NBI and WLC on bladder cancer recurrence risk.MethodsWe searched relevant studies from PubMed, Embase, Medline, Web of Science and the Cochrane Library database for all articles in English published beforeJuly26th, 2016. Pooled ADR, diagnostic accuracy, relative risk (RR) and their 95% confidence intervals (CIs) were calculated.ResultsTwenty-five studies including 17 full texts and eight meeting abstracts were included for analysis. Compared to WLC, pooled ADR of NBI for NMIBC diagnosis was 9.9% (95% CI: 0.05–0.14) and 18.6% (95% CI: 0.15–0.25) in per-patient and per-lesion analysis, respectively. Pooled ADR of NBI for carcinoma in situ (CIS) diagnosis was 25.1% (95% CI: 0.09–0.42) and 31.1% (95% CI: 0.24–0.39) for per-patient and per-lesion analyses, respectively. The pooled sensitivity of NBI was significantly higher than WLC both at the per-patient (95.8% vs. 81.6%) and per-lesion levels (94.8% vs. 72.4%). In addition, NBI significantly reduced the recurrence rate of bladder cancer with a pooled RR value of 0.43 (95% CI: 0.23–0.79) and0.81 (95% CI: 0.69–0.95) at month three and twelve, respectively.ConclusionsNBI is a valid technique that improves the diagnosis of NMIBC and CIS compared to standard WLC either at per-patient or per-lesion level. It can reduce the recurrence rate of bladder cancer accordingly.

Diagnostic Performance of Narrow Band Imaging for Laryngeal Cancer: A Systematic Review and Meta‐analysis

Objective To evaluate the performance of narrow band imaging (NBI) for the diagnosis of laryngeal cancer and to compare the diagnostic value of NBI with that of white light endoscopy. Data Sources PubMed, Embase, Cochrane Library, and CNKI databases. Review Methods Data analyses were performed with Meta-DiSc. The updated Quality Assessment of Diagnostic Accuracy Studies-2 tool was used to assess study quality and potential bias. Publication bias was assessed with the Deeks's asymmetry test. The protocol used in this article has been published on PROSPERO and is in accordance with the PRISMA checklist. The registry number for this study is CRD42015025866. Results Six studies including 716 lesions were included in this meta-analysis. The pooled sensitivity, specificity, and diagnostic odds ratio for the NBI diagnosis of laryngeal cancer were 0.94 (95% confidence interval [95% CI]: 0.91-0.96), 0.89 (95% CI: 0.85-0.92), and 142.12 (95% CI: 46.42-435.15), respectively, and the area under receiver operating characteristics curve was 0.97. Among the 6 studies, 3 evaluated the diagnostic value of white light endoscopy, with a sensitivity of 0.81 (95% CI: 0.76-0.86), a specificity of 0.92 (95% CI: 0.88-0.95), and a diagnostic odds ratio of 33.82 (95% CI: 14.76-77.49). The evaluation of heterogeneity, calculated per the diagnostic odds ratio, gave an I2 of 66%. No marked publication bias ( P = .84) was detected in this meta-analysis. Conclusion The sensitivity of NBI is superior to white light endoscopy, and the potential value of NBI needs to be validated in future studies.

