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15314995, 2017, 4, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/lary.26263 by Karuna Dewan - Ochsner Medical Foundation - New Orleans - USA , Wiley Online Library on [21/08/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License

that the sensitivity of flexible NBI and HDTV NBI in detecting recurrent malignancy after chemoradiotherapy was 100%, compared to only 66% for HDTV WL. Zabrod sky et al. 22 described mucosal lesions in 14 patients after radiotherapy, which were detected only by NBI and were undetectable by WL. This resulted in a 79% true positive rate by final pathology. Subsequently, the recent European laryngological society recommendations for follow-up in patients treated for laryngeal cancer sug gests that NBI should be considered as adjunctive tool, as its use can detect 18% more true positive laryngeal cancer lesions than the conventional WL endoscopy. 23 Premalignant and malignant glottic lesions are often keratinized. This may be considered as a confound er that hides the significant vascular changes needed to indicate malignancy. However, keratin is well enhanced under the NBI light and much can be learned from its appearance. A smooth uniform keratin layer, hairlike projections, and a strong white appearance under NBI conditions suggest nonmalignant lesion. Conversely, irregular keratin spread with islands of exposed mucosa, variances in thickness, and areas of necrosis suggest malignancy. The appearance of keratin under NBI should be further investigated and categorized. This original study examined the additive value of NBI relative to WL in preoperative flexible examination, viewed by different independent observers. The results of our study showed that different observers have similar ten dencies in interpreting NBI images of glottic lesions, enabling increased detection of malignancy and extended lesion perimeters. However, the specificity and positive predictive value of NBI alone are lower than those of WL and may result in an increased number of unnecessary pro cedures. As experience may improve the sensitivity of NBI, 24 to optimize the benefits of this tool, practitioners should be familiar with normal vascular patterns of the glottis, 25 vascular characteristics of benign lesions, and specific vascular and keratin changes in malignant lesions. CONCLUSION Dysplastic and malignant lesions of the glottis appear larger and are more frequently suspected of mali gnancy using NBI. Compared with WL, NBI demon strates increased sensitivity and decreased specificity for detection of malignancy. However, the specificity and sensitivity of NBI alone are considerably low. Therefore, NBI view alone should not dictate the decision as wheth er to obtain a specimen for histopathological investiga tion. Although the potential role of NBI requires more experience and further investigation, it may be an adjunct to WL in routine office examination. BIBLIOGRAPHY 1. Piazza C, Del Bon F, Peretti G, Nicolai P. ‘Biologic endoscopy’: optimization of upper aerodigestive tract cancer evaluation. Curr Opin Otolaryngol Head Neck Surg 2011;19:67–76.

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