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Westra JM, Scholman C, Krijnen HK, Zwakenberg MA, van der Vegt B, Schoonbeek RC, Wedman J, Wegner I, Halmos GB, Plaat BEC. Diagnosis of laryngopharyngeal carcinoma through office-based flexible laryngoscopy as a reliable alternative for biopsies under general anesthesia: Faster diagnostics with equal oncological outcome. Am J Otolaryngol 2024; 45:104424. [PMID: 39094304 DOI: 10.1016/j.amjoto.2024.104424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Accepted: 07/17/2024] [Indexed: 08/04/2024]
Abstract
PURPOSE Diagnostic endoscopy with biopsy under general anesthesia (DE-GA) is still considered as the established standard to assess laryngopharyngeal cancer patients. Office-based flexible laryngoscopic biopsy (FLB) offers an alternative, but the effect on oncological outcome remains uncertain. Therefore, the diagnostic process and survival of patients undergoing FLB, compared to those undergoing DE-GA were evaluated. METHODS Patients suspected of laryngopharyngeal cancer who underwent FLB were evaluated. Patients with FLB-confirmed squamous cell carcinoma (SCC) were matched with DE-GA patients based on tumor site, T-classification, N-classification, age, and p16 overexpression. Time from first visit to diagnosis (FVD), time to treatment interval (TTI), disease-specific survival (DSS) and overall survival (OS) were analyzed. RESULTS FLB yielded a definitive diagnosis in 155/164 (95 %) patients. No complications were observed. Ninety-eight of the 124 patients in which FLB revealed a SCC received curative treatment and were compared with 98 matched patients who underwent DE-GA. Median FVD interval was 6 days after FLB and 15 days after DE-GA (p < 0.001). Median TTI interval (FLB: 28 days, DE-GA: 28 days) was equal (p = 0.91). Oncological outcomes were comparable (p > 0.05) between FLB (OS: 2-yr: 76 %, 5-yr: 42 %; DSS: 2-yr: 86 %, 5-yr: 85 %) and DE-GA groups (OS: 2-yr: 76 %, 5-yr: 50 %; DSS: 2-yr: 81 %, 5-yr: 79 %). CONCLUSION FLB in the outpatient setting demonstrates a high diagnostic accuracy, is safe, accelerates the diagnostic process and has no negative effects on clinical outcome compared to DE-GA. Therefore, FLB should be considered as the standard diagnostic procedure in patients suspected of laryngopharyngeal cancer.
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Affiliation(s)
- Jeroen M Westra
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Constanze Scholman
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Hidde K Krijnen
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Manon A Zwakenberg
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Bert van der Vegt
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Rosanne C Schoonbeek
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Jan Wedman
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Inge Wegner
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - György B Halmos
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Boudewijn E C Plaat
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
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Scholman C, Zwakenberg MA, Wedman J, Wachters JE, Halmos GB, van der Laan BFAM, Plaat BEC. The influence of clinical experience on reliable evaluation of pharyngeal and laryngeal lesions: comparison of high-definition laryngoscopy using narrow band imaging with fibre-optic laryngoscopy. J Laryngol Otol 2024; 138:425-430. [PMID: 37880146 PMCID: PMC10950450 DOI: 10.1017/s0022215123001846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 08/16/2023] [Accepted: 08/21/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Fibre-optic laryngoscopy is still widely used in daily clinical practice; however, high-definition laryngoscopy using narrow band imaging could be more reliable in characterising pharyngeal and laryngeal lesions. METHODS Endoscopic videos were assessed in a tertiary referral hospital by 12 observers with different levels of clinical experience. Thirty pairs of high-definition laryngoscopy with narrow band imaging and fibre-optic laryngoscopy videos were judged twice, with an interval of two to four weeks, in a random order. Inter- and intra-observer reliability, sensitivity and specificity were calculated in terms of detecting a malignant lesion and a specific histological entity, for beginners, trained observers and experts. RESULTS Using high-definition laryngoscopy with narrow band imaging, inter-observer reliability for detecting malignant lesions increased from moderate to substantial in trained observers and experts (high-definition laryngoscopy with narrow band imaging κ = 0.66 and κ = 0.77 vs fibre-optic laryngoscopy κ = 0.51 and κ = 0.56, for trained observers and experts respectively) and sensitivity increased by 16 per cent. CONCLUSION Inter-observer reliability increased with the level of clinical experience, especially when using high-definition laryngoscopy with narrow band imaging.
