Narrow Band Imaging Endoscopy of the Nasopharynx for Malignancy: An Inter- and Intraobserver Study (original) (raw)
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Nasopharyngeal carcinoma detected by narrow-band imaging endoscopy
Oral Oncology, 2011
The aim of the study was to investigate the novel endoscopic findings in nasopharyngeal carcinoma (NPC) under narrow-band imaging (NBI) and to determine the reliability of screening NPC by NBI. A total of 79 adults underwent nasopharyngeal biopsy. We proposed five distinctly different findings that need to be examined by NBI: Type I: brownish spots, Type II: irregular microvascular pattern (IMVP), Type III: light crests, Type IV: side-difference, Type V: presence of either IMVP or side-difference, of which last three (Type III-V) were a new concept. The results of NPC diagnosis by detecting NBI Type V pattern, the false positive, false negative, sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 6.7%, 2.9%, 97.1%, 93.3%, 91.7%, 97.7%, and 94.9%, respectively. On the other hand, there was a higher prevalence of Type I and IV patterns in T1 category NPC. The nasopharyngeal endoscopy coupled with NBI was able to provide a rapid, convenient, and highly reliable screening for high-risk populations.
A meta-analysis of narrow-band imaging for the diagnosis of primary nasopharyngeal carcinoma
F1000Research, 2018
Narrow band imaging (NBI), an endoscopic technique featuring Background an augmented definition of microvasculature and mucosal patterns. NBI is increasingly advocated as a tool to characterize neoplasia and intestinal metaplasia in endoscopic standards, such as for colorectal polyps and tumors. Recently NBI has also been studied in the detection of Nasopharyngeal Carcinoma (NPC). Here we aimed to assess the diagnostic utility of NBI for the diagnosis of NPC. A meta-analysis of studies comparing narrow-band imaging and Methods: white light endoscopy in the diagnosis of primary nasopharyngeal carcinoma was performed. The review process involved two independent investigators. The databases used were MEDLINE, PubMed, the Cochrane library, Embase, and the Web of Science. Statistical analysis was performed with OpenMetaAnalyst, MetaDiSc version 1.4, and Medcalc version 17.9.7. : Five studies including 2480 patients were included. The sensitivity Results and specificity for narrow-band imaging were 0.90 (0.73-0.97) and 0.95 (0.81-0.99) respectively. The positive likelihood ratio and negative likelihood ratio were 18.82 (0.31-82.1) and 0.08 (0.02-0.31). For white light endoscopy, the sensitivity and specificity were 0.77 (0.58-0.89) and 0.91 (0.79-0.96). The positive likelihood ratio was 7.61 (3.61-16.04), and the negative likelihood ratio was 0.21 (0.11-0.39). The odds ratio for detection rates between narrow-band imaging and white light endoscopy was 4.29 (0.56-33.03, p = 0.16). Area under the curve for narrow-band imaging was 0.98 (SE: 0.02), and for white light it was 0.93 (SE: 0.03). There was no significant difference in the receiver operating characteristic curves between the two modalities (p = 0.14). : Narrow-band imaging showed a higher sensitivity and positive Conclusion likelihood ratio for the diagnosis of nasopharyngeal carcinoma. However, there was no significant difference in detection rates compared to white light endoscopy. Further investigation with a uniform diagnostic criteria and terminology is needed for narrow-band imaging in the diagnosis of nasopharyngeal carcinoma.
Endoscopy of nasopharyngeal cancer
Diagnostic and therapeutic endoscopy, 1994
Nasopharyngeal cancer (NPC) is a unique disease with increasing interest for many physicians due to its unusual etiology, histology, and epidemiology. The recent era of fiberoptic endoscopy now provides the clinician with better tools for the screening, diagnosis, staging, and follow-up of NPC. The use of high resolution flexible and rigid nasopharyngoscopy gives the physician an opportunity for a more sensitive examination in a higher proportion of patients. Ultimately, this will allow for earlier diagnosis of NPC, and improved prognosis and better quality of life for the patients with this disease. Also, by allowing the clinician to perform directed biopsies of the nasopharynx under local anesthesia, fiberoptic nasopharyngoscopy allows a less morbid and more cost-effective approach towards this disease, including screening protocols in certain high risk regions of the world.
