Use of endoscopy with narrow-band imaging system in evaluating oral leukoplakia

Narrow-band imaging features of oral lichenoid conditions: A multicentre retrospective study

OBJECTIVE

Narrow-band imaging (NBI), which highlights epithelial intrapapillary capillary loops (IPCLs) classified into five patterns (0 toIV) with increasing correlation to malignancy, has demonstrated effectiveness for detection of oral squamous cell carcinoma (OSCC). Lack of standardised procedures limits its use for routine inspection of oral lichenoid lesions including oral lichen planus (OLP), oral lichenoid lesion (OLL) and oral lichenoid reaction (OLR). The aim of this study was to analyse IPCL patterns of such lesions, assessing correlations with histopathological outcomes.

MATERIALS AND METHODS

A multicentre, retrospective study was performed on 84 patients who underwent NBI and subsequent biopsy for suspected OLP/OLL/OLR. Patients were examined with Evis Exera III NBI system. Recorded NBI video endoscopies were evaluated to assess IPCL patterns and correlated with histopathological outcomes.

RESULTS

No significant differences were detected among OLP/OLL/OLR on NBI inspection. All lichenoid lesions were significantly related to low-grade (0-II) IPCL patterns, clearly distinguishable from OSCC, showing pattern IV (p < 0.05).

CONCLUSIONS

NBI cannot discern among OLP/OLL/OLR lesions. Interpretation should be modulated when assessing lichenoid lesions. NBI has potential to discern malignant transformation occurring in lichenoid lesions undergoing long-term follow-up, as IPCL pattern IV may be used as a clinical marker of malignancy arising in chronic inflammatory lesions.

Accuracy of narrow band imaging for detecting the malignant transformation of oral potentially malignant disorders: A systematic review and meta-analysis

Objective

Oral potentially malignant disorders (OPMDs) are a spectrum of diseases that harbor the potential of malignant transformation and developing into oral squamous cell carcinoma (OSCC). Narrow band imaging (NBI) has been clinically utilized for the adjuvant diagnosis of OPMD and OSCC. This study aimed to comprehensively evaluate the diagnostic accuracy of NBI for malignant transformations of OPMD by applying the intraepithelial papillary capillary loop (IPCL) classification approach.

Methods

Studies reporting the diagnostic validity of NBI in the detection of OPMD/OSCC were selected. Four databases were searched and 11 articles were included in the meta-analysis. We performed four subgroup analyses by defining IPCL I/II as negative diagnostic results and no/mild dysplasia as negative pathological outcome. Pooled data were analyzed using random-effects models. Meta-regression analysis was performed to explore heterogeneity.

Results

After pooled analysis of the four subgroups, we found that subgroup 1, defining IPCL II and above as a clinically positive result, demonstrated the most optimal overall diagnostic accuracy for the malignant transformation of OPMDs, with a sensitivity and specificity of NBI of 0.87 (95% confidence interval (CI) [0.67, 0.96], p < 0.001) and 0.83 [95% CI (0.56, 0.95), p < 0.001], respectively; while the other 3 subgroups displayed relatively low sensitivity or specificity.

Conclusions

NBI is a promising and non-invasive adjunctive tool for identifying malignant transformations of OPMDs. The IPCL grading is currently a sound criterion for the clinical application of NBI. After excluding potentially false positive results, these oral lesions classified as IPCL II or above are suggested to undergo biopsy for early and accurate diagnosis as well as management.

Non-invasive imaging of oral potentially malignant and malignant lesions: A systematic review and meta-analysis