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Affiliation(s)
- Constanze Scholman
- Department of Otorhinolaryngology – Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Manon A Zwakenberg
- Department of Otorhinolaryngology – Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Jan Wedman
- Department of Otorhinolaryngology – Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Jan E Wachters
- Department of Otorhinolaryngology – Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Gyorgy B Halmos
- Department of Otorhinolaryngology – Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Bernard F A M van der Laan
- Department of Otorhinolaryngology – Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Otorhinolaryngology – Head and Neck Surgery, Haaglanden Medical Center, The Hague, the Netherlands
| | - Boudewijn E C Plaat
- Department of Otorhinolaryngology – Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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3
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Geleijnse G, Veder LL, Hakkesteegt MM, de Gier HHW, Rieger B, Metselaar RM. Edge Enhancement Optimization in Flexible Endoscopic Images to the Perception of Ear, Nose and Throat Professionals. Laryngoscope 2024; 134:842-847. [PMID: 37589285 DOI: 10.1002/lary.30981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/28/2023] [Accepted: 08/03/2023] [Indexed: 08/18/2023]
Abstract
OBJECTIVES Digital endoscopes are connected to a video processor that applies various operations to process the image. One of those operations is edge enhancement that sharpens the image. The purpose of this study was to (1) quantify the level of edge enhancement, (2) measure the effect on sharpness and image noise, and (3) study the influence of edge enhancement on image quality perceived by ENT professionals. METHODS Three digital flexible endoscopic systems were included. The level of edge enhancement and the influence on sharpness and noise were measured in vitro, while systematically varying the levels of edge enhancement. In vivo images were captured at identical levels of one healthy larynx. Each series of in vivo images was presented to 39 ENT professionals according to a forced pairwise comparison test, to select the image with the best image quality for diagnostic purposes. The numbers of votes were converted to a psychometric scale of just noticeable differences (JND) according to the Thurstone V model. RESULTS The maximum level of edge enhancement varied per endoscopic system and ranged from 0.8 to 1.2. Edge enhancement increased sharpness and noise. Images with edge enhancement were unanimously preferred to images without edge enhancement. The quality difference with respect to zero edge enhancement reaches an optimum at levels between 0.7 and 0.9. CONCLUSION Edge enhancement has a major impact on sharpness, noise, and the resulting perceived image quality. We conclude that ENT professionals benefit from this video processing and should verify if their equipment is optimally configured. LEVEL OF EVIDENCE NA Laryngoscope, 134:842-847, 2024.
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Affiliation(s)
- G Geleijnse
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - L L Veder
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - M M Hakkesteegt
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - H H W de Gier
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - B Rieger
- Department of Imaging Physics, Delft University of Technology Faculty of Applied Sciences, Delft, The Netherlands
| | - R M Metselaar
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
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Geleijnse G, Rieger B. Influence of edge enhancement applied in endoscopic systems on sharpness and noise. JOURNAL OF BIOMEDICAL OPTICS 2022; 27:JBO-220135GR. [PMID: 36203241 PMCID: PMC9535298 DOI: 10.1117/1.jbo.27.10.106001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 09/15/2022] [Indexed: 06/16/2023]
Abstract
Significance Flexible endoscopes are essential for medical internal examinations. Digital endoscopes are connected to a video processor that can apply various operations to enhance the image. One of those operations is edge enhancement, which has a major impact on the perceived image quality by medical professionals. However, the specific methods and parameters of this operation are undisclosed and the arbitrary units to express the level of edge enhancement differ per video processor. Aim Objectively quantify the level of edge enhancement from the recorded images alone, and measure the effect on sharpness and noise Approach Edge enhancement was studied in four types of flexible digital ear nose and throat endoscopes. Measurements were performed using slanted edges and gray patches. The level of edge enhancement was determined by subtracting the step response of an image without edge enhancement from images with selected settings of edge enhancement and measuring the resulting peak-to-peak differences. These values were then normalized by the step size. Sharpness was characterized by observing the normalized modulation transfer function (MTF) and computing the spatial frequency at 50% MTF. The noise was measured on the gray patches and computed as a weighted sum of variances from the luminance and two chrominance channels of the pixel values. Results The measured levels were consistent with the level set via the user interface on the video processor and varied typically from 0 to 1.3. Both sharpness and noise increase with larger levels of edge enhancement with factors of 3 and 4 respectively. Conclusions The presented method overcomes the issue of vendors expressing the level of edge enhancement each differently in arbitrary units. This allows us to compare the effects, and we can start exploring the relationship with the subjectively perceived image quality by medical professionals to find substantiated optimal settings.