Diagnostic Value of Narrow Band Imaging in Diagnosing Nasopharyngeal Carcinoma

Background : Carcinoma is the most common tumor in nasopharynx. Endoscopy is used to determine the presence of lesions suspected of malignancy. Narrow Band Imaging is an endoscopic technique that uses narrow–band spectrum as a filter to determine any mucosal vascular changes in carcinoma. Narrow Band Imaging can early detect superficial mucosal lesions that are difficult to detect with conventional endoscopy, so that diagnosing is more accurate and occurrence of unnecessary biopsies can be reduced. This study aimed to determine diagnostic value of Narrow Band Imaging in diagnosing nasopharyngeal carcinoma. Methods : This diagnostic test study was conducted at Department of Otorhinolaryngology-Head and Neck Surgery Dr. Hasan Sadikin General Hospital, Bandung from September to October 2014. Twenty four patients with clinical signs and symptoms of nasopharyngeal carcinoma that fulfilled the study criteria were assigned using consecutive sampling to examine with Narrow Band Imaging and histopathology examination. The data were then analyzed with 2x2 table to determine sensitivity, specificity, positive predictive value, negative predictive value, and accuracy. Results : In this study, the results of sensitivity, specificity, positive predictive value, negative predictive value, and accuracy in diagnosing nasopharyngeal carcinoma using Narrow Band Imaging were 93.75%, 62.5%, 83.3%, 83.3%, and 83.3%, respectively. Conclusions : Sensitivity of Narrow Band Imaging is 93.75%. [AMJ.2017;4(1):133–7] DOI : 10.15850/amj.v4n1.1034

An accurate cluster selection function for the J-PAS narrow-band wide-field survey

The impending Javalambre Physics of the accelerating universe Astrophysical Survey (J-PAS) will be the first wide-field survey of $\gtrsim$ 8500 deg$^2$ to reach the `stage IV' category. Because of the redshift resolution afforded by 54 narrow-band filters, J-PAS is particularly suitable for cluster detection in the range z$<$1. The photometric redshift dispersion is estimated to be only $\sim 0.003$ with few outliers $\lesssim$ 4\% for galaxies brighter than $i\sim23$ AB, because of the sensitivity of narrow band imaging to absorption and emission lines. Here we evaluate the cluster selection function for J-PAS using N-body+semi-analytical realistic mock catalogues. We optimally detect clusters from this simulation with the Bayesian Cluster Finder, and we assess the completeness and purity of cluster detection against the mock data. The minimum halo mass threshold we find for detections of galaxy clusters and groups with both $>$80\% completeness and purity is $M_h \sim 5 \times 10^{13}M_{\odot}$ up to $z\sim 0.7$. We also model the optical observable, $M^*_{\rm CL}$-halo mass relation, finding a non-evolution with redshift and main scatter of $\sigma_{M^*_{\rm CL} | M_{\rm h}}\sim 0.14 \,dex$ down to a factor two lower in mass than other planned broad-band stage IV surveys, at least. For the $M_{\rm h} \sim 1 \times 10^{14}M_{\odot}$ Planck mass limit, J-PAS will arrive up to $z\sim 0.85$ with a $\sigma_{M^*_{\rm CL} | M_{\rm h}}\sim 0.12 \, dex$. Therefore J-PAS will provide the largest sample of clusters and groups up to $z\sim 0.8$ with a mass calibration accuracy comparable to X-ray data.

Value of narrow band imaging endoscopy in detection of early laryngeal squamous cell carcinoma

Narrow band imaging (NBI) is an endoscopic method using filtered wavelengths in detection of microvascular abnormalities associated with preneoplastic and neoplastic changes of the mucosa. The aim of the study is to evaluate the value of NBI endoscopy in the dia-gnosis of laryngeal precancerous and early stages of cancerous lesions and to investigate impact of NBI method in prehistological diagnostics in vivo. One hundred patients were enrolled in the study and their larynx was investigated using white light HD endoscopy and narrow band imaging between 6/ 2013- 10/ 2014. Indication criteria included chronic laryngitis, hoarseness for more than three weeks or macroscopic laryngeal lesion. Features of mucosal lesions were evaluated by white light endoscopy and afterwards were compared with intra-epithelial papillary capillary loop changes, viewed using NBI endoscopy. Suspicious lesions (leukoplakia, exophytic tumors, recurrent respiratory papillomatosis and/ or malignant type of vascular network by NBI endoscopy) were evaluated by histological analysis, results were compared with prehistological NBI dia-gnosis. Using NBI endoscopy, larger demarcation of pathological mucosal features than in white light visualization were recorded in 32/ 100 (32.0%) lesions, in 4/ 100 (4.0%) cases even new lesions were detected only by NBI endoscopy. 63/ 100 (63.0%) suspected lesions were evaluated histologically - malign changes (carcinoma in situ or invasive carcinoma) were observed in 25/ 63 (39.7%). Prehistological diagnostics of malignant lesions using NBI endoscopy were in agreement with results of histological examination in 23/ 25 (92.0%) cases. The sensitivity of NBI in detecting malignant lesions was 89.3%, specificity of this method was 94.9%. NBI endoscopy is a promising optical technique enabling in vivo differentiation of superficial neoplastic lesions. These results suggest endoscopic NBI may be useful in the early detection of laryngeal cancer and precancerous lesions.