Non-invasive (NI) imaging techniques have been developed to overcome the limitations of invasive biopsy procedures, which is the gold standard in diagnosis of oral dysplasia and Oral Squamous Cell Carcinoma (OSCC). This systematic review and meta- analysis was carried out with an aim to investigate the efficacy of the NI-imaging techniques in the detection of dysplastic oral potentially malignant disorders (OPMDs) and OSCC. Records concerned in the detection of OPMDs, Oral Cancer were identified through search in PubMed, Science direct, Cochrane Library electronic database (January 2000 to October 2020) and additional manual searches. Out of 529 articles evaluated for eligibility, 56 satisfied the pre-determined inclusion criteria, including 13 varying NI-imaging techniques. Meta-analysis consisted 44 articles, wherein majority of the studies reported Autofluorescence (AFI-38.6%) followed by Chemiluminescence (CHEM), Narrow Band Imaging (NBI) (CHEM, NBI-15.9%), Fluorescence Spectroscopy (FS), Diffuse Reflectance Spectroscopy (DRS), (FS, DRS-13.6%) and 5aminolevulinic acid induced protoporphyrin IX fluorescence (5ALA induced PPIX- 6.8%). Higher sensitivities (Sen) and specificities (Spe) were obtained using FS (Sen:74%, Spe:96%, SAUC=0.98), DRS (Sen:79%, Spe:86%, SAUC = 0.91) and 5 ALA induced PPIX (Sen:91%, Spe:78%, SAUC = 0.98) in the detection of dysplastic OPMDs from non-dysplastic lesions(NDLs). AFI, FS, DRS, NBI showed higher sensitivities and SAUC (>90%) in differentiating OSCC from NDLs. Analysed NI-imaging techniques suggests the higher accuracy levels in the diagnosis of OSCC when compared to dysplastic OPMDs. 5 ALA induced PPIX, DRS and FS showed evidence of superior accuracy levels in differentiation of dysplastic OPMDs from NDLs, however results need to be validated in a larger number of studies.

Noninvasive Imaging Methods to Improve the Diagnosis of Oral Carcinoma and Its Precursors: State of the Art and Proposal of a Three-Step Diagnostic Process

Simple Summary

Oral squamous cell carcinoma (OSCC) accounts for 90–95% of malignant tumors of the lip and oral cavity and is associated with high mortality in the advanced stages. Early diagnosis is a challenge for oral pathologists and dentists, due to the ambiguous appearance of early OSCC, which is often misdiagnosed, mistreated, and associated with diagnostic delay. The gold standards for OSCC diagnosis are biopsy and histopathological assessment, but these procedures are invasive and time-consuming. Adjunctive noninvasive techniques allow the definition of the malignant features of a suspicious lesion in real time and noninvasively, thus improving the diagnostic procedure. The present review aimed to focus on some of the main promising noninvasive imaging techniques, to highlight their perspective adoption in a three-step diagnosis, which is idealistically faster and better, as well as enables the patient’s compliance.

Abstract

Oral squamous cell carcinoma (OSCC) is the most prevalent form of cancer of lips and oral cavity, and its diagnostic delay, caused by misdiagnosis at the early stages, is responsible for high mortality ratios. Biopsy and histopathological assessment are the gold standards for OSCC diagnosis, but they are time-consuming, invasive, and do not always enable the patient’s compliance, mainly in cases of follow-up with the need for more biopsies. The use of adjunctive noninvasive imaging techniques improves the diagnostic approach, making it faster and better accepted by patients. The present review aims to focus on the most consolidated diagnostic techniques, such as vital staining and tissue autofluorescence, and to report the potential role of some of the most promising innovative techniques, such as narrow-band imaging, high-frequency ultrasounds, optical coherence tomography, and in vivo confocal microscopy. According to their contribution to OSCC diagnosis, an ideal three-step diagnostic procedure is proposed, to make the diagnostic path faster, better, and more accurate.

Role of Narrow Band Imaging Endoscopy in Preoperative Evaluation of Laryngeal Leukoplakia: A Review of the Literature

INTRODUCTION

Leukoplakia is a precancerous lesion considered to be within the spectrum of histopathological results from parakeratosis, through stages of dysplasia to invasive cancer. Narrow band imaging (NBI) endoscopy has been introduced to improve early diagnosis of benign and malignant laryngeal lesions. The aim of this literature review was to evaluate the accuracy of preoperative evaluation of vocal fold leukoplakia with NBI endoscopy in comparison with histology.