Validity of narrow-band imaging (NBI) nasoendoscopy on nasopharyngeal carcinoma post therapy biopsy
Journal of thee Medical Sciences (Berkala Ilmu Kedokteran), 2018
Nasopharyngeal carcinoma (NPC) is the most common malignancy found in the head and neck. It is a unique head and neck cancer due to its radiosensitivity. Therefore, radiotherapy becomes the main modality of therapy. Post-treatment evaluation of NPC is important to assess prognosis. Biopsy that is the gold standard for the evaluation can be performed with a narrow-band imaging (NBI) nasoendoscopy guide. This study aimed to determine the validity of NBI nasoendoscopic examination of NPC post-treatment biopsy. This study was a cross-sectional design for all post-treatment NPC patients who would undergo response assessment at the Department of Otorhinolaryngology, Head and Neck Surgery, Dr. Sardjito General Hospital, Yogyakarta. A total 40 patients during May-June 2018 period who underwent examination sequentially. Biopsy examination was carried out with NBI nasoendoscopy guidance and the results of biopsy were performed histopathological examination. Forty patients showed the results of NBI nasoendoscopic validity on NPC biopsy after treatment included sensitivity (85.7%), specificity (87.8%), positive predictive value (60%), negative predictive value (96.6 %), positive trend ratio (7.07), negative trend ratio (0.16), and accuracy (87.5%). Postoperative NBI nasoendoscopy features appear homogeneous (75%) and inhomogenous (25%). In conclusion, NBI nasoendoscopic validity on postoperative NPC biopsy is good. ABSTRAK Karsinoma nasofaring (KNF) merupakan keganasan paling sering di bagian kepala dan leher. Keganasan ini merupakan keganasan yang unik pada bagian kepala dan leher karena radiosensitivitasnya. Oleh Karena itu radioterapi menjadi modalitas terapi yang utama. Evaluasi pasca pengobatan pada KNF penting dilakukan untuk menentukan prognosisnya. Biopi yang merupakan standar emas evaluasi dapat dilakukan dengan petunjuk nasoendoskopi narrow-band imaging (NBI). Penelitian ini bertujuan untuk menentukan validitas pemeriksaan nasoendoskopi NBI dari biopsi pasien KNF pasca pengobatan. Penelitian ini menggunakan rancangan potong lintang untuk semua pasien KNF pasca pengobatan yang akan menjalani penilaian respon di Departemen Otorinolaringologi, Bedah Kepala dan Leher, RSUP Dr. Sardjito, Yogyakarta. Total 40 pasien selama Mei-Juni 2018 yang menjalani pemeriksaan secara berurutan. Pemeriksaan biopsy dilakukan sesusi petunjuk nasoendoskopi NBI dan hasil biopsi selanjutnya dilakukan pemeriksaan histopatologi. Empat puluh pasien menunjukkan validitas endoskopi NBI pada biopsy KNF setelah pengobatan yang meliputi sensitivitas (85,7%), spesifisitas (87,8%), nilai predeksi positif (60%), nilai predeksi negative (96,6%), rasio kecenderungan positif (7,07), rasio kecenderungan negative (0,16), akurasi (87,5%). Gambaran nasoendoskopi NBI setelah operasi kelihatan homogeny (75%) dan tidak homogeny (25%). Dapat disimpulkan, validitas nasoendoskopi NBI pada biopsi KNF setelah operasi bagus.
The role of nasopharyngeal examination and biopsy in the diagnosis of malignant diseases
Brazilian Journal of Otorhinolaryngology, 2019
Introduction: In direct proportion to the increasing rate of nasopharynx examinations applied, the early diagnosis and treatment of lesions in this region is possible. At times the clinical findings and the biopsy results are not consistent, so biopsies may have to be repeated. Objectives: The aim of this study was to evaluate the distribution of pathology test results obtained from cases of nasopharynx biopsy, to determine with which methods determination most often was made, and to investigate which kinds of cases required the biopsy to be repeated. Methods: The study included a total of 1074 patients (500 female, 574 male) who underwent nasopharyngeal biopsy in our clinic between June 2011 and June 2017. Data were obtained from patient records of age, gender, clinical findings, imaging findings if available and pathological diagnosis. The pathological diagnoses were separated into 3 main groups as chronic nasopharyngitis, benign cytology and malignant cytology. Results: The examinations resulted in 996 cases reported as chronic nasopharyngitis, 47 as benign cytology and 31 as malignant cytology. Of the 31 malignant lesions, diagnosis was made in 15 patients (48.4%) with a single biopsy, and in 16 patients (51.6%), as a result of the pathology report when 2 or more biopsies were taken. In the comparison of the benign and malignant lesions in respect of the need for repeated biopsies, the cases determined with malignancy were found to have a statistically significantly higher rate of repeated biopsy (p < 0.001).
AJNR. American journal of neuroradiology, 2015
Our previous nasopharyngeal carcinoma detection study, comparing MR imaging, endoscopy, and endoscopic biopsy, showed that MR imaging is a highly sensitive test that identifies nasopharyngeal carcinomas missed by endoscopy. However, at the close of that study, patients without biopsy-proved nasopharyngeal carcinoma nevertheless had shown suspicious abnormalities on endoscopy and/or MR imaging. The aim of this study was to determine whether there were any patients with undiagnosed nasopharyngeal carcinoma by obtaining long-term follow-up and to use these data to re-evaluate the diagnostic performance of MR imaging. In the previous study, 246 patients referred to a hospital ear, nose, and throat clinic with suspected nasopharyngeal carcinoma, based on a wide range of clinical indications, had undergone MR imaging, endoscopy, and endoscopic biopsy, and 77 had biopsy-proved nasopharyngeal carcinoma. One hundred twenty-six of 169 patients without biopsy-proved nasopharyngeal carcinoma un...
