Utility of narrow band imaging in the diagnosis of middle turbinate head edema

Evaluation of an image enhancement system for the assessment of nasal and paranasal sinus diseases

PURPOSE

Dysplasia and cancer of the upper aerodigestive tract are characterized by significant neoangiogenesis. This can be recognized by optical methods like the Storz Professional Image Enhancement System (SPIES). Up to now, there are no reports of using this novel technique for examining nasal diseases. The objective of this study was to evaluate the use of SPIES during sinus surgery to help differentiate various nasal pathologies and determine their extension.

METHODS

Patients (n = 27) with different pathologies in the region of the paranasal sinuses were operated via functional endoscopic surgery using a 2D-HD-camera with white light and SPIES. In addition, 10 healthy individuals were examined. The system was evaluated using two different questionnaires.

RESULTS

The handling and operation of SPIES was intuitive and easy. Use of SPIES did not prolong the procedure. There was no disturbing image distortion. SPIES seemed to improve the visualization, differentiation and evaluation of vascularization of paranasal pathologies and allowed for precise and accurate surgery. Compared to examination with the 2D-HD-camera and white light alone, SPIES appeared to facilitate the identification of mucosal pathologies.

CONCLUSION

SPIES could be a promising adjunct tool to evaluate nasal pathologies intraoperatively. Especially in the case of vascularized tumors the enhanced image endoscopy seemed to be clearly superior to standard white light alone. In our study, the system facilitated the assessment of tumor extension and vascularization as well as the differentiation of healthy mucosa. Future randomized studies will be necessary to prove the potential of integrating this novel technique into the clinical routine for the differentiation of nasal pathologies and the improvement of resection margins during nasal tumor surgery.

The role of Narrow Band Imaging (NBI) in the diagnosis of sinonasal diseases

BACKGROUND

Narrow band imaging (NBI) endoscopy is an optical method that helps to characterise tissue vasculature. Its appli- cation in sinonasal pathology remains scarce and a systematic study of its application to rhinology is lacking. The aim of this study is to analyse and describe the normal sinonasal mucosa under NBI light and to characterise the microvascular features of various sinonasal pathologies. We also want to suggest a classification of the patterns, peculiar to this district, and to evaluate whether they can be indicative of a specific physiological or pathological condition.

METHODS

Digital videos and images under white light and NBI of 103 patients (82 evaluated) with 29 sinonasal pathologies and 55 controls (33 evaluated). were independently analysed by three otolaryngologists and the final pattern was then arranged for each image, reaching an agreement between the individual evaluations.

RESULTS

Once the appearance of normal sinonasal (SN) mucosa was established (SN1), four patterns for the pathological mucosa were described and a working classification was proposed (SN2, SN3, SN4, SN5). We calculated specificity (80.6% vs 90.6%), sensi- tivity (20% vs 38.5%), PPV (46.1% vs 50%), NPV (54.7% vs 85.7%) and accuracy (53% vs 80.3%) of the ability of SN4 and SN5 pattern to discriminate between benign and malignant nasal neoformations.

CONCLUSIONS

This is the first study to propose a systematic NBI description and a classification of the vasculature of healthy and pathological mucosa in the sinonasal tract. Our preliminary results show that this technique can help in the workup of several rhinologic conditions and especially in distinguishing benign from malignant tumors.

Evaluation of narrow band imaging for diagnosis of unilateral nasal lesions

OBJECTIVES

This study aimed to investigate the effect of narrow band imaging (NBI) examination on differentiating diagnosis between benign and malignant neoplasms involving nasal cavity.

DESIGN, SETTING, PARTICIPANTS

A retrospective study was conducted to analyse cases from January 2018 to December 2019 at a single centre. A total of 188 consecutive patients who were newly diagnosed with lesions in unilateral nasal cavity underwent complete examination with white light endoscopy (WLE) and NBI endoscopy. Biopsy specimens were harvested from the target lesions and sent to the pathologist for definite diagnosis. Participants with a history of congenital malformation, trauma and surgery in nasal cavity were excluded from the study.

MAIN OUTCOME MEASURES

Endoscopic diagnosis was assessed using sensitivity, specificity, accuracy, positive and negative predictive values (PPV and NPV, respectively).

RESULTS

In identifying benign and malignant lesions of nasal cavity, NBI had a significant higher sensitivity (92.7% vs 70.7%, P = .020) and NPV (98% vs 92.3%, P = .032) than WLE, but there were no significant differences between NBI and WLE in specificity (98.6% vs 97.3%, P = .684), accuracy (97.3% vs 91.5%, P = .416) and PPV (95% vs 87.9%, P = .400).

CONCLUSION

NBI as an emerging technique can improve the diagnostic accuracy by distinguishing benign and malignant lesions in nasal cavity and remains a promising and helpful adjunct to the endoscopy techniques.