METHODS

A systematic review of the literature was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, using 3 different databases: PubMed, Embase, and Scopus. The included articles in the systematic review were identified combining each of the following terms: "narrow band imaging" OR "NBI," [AND] with each of these terms: "laryngeal leukoplakia," OR "vocal fold leukoplakia," OR "vocal cord leukoplakia."

RESULTS

The articles that fully met the inclusion criteria were 5 case series, conducted between January 2010 and February 2018, and published between 2017 and 2019. The selected articles included 312 patients (86% males and 14% females), affected by 382 vocal cord leukoplakia, evaluated with NBI endoscopy and that underwent surgical microlaryngoscopy with biopsy. Based on the studies included in the review, accuracy of NBI in predicting malignancy within leukoplakia ranged from 81% to 97.8%, demonstrating to be an accurate method to predict the risk of malignant transformation of vocal fold leukoplakia.

CONCLUSION

Narrow band imaging can help otolaryngologists in the decision-making process on the necessity to perform a biopsy and transoral surgery or long-term follow-up. Larger studies are necessary to confirm the high association of NBI evaluation of the epithelium surrounding the leukoplakia with the histological diagnosis.

Tailored resections in oral and oropharyngeal cancer using narrow band imaging

PURPOSE

In a previous pilot study we observed that intra-operative narrow-band imaging (NBI) helps achieve clear superficial resection margins. The aim of this study was to verify if the use of intra-operative NBI can help to obtain tailored resections and if it is influenced by the lesion site, aspects not investigated in our previous study.

MATERIALS AND METHODS

The resection margins of 39 oral and 22 oropharyngeal squamous cell carcinomas were first set at 1.5cm from the macroscopic lesion boundary (white light, WL, tattoo). Then, the superficial tumor extension was more precisely defined with NBI, giving rise to three possible situations: NBI tattoo larger than the WL tattoo, NBI tattoo coinciding with the WL tattoo, or NBI tattoo smaller than the WL tattoo. For each of these situations the space comprised between the NBI and WL tattoos was defined "NBI positive", "NBI null", and "NBI negative", respectively. Resections were performed following the outer tattoo. The number of clear superficial resection margins, and the pathological response on the "NBI-positive" and the "NBI-negative" areas were recorded.

RESULTS

We obtained 80.3% negative superficial resection margins. NBI provided a more precise definition of superficial tumor extension in 43 patients. Sensitivity, specificity, positive and negative predictive values were 94.4%, 64%, 79.1% and 88.9%, respectively; a test of proportions demonstrated they were not influenced by tumor site.

CONCLUSIONS

NBI could allow for real-time definition of superficial tumor extension with possible tailored resections and fewer positive superficial resection margins; it is not influenced by tumor site.

The usefulness of narrow-band imaging for the diagnosis and treatment of vocal fold leukoplakia

OBJECTIVE

This research was aimed to explore the efficacy of narrow-band imaging (NBI) on distinguishing the degree of dysplasia of vocal fold leukoplakia.

METHODS

Patients were examined by flexible endoscopy, under white light endoscopy (WLE) and NBI. 78 lesions were divided into two groups according to the NBI classification. Group 1: non-dysplasia (ND), including squamous hyperplasia with hyperkeratosis or parakeratosis; Group 2: squamous hyperplasia with mild or moderate dysplasia (MD) or severe dysplasia (SD), or carcinoma in situ (CIS).

RESULTS

The diagnostic accuracy of NBI for Group 1 and Group 2 was 69.70% (23/33) and 95.56% (43/45), respectively, and the kappa index was 0.711 and a p value < .05, which was considered statistically significant.

CONCLUSIONS

The NBI could roughly estimate the degree of dysplasia. Differentiating between ND, MD, SD, and CIS, which may be useful for clinicians on selecting suitable therapies.

Usefulness of office examination with narrow band imaging for the diagnosis of head and neck squamous cell carcinoma and follow-up of premalignant lesions

BACKGROUND

The purpose of this study was to evaluate the value of narrow band imaging (NBI) examination in the office for the diagnosis and follow-up of upper airway premalignant and malignant lesions.

METHODS

Four hundred eighty lesions were evaluated with white light endoscopy (WLE) and NBI before a biopsy/excision. Additionally, 151 premalignant lesions were followed up without proven biopsy. Carcinoma-free survival was calculated. The learning curve was analyzed.