The role of cross-sectional imaging in suspected nasopharyngeal carcinoma
Annals of The Royal College of Surgeons of England, 2019
INTRODUCTION Nasopharyngeal carcinoma is a rare neoplasm in the UK. The current gold standard for detection is endoscopic examination under anaesthesia of the nasopharynx with biopsy. Many clinicians are now advocating cross-sectional imaging as the primary investigation. The objective of this study is to evaluate the role of cross-sectional imaging in detecting nasopharyngeal carcinoma and ultimately to avoid unnecessary biopsy. MATERIAL AND METHODS This is a retrospective uncontrolled case series review of patients who were investigated for suspected nasopharyngeal carcinoma between 2009 and 2017 at York Teaching Hospital NHS Foundation Trust. At present, any suspected nasopharyngeal carcinoma requires biopsy. Search terms used were 'endoscopic biopsy of nasopharynx', 'endoscopic examination + biopsy nasopharynx'. The main outcome measures are reported histological and radiological features of malignancy. Only patients who had imaging prior to the biopsy were included. RESULTS A total of 144 patients had endoscopic examination under anaesthesia of the nasopharynx with biopsy. Approximately one-third of these patients had cross-sectional imaging before the biopsy. The study revealed that magnetic resonance imaging had 100% sensitivity and 84% specificity; however, the endoscopic examination under anaesthesia and biopsy had only 88% sensitivity. This is due to a negative histological finding despite radiological characteristics of nasopharyngeal carcinoma in some patients. However, the specificity was 100%. CONCLUSION The study supports magnetic resonance imaging as the primary investigation in patients with suspected nasopharyngeal carcinoma followed by endoscopic examination under anaesthesia and biopsy in cases with suspicious findings on imaging only.
International Journal of Radiation Oncology*Biology*Physics, 2012
NBI endoscopy can improve the sensitivity of detecting mucosal recurrent nasopharyngeal neoplasia. However, postradiation effects may cause false-positive results. NBI closer view is superior for flat mucosal lesion detection than MRI, and observing an irregularities sign pattern was considered to indicate neoplastic lesions. NBI not only can offer a timely, convenient, and highly reliable assessment of mucosal recurrent NPC, it can also make endoscopic removal possible.
Pitfalls in the staging of cancer of nasopharyngeal carcinoma
Neuroimaging clinics of North America, 2013
Although nasopharyngeal carcinoma (NPC) is the most common primary malignancy of the nasopharynx, it is an uncommon malignancy in much of the Western world. Over the last several years, there have been important changes in the terminology used for histologic classification of NPC and important changes to the American Joint Committee on Cancer TNM staging of NPC. Accurate imaging assessment is critical for diagnose, to stage and plan radiation treatment, and for ongoing follow-up and surveillance. This article emphasizes important nasopharyngeal anatomy landmarks and the imaging appearances and pitfalls of NPC, its patterns of spread, and posttreatment appearances.
A clinical study of endoscopic management of benign tumors of nasopharynx
International Journal of Otorhinolaryngology and Head and Neck Surgery, 2019
Background: Benign tumors of nasopharynx are extremely rare; seen predominantly in children and young adults. Patients usually present with seemingly innocuous symptoms and an error in judgment can be catastrophic. Aim of our study is to analyse the incidence of these lesions, common presenting features and outcomes of endoscopic management. Methods: This is a retrospective analysis of patients diagnosed to have benign tumours of nasopharynx by histopathological examination in our ENT department of civil hospital, B. J. Medical College, Ahmedabad. The period of study is from January 2016 to January 2018. Forty patients with complete clinical data were identified and included in the study. 33 patients out of 40 (83%) were males and 7 were females (17%). Following surgical excision patients were followed up for a mean period of 2 years. The Clinical profile, investigation modalities, treatment options are being analysed here. Results: Forty patients had undergone surgical excision for tumours arising from the nasopharynx. The mean age was 21.37 years (range 10-43). Thirty three patients were males and seven were females. Indications for resection were juvenile nasopharyngeal angiofibroma in thirty cases, lobular capillary hemangioma in four cases, paraganglioma in two cases, hemangiopericytoma in two cases, and neurofibroma in two cases. There were no significant postoperative complications. Recurrence due to residual lesion was seen in three cases. The mean follow up period was 2 years (range 1-3 years). Conclusions: It is important to note that patients with similar symptoms have varied pathology and thus need for radiological evaluation, JNA is commonest benign nasopharyngeal tumor and surgical approach depends on size and extent of tumor.