| Objectives:1.Discuss the application of electronic laryngoscopy NBI in the diagnosis and treatment of laryngeal tumors,and evaluate the accuracy and sensitivity of NBI for tumor detection.Evaluate the sensitivity of combined NBI and WLE endoscope.2.Understand the anatomical structure of the larynx,and provide an anatomical basis for patients with laryngeal and hypopharyngeal cancer to undergo laryngectomy to preserve laryngeal function.The link between NBI and laryngeal anatomy was explored by analyzing the vascular morphology of the lesioned mucosa using IPCL.3.Study the correlation between NBI examination results and surgical margins and pathological results,and use NBI for laryngeal postoperative review to provide more clinical guidance for the application of NBI in laryngeal tumors and precancerous lesions.Methods:This subject conducted a retrospective cross-sectional study of cases from December 2018 to June 2022.For evaluation,200 patients with different laryngeal lesions underwent conventional video laryngoscopy with white light endoscopy(WLE),followed by NBI examination,intraoperative and postoperative microlaryngoscopy.The study is divided into three parts.Part I: A total of 114 patients were included,and the correlation between outpatient or preoperative electronic laryngoscopy,anatomical characteristics of NBI lower laryngeal lesions,and intraoperative and postoperative evaluations was analyzed.According to the characteristics of "intraepithelial papillary capillary ring(IPCL)",the results of NBI electronic laryngoscopy are divided into five types(Ni type,Ⅰ-Ⅴ type).Types Ⅰ to Ⅳ are considered normal to atypical hyperplastic findings,while type Ⅴ is considered a neoplastic finding.The results of NBI examination were compared with those of pathological examination,and the negative and positive predictive value,specificity,accuracy,and sensitivity of WLE combined with NBI were assessed.Part Ⅱ: The laryngeal cross-section observational study of 4 cases of adult male cadavers.Anatomical studies of the recurrent laryngeal nerve,inferior laryngeal artery,and musculature associated with cricoarytenoid motion.At the same time,a diagnostic study was performed on 4 clinical patients to assess the association of NBI and WLE with laryngeal anatomy by analyzing the morphology of lesioned mucosal vasculature using IPCL and linking NBI to laryngeal anatomy.Part Ⅲ: A retrospective,a clinical observational and a diagnostic study of 78 patients(5 women and 73 men)with laryngeal cancer were examined by NBI to determine the resection margin during the operation,and the pathological examination of the resection margin was performed to compare the results of NBI examination and histopathology.Negative and positive predictive value,specificity,precision and sensitivity,accuracy WLE alone,or NBI alone in the application of laryngeal neoplasms were evaluated.In addition,this topic also used NBI and WLE to evaluate the recurrence rate of patients with laryngeal cancer who underwent CO2 laser vocal cord microsurgery.Results:A total of 114 patients were included in this study.Forty-six were squamous cell carcinomas(SCC),38 were dysplasia(mild,moderate,and severe),and 30 were benign vocal cord lesions.The negative and positive predictive values,specificity,and sensitivity of WLE combined with NBI were 89%,98%,96.4%,and 97.5%,respectively,compared with 88%,90%,91.7%,and 86.4%,respectively,for WLE alone.However,similar values 89.0% and 88.0% were recorded for combined NBI and white light endoscope and WLE alone for positive predictive values respectively.NBI grade: Ⅲ:6.1%,Ⅳ: 8.8%,Va: 28.1%,Vb: 45.6%,Vc: 11.4%.Histopathological examination was 46 malignant lesions(32 T1N0 SCC,14 Tis N0 SCC),9 severe dysplasia,24 moderate dysplasia,5 mild dysplasia,and 30 benign vocal cords Lesions(23 hyperkeratotic,4 inflammatory,and 3 polyps).Higher NBI scores were strongly associated with more advanced disease progression,with a Spearman correlation value of 0.58.The accuracy of the combination of NBI and white-light endoscopy was 96.8% vs.85.5% higher than white-light endoscopy alone,p-value <0.05.Part Ⅱ: Observations of 4 laryngeal specimens taken from 4 adult male cadavers it was observed that the cricoarytenoid joint plays a very important role in vocalization,respiration and swallowing.The cricoarytenoid posterior and lateral cricoarytenoids contribute more to the cricoarytenoid joint action than the thyroid and arytenoids.The posterior cricoarytenoid is located posterior to the cricoid plate;the lateral cricoarytenoid is located posterolaterally of the larynx.The recurrent laryngeal nerve innervating the internal laryngeal muscles and the inferior laryngeal artery supplying the sublaryngeal structures may pass through the tracheoesophageal groove and enter the laryngeal cavity behind the cricoarytenoid joint.The morphology of the laryngeal mucosal vasculature correlated significantly with NBI examination in all 4 patients.The sensitivities of NBI and WLE for laryngeal mucosal vasculature and morphology were 100.0% and 75.0%observed,respectively.NBI is highly sensitive in determining the morphology of IPCL vessels in laryngeal lesions.Part Ⅲ: The sensitivity of intraoperative NBI for the detection of laryngeal lesions was higher,98.0% and 87.7%,respectively,while that of WLE was slightly lower.NBI examination has a high accuracy in the diagnosis of intraoperative resection margins in lesions,the precision rates of negative and positive resection margins are 100.0% and 0.0% respectively,and the negative and positive resection margins of WLE are 98.0%and 1.8%,respectively,P value <0.05 indicating its significant.The sensitivities of preoperative and intraoperative NBI were similar,97.5% and 98.0%,respectively,but the accuracy of intraoperative NBI was 98.2%,which was slightly higher than that of outpatient or preoperative NBI(96.0%).The intraoperative accuracy rates of NBI and WLE examinations were 98.2% and 85.5%,respectively.In addition,after postoperative NBI examination,patients with laryngeal NBI types Ⅲ and Ⅳ had no recurrence,and the recurrence rate was 0(0.0%);the recurrence rates of NBI types Va,Vb,and Vc were3(12.5%),5(12.8%)and 2(28.6%).Conclusion:1.Sensitivity for detection of laryngeal precancerous lesions as well as laryngeal cancer was increased when WLE and NBI were combined.The accuracy of pre-operative narrow band imaging was higher in combined NBI and WLE.2.The complete cricoarytenoid joint and the posterior and lateral cricoarytenold muscles with normal functions are the basic conditions when the patients with laryngeal cancers to be performed partial laryngectomies.3.The results of NBI examination were closely related to the morphology of IPCL on the surface of laryngeal mucosa.4.For laryngeal lesions,intraoperative NBI is more effective than pre-operative NBI.Intra-operative NBI is more precise for the diagnosis of tumor margins than white light endoscope,also highly conducive to determining the extent of tumor resection.5.At the same time,NBI examination also plays an important role in postoperative review,and Vc type indicates that patients have a higher recurrence tendency. |
PDF Full Text Request