FLEX October 2023

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

Fig. 1. The following figures consist of representative images from our study. Images from left to right in each panel: 1) the white light (WL) image of the lesion that was presented to the observers; 2) the narrow band imaging (NBI) image of the same lesion that was presented to the observers; 3) a drawing of the lesion (red line) by one of the observers on a schematic vocal fold (VF) image as seen with WL; and 4) the drawing of the lesion (red line) as seen with NBI, by the same observer. Each panel presents drawings by a different observer. (A) Invasive squamous cell carcinoma. WL laryn goscopy revealed an exophytic lesion on the right VF. NBI enhanced irregular intraepithelial papillary capillary loops (IPCLs) and blue to brown dots. The observer drew the lesion’s perimeters as more extended by NBI relative to WL. (B) Microinvasive squamous cell carcinoma. WL revealed a lesion encompassing the left VF along with granulation tissue and fibrin. NBI enhanced an irregular pattern of IPCLs with blue to brown dots. The observer drew the lesion as a continuous lesion with extended perimeters by NBI compared to the drawing by WL. (C) Bilateral mild dysplasia. WL revealed bilateral superficial spread of keratin. NBI enhanced the keratin in contrast to the irregular mucosal vascularization. The observer drew the right VF lesion’s perimeters as more extended by NBI.

RESULTS Estimation of Lesion Size and Location

result of subjective interpretations and the tendencies of the different clinicians. ICC was used to validate the agreement for this tendency among the observers. The ratio between the lesion area using NBI and WL images was calculated for each observer, and the agreement between the observers using ICC was 0.832 (95% CI 5 0.7–0.918). In the drawings, the lesion margins tended to be closer to the vocal process and the anterior commissure when drawn by NBI. The drawn lesions were signifi cantly closer to the vocal process using NBI compared to WL by an average of 0.6 mm ( P 5 .002; Table II). The observers were asked to estimate the lesion size by assigning the lesion to one of three size categories. Using WL, 27.8% were estimated to be less than one-third

When the observers were asked to draw the lesions’ margins on a VF schematic image, the lesion area with NBI was larger than that of WL by an average of 2.4 mm 2 (95% confidence interval [CI] 5 0.8–4.1). This accounts for a 9% increase in the estimated area. The average area of the lesions was larger using NBI compared with WL: 29.9 6 18.9 mm 2 versus 28.1 6 19.3 mm 2 , respectively ( P 5 .04). Analyzing the results for each observer separate ly, the differences in the estimated area demonstrated an increase using NBI in five of the six observers (Table I). A substantial difference between the observers’ area estima tions (e.g., 38.7 mm 2 and 18.8 mm 2 in WL lesion area of observers 1 and 6, respectively) was demonstrated as a

Laryngoscope 127: April 2017

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

896