RESULTS

Overall, the accuracy improved from 74.1% with WLE to 88.9% with NBI, being relevant in all anatomic subsites. The accuracy of NBI increased significantly with increasing experience (area under the curve [AUC] >0.9). After a follow-up of 25 months, 14 of 151 lesions (9.3%) converted into carcinoma. The 4-year carcinoma-free survival rate was 86.4%. The 4-year carcinoma-free survival rate differed significantly between lesions classified as benign/mild dysplasia versus those presenting as moderate/severe dysplasia (88.9% vs 73.5%; P = .018).

CONCLUSION

The NBI provided a greater accuracy than WLE and showed promising usefulness for the follow-up of premalignant lesions.

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.

NBI utility in the pre-operative and intra-operative assessment of oral cavity and oropharyngeal carcinoma

PURPOSE

Despite advances in the surgical management of head and neck squamous cell carcinoma, the identification of synchronous lesions, precancerous lesions around the main tumor, or the unknown primary in the case of neck metastasis remains a problem, as these lesions may be invisible to the naked eye or with standard white light (WL) endoscopy. However, the advent of tools such as narrow-band imaging (NBI) could help the clinician. The purpose of this study was to assess the impact of NBI during the pre-operative and intra-operative stages of management of oral and oropharyngeal cancers.

MATERIALS AND METHODS

NBI was used pre-operatively in 47 patients with oral or oropharyngeal squamous cell carcinoma to identify the involvement of adjacent subsites, multifocality, synchronous lesions or an unknown primary. NBI was used intra-operatively in 30 patients to better define the tumor limits and guide the resection. The advantage of NBI versus WL endoscopy was analyzed by calculating the true and false positive rate pre-operatively, and the need for resection enlargements, histology of the enlargement, and the rate of clear margins at definitive histology, intra-operatively.

RESULTS

Pre-operatively, the diagnostic gain of NBI was 8.5%, allowing identification of three synchronous tumors and one unknown primary. Intra-operatively, NBI improved the definition of tumor limits in 67.7% of cases, with resection enlargements showing dysplasia and carcinoma in 8 and 12 patients, respectively; we obtained 74.2% negative margins at histology.

CONCLUSIONS

NBI could represent an added value in the pre-operative and intra-operative assessment of oral cavity and oropharyngeal carcinoma.

Diagnostic accuracy of Narrow Band Imaging for the detection of oral potentially malignant disorders

OBJECTIVE

To determine the clinical diagnostic accuracy of Narrow Band Imaging(™) for the detection of oral potentially malignant disorders in a prospective series of patients.

MATERIALS AND METHODS

New and existing patients referred to an oral medicine and pathology specialist clinic for assessment of at least one white, red or red-white oral mucosal lesion underwent conventional oral examination, followed by examination with the white light mode and then narrow band imaging mode of a Narrow Band Imaging(™) system. The clinical presentation, microvascular architecture and relevant histopathology of all lesions were recorded.

RESULTS

A total of 272 lesions from 95 patients were observed. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy for the detection of oral potentially malignant disorders or worse by Narrow Band Imaging(™) were 100%, 74.63%, 92.38%, 100% and 93.77%, respectively, when compared with conventional oral examination. Narrow Band Imaging(™) aided the detection of 24 lesions undetected by conventional oral examination and 13 lesions undetected by white light endoscopy.

CONCLUSION

Narrow Band Imaging(™) demonstrates great utility as a visualisation adjunct for detecting and monitoring oral potentially malignant diseases, particularly lesions not identified by conventional oral examination or white light examination alone.

Is NBI-Guided Resection a Breakthrough for Achieving Adequate Resection Margins in Oral and Oropharyngeal Squamous Cell Carcinoma?

OBJECTIVES

Obtaining free resection margins is the main goal of oncological surgeons. Narrow-band imaging (NBI) has been recently used to help define resection margins in transoral laser microsurgery for laryngeal carcinoma. The aim of this study was to evaluate the effect of intraoperative NBI in defining the surgical resection margins of oral and oropharyngeal cancers.