Decision Based on Narrow Band Imaging Cystoscopy without a Referential Normal Standard Rather Increases Unnecessary Biopsy in Detection of Recurrent Bladder Urothelial Carcinoma Early after Intravesical Instillation.

PurposeThe purpose of this study was to calculate the operating characteristics of narrowband imaging (NBI) cystoscopy versus traditional white light cystoscopy (WLC) in common clinical scenarios involving suspicion of bladder urothelial carcinoma (UC).Materials and MethodsSixty-three consecutive patients initially underwent WLC and then NBI in a single session for evaluation of microscopic hematuria (group I, n=20), gross hematuria (group II, n=19), and follow-up for prior UC (group III, n=24), by an experienced urologist. All lesions that were abnormal in contrast with adjacent normal mucosa were diagnosed as positive and biopsied.ResultsSixty-six biopsies from 47 patients were performed. Pathologic examination showed 17 cases of UC from 21 sites. While the overall sensitivity of NBI was similar to that of WLC (100% vs. 94.1%), the specificity of NBI was significantly lower than that of WLC (50% vs. 86.9%, p < 0.001), particularly in group III (38.9% vs. 88.9%, p=0.004). Based on identification by NBI only, 23 additional biopsies from 18 cases were performed for identification of one patient with UC, who belonged to group III. In this group, to identify this specific patient, 15 additional biopsies were performed from 10 patients. All seven cases with positive findings from NBI within 2 months after the last intravesical therapy were histologically proven as negative.ConclusionIn evaluation for recurrence early after intravesical instillation, the decision based on NBI increased unnecessary biopsy in the absence of an established standard for judging NBI.

Meta-Analysis: Narrow Band Imaging for Diagnosis of Gastric Intestinal Metaplasia

BackgroundDistinguishing early gastric cancer is challenging with current imaging techniques. Narrow band imaging (NBI) is effective for characterizing gastric lesions.ObjectivesThe aim of this meta-analysis was to estimate the diagnostic accuracy of NBI in the gastric intestinal metaplasia (GIM).MethodsWe performed data analysis using Meta-DiSc (version 1.4) and STATA (version 11.0) software. To assess study quality and potential for bias, we used the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool.ResultsSix studies involving 347 patients were included. On a per-patient basis, the sensitivity of NBI for diagnosis of GIM was 0.65 (95% CI = 0.56–0.74), and the specificity was 0.93 (95% CI = 0.88–0.97). The area under the summary receiver operating characteristic (SROC) curve was 0.8731. However, on a per-lesion basis, the sensitivity and specificity of NBI were 0.69 (95% CI = 0.63–0.74) and 0.91 (95% CI = 0.87–0.94), respectively. The SROC was 0.9009. The pooled sensitivity and specificity of magnification endoscopy (NBI-ME) were 0.76 (95% CI = 0.61–0.87) and 0.89 (95% CI = 0.80–0.94), respectively, on per-patient analysis. On a per-lesion basis, the pooled sensitivity and specificity of NBI-ME were 0.84 (95% CI = 0.76–0.89) and 0.93 (95% CI = 0.89–0.96), respectively. Heterogeneity was observed with an I2 for diagnostic odds ratio (DOR) of 0.01% and 85.8%, respectively. There was no statistical significance for the evaluation of publication bias.ConclusionsOur meta-analysis shows that NBI is a useful tool for differential diagnosis of GIM with relatively low sensitivity and high specificity.