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Affiliation(s)
- Geert Geleijnse
- Erasmus University Medical Center, Department of Ear, Nose, & Throat, Rotterdam, The Netherlands
| | - Bernd Rieger
- Delft University of Technology, Department of Imaging Physics, Faculty of Applied Sciences, Delft, The Netherlands
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5
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Bakker LEH, Verstegen MJT, Ghariq E, Verbist BM, Schutte PJ, Bashari WA, Kruit MC, Pereira AM, Gurnell M, Biermasz NR, van Furth WR, Bouda LMPA. Implementation of functional imaging using 11C-methionine PET-CT co-registered with MRI for advanced surgical planning and decision making in prolactinoma surgery. Pituitary 2022; 25:587-601. [PMID: 35616762 PMCID: PMC9345807 DOI: 10.1007/s11102-022-01230-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/06/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE To report the first experience of our multidisciplinary team with functional imaging using 11C-methionine positron emission tomography-computed tomography (11C-methionine PET-CT) co-registered with MRI (Met-PET/MRICR) in clinical decision making and surgical planning of patients with difficult to treat prolactinoma. METHODS In eighteen patients with prolactinoma, referred to our tertiary referral centre because of intolerance or resistance for dopamine agonists (DA), Met-PET/MRICR was used to aid decision-making regarding therapy. RESULTS Met-PET/MRICR was positive in 94% of the patients. MRI and Met-PET/MRICR findings were completely concordant in five patients, partially concordant in nine patients, and non-concordant in four patients. In five patients Met-PET/MRICR identified lesion(s) that were retrospectively also visible on MRI. Met-PET/MRICR was false negative in one patient, with a cystic adenoma on conventional MRI. Thirteen patients underwent transsphenoidal surgery, with nine achieving full biochemical remission, two clinical improvement and near normalized prolactin levels, and one patient clinical improvement with significant tumour reduction. Hence, nearly all patients (94%) were considered to have a positive outcome. Permanent complication rate was low. Three patients continued DA, two patients have a wait and scan policy. CONCLUSION Met-PET/MRICR can provide additional information to guide multidisciplinary preoperative and intraoperative decision making in selected cases of prolactinoma. This approach resulted in a high remission rate with a low rate of complications in our expert centre.
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Affiliation(s)
- Leontine E H Bakker
- Division of Endocrinology, Department of Medicine, Leiden University Medical Center, Leiden, The Netherlands.
- Center for Endocrine Tumors Leiden (CETL), Pituitary Center, Leiden University Medical Center, Leiden, The Netherlands.
| | - Marco J T Verstegen
- Center for Endocrine Tumors Leiden (CETL), Pituitary Center, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Eidrees Ghariq
- Section of Nuclear Medicine, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Berit M Verbist
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Pieter J Schutte
- Center for Endocrine Tumors Leiden (CETL), Pituitary Center, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Waiel A Bashari
- Wellcome-MRC Institute of Metabolic Science, Addenbrooke's Hospital, University of Cambridge and National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Mark C Kruit
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Alberto M Pereira
- Division of Endocrinology, Department of Medicine, Leiden University Medical Center, Leiden, The Netherlands
- Center for Endocrine Tumors Leiden (CETL), Pituitary Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Mark Gurnell
- Wellcome-MRC Institute of Metabolic Science, Addenbrooke's Hospital, University of Cambridge and National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Nienke R Biermasz
- Division of Endocrinology, Department of Medicine, Leiden University Medical Center, Leiden, The Netherlands
- Center for Endocrine Tumors Leiden (CETL), Pituitary Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Wouter R van Furth
- Center for Endocrine Tumors Leiden (CETL), Pituitary Center, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Lenka M Pereira Arias Bouda
- Section of Nuclear Medicine, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
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6
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Azam MA, Sampieri C, Ioppi A, Africano S, Vallin A, Mocellin D, Fragale M, Guastini L, Moccia S, Piazza C, Mattos LS, Peretti G. Deep Learning Applied to White Light and Narrow Band Imaging Videolaryngoscopy: Toward Real-Time Laryngeal Cancer Detection. Laryngoscope 2021; 132:1798-1806. [PMID: 34821396 PMCID: PMC9544863 DOI: 10.1002/lary.29960] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 11/05/2021] [Accepted: 11/15/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To assess a new application of artificial intelligence for real-time detection of laryngeal squamous cell carcinoma (LSCC) in both white light (WL) and narrow-band imaging (NBI) videolaryngoscopies based on the You-Only-Look-Once (YOLO) deep learning convolutional neural network (CNN). STUDY DESIGN Experimental study with retrospective data. METHODS Recorded videos of LSCC were retrospectively collected from in-office transnasal videoendoscopies and intraoperative rigid endoscopies. LSCC videoframes were extracted for training, validation, and testing of various YOLO models. Different techniques were used to enhance the image analysis: contrast limited adaptive histogram equalization, data augmentation techniques, and test time augmentation (TTA). The best-performing model was used to assess the automatic detection of LSCC in six videolaryngoscopies. RESULTS Two hundred and nineteen patients were retrospectively enrolled. A total of 624 LSCC videoframes were extracted. The YOLO models were trained after random distribution of images into a training set (82.6%), validation set (8.2%), and testing set (9.2%). Among the various models, the ensemble algorithm (YOLOv5s with YOLOv5m-TTA) achieved the best LSCC detection results, with performance metrics in par with the results reported by other state-of-the-art detection models: 0.66 Precision (positive predicted value), 0.62 Recall (sensitivity), and 0.63 mean Average Precision at 0.5 intersection over union. Tests on the six videolaryngoscopies demonstrated an average computation time per videoframe of 0.026 seconds. Three demonstration videos are provided. CONCLUSION This study identified a suitable CNN model for LSCC detection in WL and NBI videolaryngoscopies. Detection performances are highly promising. The limited complexity and quick computational times for LSCC detection make this model ideal for real-time processing. LEVEL OF EVIDENCE 3 Laryngoscope, 2021.