METHODS

Between January 2014 and March 2015, NBI was used intraoperatively after an initial definition of resection margins with white light in 26 patients (group A). The rate of superficial positive margins at definitive histology was compared with that of a historical cohort of 44 patients (group B) previously managed without the use of intraoperative NBI.

RESULTS

A statistically significant reduction in the rate of positive superficial margins was observed at definitive histology in group A (P = .028). NBI helped to identify the presence of dysplasia and cancer around the visible tumor not otherwise detectable with visual examination alone.

CONCLUSIONS

NBI could be a useful tool for obtaining free resection margins in oral and oropharyngeal carcinoma.

The diagnostic value of narrow band imaging in different oral and oropharyngeal subsites

The diagnostic value of narrow band imaging (NBI) in the "optical biopsy" of leukoplakias (LP) and erythroplakias (EP) in different oral cavity (OC) and oropharyngeal (OP) subsites is still to be defined. We evaluated 128 unbiopsied and untreated OC/OP LP and EP by conventional oral examination (COE), white light (WL) endoscopy, and NBI and categorized them as "suspicious" or "innocuous". All lesions were treated by excisional biopsy. True positives were those considered as "suspicious" and with histopathology ranging from mild dysplasia to invasive carcinoma. Epithelia were classified as follows: type 1, keratinized thick stratified (gingiva, hard palate, dorsal tongue); type 2a, non-keratinized thin stratified (floor of mouth, vestibule, ventral tongue, soft palate, palatine tonsils, base of tongue); type 2b, non-keratinized, very thick stratified (retromolar trigon, lateral tongue, labial and buccal mucosa). Histopathology revealed 32 % benign lesions, 13 % mild to moderate dysplasias, 15 % severe dysplasias/carcinoma in situ, 16 % microinvasive, and 23 % invasive carcinomas. The false positive rates were 32 % at COE, 27 % at WL, and 15 % at NBI. The false negative rates were 49, 22, and 11 %, respectively. Diagnositic performance was higher for NBI compared to COE (p < 0.001) and to WL (p = 0.004). Comparison of the diagnostic value of NBI among different OC/OP subsites did not show statistically significant difference. NBI as an "optical biopsy" tool significantly reduces the rates of false positives and false negatives in diagnosis of OC/OP cancer compared with COE and WL. No statistically significant difference was noted in its diagnostic value among different OC/OP subsites.

Narrow band imaging: clinical applications in oral and oropharyngeal cancer

Narrow Band Imaging (NBI) is an endoscopic optical imaging enhancement technology that improves the contrast of mucosal surface texture, and enhances visualisation of mucosal and submucosal vasculature. White light is filtered to emit two 30-nm narrow bands of blue (415 nm) and green light (540 nm) light simultaneously, the former corresponding to the main peak absorption spectrum of haemoglobin, and the latter allowing visualisation of blood vessels in the deeper mucosal and submucosal layers. NBI has been used to better assess oral potentially malignant disorders (OPMD), identify oral and oropharyngeal squamous cell carcinoma (SCC), and to define surgical margins of head and neck malignancies. NBI shows great potential in improving detection rates of OPMD, facilitating better assessment of oral and oropharyngeal SCC, and reducing the risk of recurrence for oral SCC. Although further research is required to better understand and define intrapapillary capillary loop (IPCL) patterns and to relate these with clinical, histopathological and molecular parameters especially for early mucosal changes, there is building evidence to recommend its use as the new gold standard for endoscopic assessment in head and neck oncology.

Open questions and novel concepts in oral cancer surgery

The persistence of cancerous cells after surgery in oral squamous cell carcinoma (OSCC) represents a major challenge, as it often leads to local recurrences and secondary primary tumors, which are eventually responsible for a large proportion of deaths. This persistence is currently evaluated by histological analyses. In this review we discuss some important pitfalls of the histopathological analysis, such as margin evaluation, specimen shrinkage and T staging. In addition, we critically analyze the appropriateness of current surgical techniques in relation to the concept of field cancerization. Finally, we describe some novel imaging and molecular approaches, which might be useful in tailoring surgical resections and encourage the use of OSCC animal models to explore and provide proof of concept of the feasibility and potential clinical utility of innovative surgical protocols.