Combination of narrow-band imaging and autofluorescence imaging videobronchoscopy in the assessment of lung cancer

背景与目的窄带成像（narrow-band imaging, NBI）与自荧光成像（autofluorescence imaging, AFI）是近几年临床诊断肺癌的支气管镜新技术。本研究旨在研究这两种技术的结合是否能提高肺癌诊断的敏感性和特异性。方法该项目共纳入137例疑似肺癌患者，所有患者的检查均基于Olympus Evis Lucera电子支气管镜系统，依次进行白光支气管镜（white light bronchoscopy, WLB）、窄带成像、自荧光成像检查，在每位患者镜下异常部位至少取3块组织送检。结果WLB的敏感性、特异性分别为56.6%和62.5%；NBI成像的敏感性、特异性分别为71.3%和75.0%；AFI敏感性、特异性分别为82.2%和25.0%；NBI联合AFI的敏感性、特异性分别为94.6%和87.5%。NBI+AFI与AFI相比，两者敏感性及特异性均有统计学差异（P < 0.01），与单用NBI相比，两者敏感性及特异性亦有统计学差异（P < 0.05）。结论NBI或AFI比WLB在肺癌诊断方面具有更好的敏感性，且联合使用NBI+AFI比其它任何一种单用技术具有更高的敏感性和特异性优势。

Resect and discard strategy in clinical practice: a prospective cohort study

Narrow-band imaging (NBI) has shown promising results in discriminating adenomatous from non-adenomatous colonic polyps. In patients with small polyps (< 10 mm), the application of NBI within a "resect and discard" strategy, might allow post-polypectomy surveillance intervals to be determined independently from histopathology. The aim of the present study was to assess the feasibility and safety of this approach in routine clinical practice. Consecutive colonoscopy outpatients with one or more polyps smaller than 10 mm were prospectively included. Each polyp was categorized by the endoscopist as adenoma or non-adenoma according to simplified NBI criteria, and future post-polypectomy surveillance interval was assigned accordingly. Following histopathology, post-polypectomy surveillance interval was subsequently re-assigned, and the accordance between endoscopy- and histology-directed surveillance strategies was calculated. Among 942 colonoscopy patients, 286 (30.4 %) with only small polyps were included. In total, 511 small polyps were evaluated; 350 (68.5 %) were adenomas and 18 of these (5.1 %) had histologic features of advanced neoplasia. For the in vivo diagnosis of adenoma, NBI sensitivity, specificity, accuracy, and positive and negative likelihood ratios were 94.9 %, 65.8 %, 85.7 %, 2.80, and 0.08, respectively. The endoscopy-directed surveillance strategy was in accordance with the histology-directed strategy in 237 of 286 patients (82.9 %). In 9.8 % and 7.3 % patients, the endoscopy-directed approach would have resulted in early and delayed surveillance, respectively. The resect and discard strategy seems to be a viable, safe, and cost-effective approach for the management of patients with small polyps. However, caution in the application of the strategy should be advocated for patients with polyps 6 - 9 mm in size and those with right-sided lesions, due to their malignant potential. The study was registered on Clinicaltrials.gov (NCT01462123).