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Affiliation(s)
- Muhammad Adeel Azam
- Department of Advanced Robotics, Istituto Italiano di Tecnologia, Genoa, Italy.,Department of Informatics, Bioengineering, Robotics, and System Engineering, University of Genoa, Genoa, Italy
| | - Claudio Sampieri
- Unit of Otorhinolaryngology - Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Alessandro Ioppi
- Unit of Otorhinolaryngology - Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Stefano Africano
- Unit of Otorhinolaryngology - Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Alberto Vallin
- Unit of Otorhinolaryngology - Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Davide Mocellin
- Unit of Otorhinolaryngology - Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Marco Fragale
- Unit of Otorhinolaryngology - Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Luca Guastini
- Unit of Otorhinolaryngology - Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Sara Moccia
- The BioRobotics Institute and Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Cesare Piazza
- Unit of Otorhinolaryngology - Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy.,Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Leonardo S Mattos
- Department of Advanced Robotics, Istituto Italiano di Tecnologia, Genoa, Italy.,Department of Informatics, Bioengineering, Robotics, and System Engineering, University of Genoa, Genoa, Italy
| | - Giorgio Peretti
- Unit of Otorhinolaryngology - Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
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7
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Williams EJ, Nouraei SAR. Should twin-mode white-light and virtual chromoendoscopy of pre-defined mucosal stations be considered a standard of care for Transnasal Panendoscopy? Clin Otolaryngol 2021; 46:915-917. [PMID: 33864729 DOI: 10.1111/coa.13783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 02/23/2021] [Accepted: 03/07/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Elizabeth J Williams
- Consultant Gastroenterologist, University Hospitals of Dorset NHS Foundation Trust, Poole, UK
| | - S A Reza Nouraei
- Robert White Professor of Laryngology and Clinical Informatics, University of Southampton, Southampton, UK
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8
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Scholman C, Westra JM, Zwakenberg MA, Dikkers FG, Halmos GB, Wedman J, Wachters JE, van der Laan BFAM, Plaat BEC. High-definition videolaryngoscopy is superior to fiberoptic laryngoscopy: a 111 multi-observer study. Eur Arch Otorhinolaryngol 2021; 278:1927-1932. [PMID: 33606082 PMCID: PMC8131328 DOI: 10.1007/s00405-021-06673-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 02/01/2021] [Indexed: 11/24/2022]
Abstract
Purpose This study aims to analyse differences in fiberoptic laryngoscopy (FOL) versus high definition laryngoscopy (HDL) by examining videolaryngoscopy images by a large group of observers with different levels of clinical expertise in ear, nose and throat (ENT) medicine. Methods This study is a 111 observer paired analysis of laryngoscopy videos during an interactive presentation. During a National Meeting of the Dutch Society of ENT/Head and Neck Surgery, observers assessed both FOL and HDL videos of nine cases with additional clinical information. Observers included 41 ENT consultants (36.9%), 34 ENT residents (30.6%), 22 researchers with Head and Neck interest (19.8%) and 14 with unspecified clinical expertise (12.6%). For both laryngoscopic techniques, sensitivity, specificity, positive and negative predictive value and diagnostic accuracy were determined for identifying a normal glottis, hyperkeratosis, radiotherapy adverse effects and squamous cell carcinoma. The sensitivities for FOL and HDL were analysed with regard to the different levels of clinical expertise. Results The overall sensitivity for correctly identifying the specific histological entity was higher in HDL (FOL 61% vs HDL 66.3%, p < 0.05). HDL was superior to FOL in identifying a normal glottis (FOL 68.1% vs HDL 91.6%, p < 0.01) and squamous cell carcinoma (FOL 70.86% vs HDL 79.41%, p = 0.02). Residents and researchers with Head and Neck interest diagnosed laryngeal lesions more correctly with HDL (p < 0.05). Conclusions In a large population of observers with different levels of clinical expertise, HDL is superior to FOL in identifying laryngeal lesions.