Clinical characteristics of narrow-band imaging of oral erythroplakia and its correlation with pathology

Background

To analyze the clinical application of endoscope with narrow-band imaging (NBI) system in detecting high-grade dysplasia, carcinoma in situ, and carcinoma in oral erythroplakia.

Methods

The demographic, histopathological data, and NBI vasculature architectures of patients receiving surgical intervention for oral erythroplakia were retrospectively reviewed and analyzed statistically.

Results

A total of 72 patients, including 66 males and 6 females, with mean age of 54.6 ± 11.2 years, were enrolled. The odds ratio of detecting high-grade dysplasia, carcinoma in situ, and carcinoma by twisted elongated morphology and destructive pattern of intraepithelial microvasculature was 15.46 (confidence interval 95 %: 3.81–72.84), and the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 80.95 %, 78.43 %, 60.71 %, 90.91 %, and 79.17 %, respectively, which were significantly better than other two established NBI criteria (p < 0.001).

Conclusions

Twisted, elongated, and destructive patterns of intraepithelial papillary capillary loop of NBI images are indicators for high-grade dysplasia, carcinoma in situ, and invasive carcinoma in oral erythroplakia.

Efficacy of narrow band imaging for detection and surveillance of potentially malignant and malignant lesions in the oral cavity and oropharynx: a systematic review

OBJECTIVE

Narrow band imaging (NBI) is an endoscopic technique that enhances the mucosal surface texture, and mucosal and submucosal vascular morphology. This paper systematically reviews the available literature regarding the efficacy of NBI for the detection and monitoring of potentially malignant and malignant lesions in the oral cavity and oropharynx.

METHODS

Databases searched included PubMed, EMBASE, Web of Science and Scopus (to September 2013). Additional articles were found by conducting an author publication search using PubMed and by scanning the reference lists of relevant articles. Only trials that investigated and evaluated the effectiveness of both white light (WL) and NBI for aiding the detection of only oral potentially malignant lesions, oral squamous cell carcinomas and/or oropharyngeal squamous cell carcinomas were considered for this review. Two reviewers (ANV and CSF) independently assessed retrieved articles against the criteria, and included articles underwent data extraction and risk of bias assessment.

RESULTS

Two studies, one retrospective and one prospective, met the inclusion criteria. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy for WL ranged between 56-96%, 60-100%, 33-100%, 87-99% and 66-89% respectively, whereas it was 87-96%, 94-98%, 73-96%, 97-98% and 92-97% respectively for NBI.

CONCLUSION

While more research is required to determine the full value of NBI, it has great potential in accurately aiding the detection and assessment of neoplastic lesions, and influencing how these lesions are managed.

Advances in optical adjunctive AIDS for visualisation and detection of oral malignant and potentially malignant lesions

Traditional methods of screening for oral potentially malignant disorders and oral malignancies involve a conventional oral examination with digital palpation. Evidence indicates that conventional examination is a poor discriminator of oral mucosal lesions. A number of optical aids have been developed to assist the clinician to detect oral mucosal abnormalities and to differentiate benign lesions from sinister pathology. This paper discusses advances in optical technologies designed for the detection of oral mucosal abnormalities. The literature regarding such devices, VELscope and Identafi, is critically analysed, and the novel use of Narrow Band Imaging within the oral cavity is also discussed. Optical aids are effective in assisting with the detection of oral mucosal abnormalities; however, further research is required to evaluate the usefulness of these devices in differentiating benign lesions from potentially malignant and malignant lesions.

Use of endoscopy with narrow-band imaging system in detecting squamous cell carcinoma in oral chronic non-healing ulcers

OBJECTIVES

This study seeks to analyze the factors associated with the occurrence of squamous cell carcinoma in oral non-healing ulcers for more than 3 weeks and investigate the role of endoscopy with narrow-band imaging system (NBI) in detecting carcinoma in these lesions.