Is it proper to use non‐magnified narrow‐band imaging for esophageal neoplasia screening? Japanese single‐center, prospective study

Most screening examinations in Japanese general hospitals are carried out by high-definition television-incompatible (non-HD) scopes and non-magnifying endoscopes. We evaluated the narrow-band imaging (NBI) real-time diagnostic yield of esophageal neoplasia in high-risk patients at a general hospital. In a single-center, prospective, non-randomized controlled trial, 117 consecutive screening patients with high risk for esophageal cancer received primary white-light imaging (WLI) followed by NBI and iodine-staining endoscopy (59 by HDTV-compatible [HD] endoscopy and 58 by non-HD endoscopy). The primary aim was to evaluate the diagnostic yield of non-magnified images in diagnosing esophageal neoplasia. The secondary aim was to compare HD endoscopy and non-HD endoscopy in terms of diagnostic performance. Overall, the sensitivity of NBI for screening of esophageal neoplasia was superior to WLI, and equivalent to iodine staining (92% vs 42%; P < 0.05, 92% vs 100%; ns). The specificity of NBI was equivalent to WLI (89% vs 94%; ns). In HD, NBI sensitivity was equivalent to both iodine staining and WLI (100% vs 75%; ns). In non-HD, NBI sensitivity was equivalent to iodine staining, but WLI sensitivity was significantly inferior to NBI (88% vs 100%; ns, 25% vs 88%; P < 0.05). The NBI specificity was equivalent to WLI not only in HD but also in non-HD (90% vs 96%; ns, 88% vs 93%; ns). In both HD and non-HD endoscopy, NBI is less likely than WLI to miss a lesion. Even with non-HD endoscopy, NBI is suitable for esophageal standard examinations in general hospitals.

Original article: Prospective evaluation of narrow-band imaging endoscopy for screening of esophageal squamous mucosal high-grade neoplasia in experienced and less experienced endoscopists

Narrow-band imaging (NBI) is a novel, noninvasive optical technique that uses reflected light to visualize the organ surface. However, few prospective studies that examine the efficacy of NBI screening for esophageal cancer have been reported. To compare the diagnostic yield of NBI endoscopy for screening of squamous mucosal high-grade neoplasia of the esophagus between experienced and less experienced endoscopists. Patients with a history of esophageal neoplasia or head and neck cancer received NBI endoscopic screening for esophageal neoplasia followed by chromoendoscopy using iodine staining. Biopsy specimens were taken from iodine-unstained lesions and the histological results of mucosal high-grade neoplasias served as the reference standard. The primary outcome was the sensitivity of NBI for detecting new lesions. The secondary outcome was the positive predictive value of NBI and the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of NBI in a per lesion basis. A total of 350 patients (170 by experienced endoscopists and 180 by less experienced endoscopists) underwent endoscopic examination. A total of 42 new mucosal high-grade neoplastic lesions (25 in the experienced endoscopist group and 17 in the less experienced endoscopist group) were detected. In the per-lesion-based analysis, the sensitivity was significantly higher in the experienced endoscopist group (100%; 25/25) compared with the less experienced endoscopist group (53%; 9/17) (P < 0.001). The positive predictive value of NBI was higher in the experienced endoscopist group than in the less experienced endoscopist group (45%, 25/55 vs. 35%, 9/26), although the difference was not significant (P = 0.50). The sensitivity of NBI in the less experienced endoscopist group was 43% in the former half of patients, and increased to 60% in the latter half of patients. In the per-patient-based analysis, the sensitivity of NBI was significantly higher in the experienced endoscopist group (100%) than in the less experienced endoscopist group (100 vs. 69%, respectively; P = 0.04). The positive predictive values of the experienced endoscopist group and the less experienced endoscopist group were similar, and were 48 and 47%, respectively. In conclusion, compared with the gold standard of chromoendoscopy with iodine staining, the sensitivity of NBI for screening of mucosal high-grade neoplasia was 100% with the experienced endoscopists but was low with the less experienced endoscopists. Electronic chromoendoscopy with NBI is a promising screening tool in these high-risk patients with esophageal mucosal high-grade neoplasia, particularly when performed by endoscopists with experience of using NBI.