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Affiliation(s)
- Constanze Scholman
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Groningen, University Medical Center, Groningen Hanzeplein 1, 9700 RB, Groningen, The Netherlands.
| | - Jeroen M Westra
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Groningen, University Medical Center, Groningen Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - Manon A Zwakenberg
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Groningen, University Medical Center, Groningen Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - Frederik G Dikkers
- Department of Otorhinolaryngology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Gyorgy B Halmos
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Groningen, University Medical Center, Groningen Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - Jan Wedman
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Groningen, University Medical Center, Groningen Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - Jan E Wachters
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Groningen, University Medical Center, Groningen Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - Bernard F A M van der Laan
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Groningen, University Medical Center, Groningen Hanzeplein 1, 9700 RB, Groningen, The Netherlands.,Department of Otorhinolaryngology-Head and Neck Surgery, Haaglanden Medical Center, The Hague, The Netherlands
| | - Boudewijn E C Plaat
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Groningen, University Medical Center, Groningen Hanzeplein 1, 9700 RB, Groningen, The Netherlands
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9
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Scholman C, Westra JM, Zwakenberg MA, Dikkers FG, Halmos GB, Wedman J, Wachters JE, van der Laan BFAM, Plaat BEC. Differences in the diagnostic value between fiberoptic and high definition laryngoscopy for the characterisation of pharyngeal and laryngeal lesions: A multi-observer paired analysis of videos. Clin Otolaryngol 2019; 45:119-125. [PMID: 31747481 PMCID: PMC6972529 DOI: 10.1111/coa.13476] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 11/06/2019] [Accepted: 11/17/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES High definition laryngoscopy (HDL) could lead to better interpretation of the pharyngeal and laryngeal mucosa than regularly used fiberoptic laryngoscopy (FOL). The primary aim of this study is to quantify the diagnostic advantage of HDL over FOL in detecting mucosal anomalies in general, in differentiating malignant from benign lesions and in predicting specific histological entities. The secondary aim is to analyse image quality of both laryngoscopes. DESIGN Retrospective paired analysis with multiple observers evaluating endoscopic videos simulating daily clinical practice. SETTING A tertiary referral hospital. PARTICIPANTS In 36 patients, both FOL and HDL videos were obtained. Six observers were provided with additional clinical information, and 36 FOL and HDL videos were evaluated in a randomised order. MAIN OUTCOME MEASURES Sensitivity, specificity, positive and negative predictive value and diagnostic accuracy of observers using both flexible laryngoscopes were calculated for detection of mucosal lesions in general and uncovering malignant lesions. Sensitivities were calculated for prediction of specific histological entities. Image quality (scale 1-10) was assessed for both flexible laryngoscopes. RESULTS HDL reached higher sensitivity compared to FOL for detection of mucosal abnormalities in general (96.0% vs 90.4%; P = .03), differentiating malignant from benign lesions (91.7% vs 79.8%; P = .03) and prediction of specific histological entities (59.7% vs 47.2%; P < .01). Image quality was judged better with HDL in comparison with FOL (mean: 8.4 vs 5.4, P < .01). CONCLUSIONS HDL is superior to FOL in detecting mucosal anomalies in general, malignancies and specific histological entities. Image quality is considered as superior using HDL compared to FOL.
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Affiliation(s)
- Constanze Scholman
- Department of Otorhinolaryngology - Head & Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jeroen M Westra
- Department of Otorhinolaryngology - Head & Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Manon A Zwakenberg
- Department of Otorhinolaryngology - Head & Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Frederik G Dikkers
- Department of Otorhinolaryngology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Gyorgy B Halmos
- Department of Otorhinolaryngology - Head & Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jan Wedman
- Department of Otorhinolaryngology - Head & Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jan E Wachters
- Department of Otorhinolaryngology - Head & Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Bernard F A M van der Laan
- Department of Otorhinolaryngology - Head & Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Boudewijn E C Plaat
- Department of Otorhinolaryngology - Head & Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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