METHODS

The demographic and clinicopathological data of patients receiving surgical interventions for chronic oral non-healing ulcers, and the intraepithelial papillary capillary loop patterns shown by NBI were retrospectively reviewed and analyzed.

RESULTS

A total of 63 patients (41 males and 22 females) with mean age of 57.9 ± 16.7 years were enrolled. In univariate analysis, ulcers with induration, history of oral cancer, and intraepithelial microvasculature of NBI were factors associated with the occurrence of squamous cell carcinoma in oral non-healing ulcers. Multivariate analysis showed that the intraepithelial microvasculature of NBI was the only independent factor predicting the occurrence of carcinoma in oral chronic non-healing ulcers with sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 93.75 %, 91.49 %, 78.95 %, 97.73 %, and 92.06 %, respectively.

CONCLUSIONS

Morphology of intraepithelial microvasculature of NBI, or twisted, elongated, and destructive pattern of intraepithelial papillary capillary loop, is the only independent factor associated with the occurrence of squamous cell carcinoma in oral chronic non-healing ulcers. Endoscope with NBI is a rapid, safe, and promising tool in detecting squamous cell carcinoma in oral chronic non-healing ulcers.

Light sources used in evaluating oral leukoplakia: broadband white light versus narrowband imaging

This study aimed to investigate the clinical efficacy of using broadband white light (BWL) to observe morphologic appearance, narrow-band imaging (NBI) to observe intraepithelial microvasculature, and both BWL and NBI for the detection of high-grade dysplasia and carcinoma in oral leukoplakia. Among 317 patients (274 males and 43 females; aged 52.4±10.7 years), the odds ratio (95% confidence interval) for detecting high-grade dysplasia and carcinomatous lesions based on morphologic appearances of BWL, and microvasculature patterns of NBI, were 39.12 (9.33-64.10), and 97.16 (38.19-247.21), respectively, which were significantly better than BWL (p<1×10(-15)). The sensitivity, specificity, positive and negative predictive values, and accuracy of use of traditional BWL classification, NBI classification, and combined BWL and NBI classification for detecting high-grade dysplasia and carcinomatous lesions were 96.30, 60.08, 33.12, 98.75, 66.25, 39.92, and 3.70%; 87.04, 93.54, 73.44, 97.23, and 92.43%; and 100.00, 60.08, 33.96, 100.00, and 66.88%, respectively. In conclusion, the diagnostic accuracy by NBI classification of oral leukoplakia based on the intraepithelial microvasculature patterns is significantly better than BWL indicating that NBI is a promising non-invasive tool in detecting high-grade dysplasia and carcinomatous lesions in oral leukoplakia.

Implications of morphologic patterns of intraepithelial microvasculature observed by narrow-band imaging system in cases of oral squamous cell carcinoma

PURPOSE

To investigate the intraepithelial microvascular morphology of oral squamous cell carcinoma (OSCC) by using narrow-band imaging (NBI) and analyze whether the intraepithelial papillary capillary loop (IPCL) patterns correlate with infiltration depth and disease severity in OSCC.

METHODS

The clinicopathologic data, morphology of vascular architecture as observed by NBI, and histopathology of patients with OSCC were retrospectively reviewed and analyzed.

RESULTS

A total of 80 patients, including 73 males and 7 females with an average age of 54.18±12.23 years, were enrolled. Three patterns of intraepithelial microvasculature were revealed by NBI and differences in these three patterns were significant with regard to pathologic T-classification (p<0.0001), N-classification (p=0.00022), TNM stage (p<0.0001), lymphovascular invasion (p<0.0001), perineural invasion (p=0.000299), depth of tumor infiltration (p<0.0001), and tumor differentiation (p<0.0001). A cut-off point of tumor infiltration of 10.012 mm was best predicted for the destructive pattern of IPCL (sensitivity=100%, specificity=90.0%).

CONCLUSIONS

Three different patterns of IPCL, showing step-wise increased severity according to pathologic parameters, were observed by NBI in cases of OSCC. The pattern indicating IPCL destruction with angiogenesis was associated with more advanced disease stage.