FLEX October 2023

The Laryngoscope V C 2016 The American Laryngological, Rhinological and Otological Society, Inc.

Does Narrow Band Imaging Improve Preoperative Detection of Glottic Malignancy? A Matched Comparison Study

Hagit Shoffel-Havakuk, MD; Yonatan Lahav, MD; Barak Meidan, MD; Yaara Haimovich, BSc; Meir Warman, MD; Moshe Hain, MD; Yaniv Hamzany, MD; Alexander Brodsky, MD; Tali Landau-Zemer, MD; Doron Halperin, MD

Objectives/Hypothesis: The primary suspicion for glottic malignancy during office laryngoendoscopy is based on lesion appearance. Previous studies investigating laryngeal use of narrow band imaging (NBI) are mostly descriptive. The additive value of NBI relative to white light (WL) requires further investigation. Study Design: Observational matched study. Methods: NBI was compared with WL images of 45 vocal fold lesions suspected for malignancy (21 carcinoma, 22 dys plasia, two benign). All images were presented randomly and evaluated by six independent otolaryngology specialists. The observers were asked to estimate lesion size, location, and pathology. The results for the two imaging modalities were com pared with each other and with the final pathology. Results: The observers estimated lesion size to be larger in the NBI images by an average of 9% (2.4 mm 2 ; P 5 .04) compared to WL. In 64.6% of cases, the observers estimated similar pathology for NBI and WL. When there was a discrepan cy, the estimated pathology was “malignant” in 24.3% by NBI, compared with 11.1% by WL. Overall, 44.7% of the lesions were estimated to be malignant by NBI, compared with 33.8% by WL ( P 5 .001). The sensitivity and specificity rates for malignancy detection by NBI were 58.6% and 61.2%, respectively, compared to 48.7% and 76.1% by WL. Conclusions: Observers tend to estimate vocal fold lesions to be larger and more frequently suspect malignancy while assessing NBI images. Compared with WL, NBI demonstrates increased sensitivity and decreased specificity for detection of

malignancy. Nevertheless, the specificity and sensitivity of NBI alone are considerably low. KeyWords: Laryngoscopy, narrow band imaging, early glottic cancer, vascularization, larynx. Level of Evidence: 4

Laryngoscope , 127:894–899, 2017

INTRODUCTION Malignant glottic lesions often express typical fea tures on initial office laryngoscopy, suggesting further workup and treatment. However, histopathology of a formalin-fixed tissue sample remains the gold standard for final diagnosis. Management of glottic lesions suspected of From the Department of Otolaryngology–Head and Neck Surgery, Kaplan Medical Center, Rehovot ( H . S .- H ., Y . L ., Y . HAIMOVICH , M . W ., D . H .); Hadassah Medical School, Hebrew University, Jerusalem( H . S .- H ., Y . L ., B . M ., M . W ., T . L .- Z ., D . H .); Schneider Children’s Medical Center, Petah Tikva ( M . H .); Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv ( M . H ., Y . H ); Department of Otolaryngology–Head and Neck Surgery, Rabin Med ical Center, Petah Tikva ( Y . H ); Department of Otolaryngology–Head and Neck Surgery, Bnai Zion Medical Center, Haifa ( A . B .); Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa ( A . B .); and Department of Otolaryngology, Head and Neck Surgery, Hadassah Medi cal Center, Jerusalem ( T . L .- Z .), Israel. Editor’s Note: This Manuscript was accepted for publication on August 1, 2016. Presented as a podium presentation at the American Laryngologi cal Association annual meeting at the Combined Otolaryngological Spring Meetings, Chicago, Illinois, U.S.A., May 18–21, 2016. H . S .- H . and Y . L . contributed equally to this work. The authors have no funding, financial relationships, or conflicts of interest to disclose. Send correspondence to Yonatan Lahav, MD, Department of Oto laryngology–Head and Neck Surgery, Kaplan Medical Center, Pasternak St. P.O.B 1, Rehovot, 76100 Israel. E-mail: yonatan.lahav@gmail.com

malignancy should balance voice preservation and func tionality, along with the need for sufficient tissue sampling. This dilemma results in clinicians’ continuous pursuit of a reliable, noninvasive tool to detect true malignancies and avoid unnecessary biopsies. For that reason, biologic endoscopy techniques attract clinicians’ attention. The term biologic endoscopy encompasses an array of diagnos tic tools including toluidine blue staining, autofluores cence, and confocal microendoscopy. 1 In the past decade, new biologic endoscopy techni ques using optical filters and amplifications, such as nar row band imaging (NBI), have become more common and broadly investigated. As opposed to other biologic endosco py techniques, NBI does not focus on biological properties of the neoplasm itself, but highlights its vascularization. 2 NBI was primarily introduced in gastrointestinal (GI) endoscopy, 3–8 and its use was later extended to other med ical specialties as otolaryngology. 2 NBI applies filters that narrow the frequency range of light into bands of blue ( 415 nm) and green ( 540 nm). The blue and green lights enhance visualization of mucosal and submucosal microvascularization, based on their absorption by hemo globin and the different depth of penetration of different light wavelengths. 2 Studies of the GI system established the notion that morphological changes of intraepithelial

DOI: 10.1002/lary.26263

Laryngoscope 127: April 2017

Shoffel-Havakuk et al.: NBI Preoperative Detection of Malignancy

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