Early Detection of Superficial Squamous Cell Carcinoma in the Head and Neck Region and Esophagus by Narrow Band Imaging: A Multicenter Randomized Controlled Trial

Most of the esophageal squamous cell carcinomas (ESCCs) and cancers of the head and neck (H&N) region are diagnosed at later stages. To achieve better survival, early detection is necessary. We compared the real-time diagnostic yield of superficial cancer in these regions between conventional white light imaging (WLI) and narrow band imaging (NBI) in high-risk patients. In a multicenter, prospective, randomized controlled trial, 320 patients with ESCC were randomly assigned to primary WLI followed by NBI (n = 162) or primary NBI followed by WLI (n = 158) in a back-to-back fashion. The primary aim was to compare the real-time detection rates of superficial cancer in the H&N region and the esophagus between WLI and NBI. The secondary aim was to evaluate the diagnostic accuracy of these techniques. NBI detected superficial cancer more frequently than did WLI in both the H&N region and the esophagus (100% v 8%, P < .001; 97% v 55%, P < .001, respectively). The sensitivity of NBI for diagnosis of superficial cancer was 100% and 97.2% in the H&N region and the esophagus, respectively. The accuracy of NBI for diagnosis of superficial cancer was 86.7% and 88.9% in these regions, respectively. The sensitivity and accuracy were significantly higher using NBI than WLI in both regions (P < .001 and P = .02 for the H&N region; P < .001 for both measures for the esophagus, respectively). NBI could be the standard examination for the early detection of superficial cancer in the H&N region and the esophagus.

Influence of Narrow Band Imaging (NBI) Videobronchoscopy on the Assessment of Central Lung Cancer Extension and Therapeutic Decision

ABSTRACTObjectives: Determination of specificity and sensitivity of narrow band imaging (NBI) in the assessment of tumor extension in centrally located lung cancer, when compared to white light bronchoscopy (WLB) alone, and evaluation of possible influence of NBI on therapeutic decision in patients with lung cancer. Patients and methods: We evaluated 36 patients with suspected lung cancer. All patients underwent WLB followed by NBI bronchoscopy. We were using videobronchoscope BF-1T180 and EVIS LUCERA SPECTRUM processor unit. Results: Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for NBI in the assessment of tumor extension were 97.8, 85, 93.7, and 94.4%, respectively; and for WLB 92.3, 60, 69.6, and 88.9%, respectively. In 14 patients, NBI revealed more extensive tumor than WLB (p =.0057). In eight patients, NBI showed significant influence on therapeutic decision (p =.001). Conclusion: NBI videobronchoscopy had better specificity and sensitivity in the assessment of tumor extension in centrally located lung cancer, and it might play a significant role in the therapeutic decision.

Narrow Band Imaging Videobronchoscopy Improves Assessment of Lung Cancer Extension and Influences Therapeutic Strategy

Narrow band imaging (NBI) videobronchoscopy is a new technique aimed at lung cancer detection. This study investigated its sensitivity and specificity for evaluation of lung cancer extension and its possible influence on therapeutic decision, compared with white light videobronchoscopy. In this prospective study, we evaluated 106 patients with suspected lung cancer. All patients were examined using EVIS LUCERA videoendoscopy system. In every patient, at least three biopsies were taken from places visualized as pathologic, surrounding primary tumor, and three biopsies from places that appeared normal. The overall number of biopsies performed in 106 patients was 636. The specificity and sensitivity of NBI in revealing greater lung cancer extension were 85.6% and 95%, respectively; positive and negative predictive values were 84% and 95.6%, respectively. Specificity and sensitivity were significantly better when compared with white light bronchoscopy alone (P < 0.01). NBI led to the change in therapeutic decision in 14 patients. There was statistically significant correlation between NBI assessment of tumor extension and change in therapeutic decision (P < 0.000). NBI showed significantly better specificity and sensitivity in the assessment of lung cancer extension. NBI proved that it might have potential influence on therapeutic decision, making it more accurate. The procedure is safe and easily deployed in everyday practice.