| Objective:The Narrow Band Imaging(NBI)is a simple and easy technique to operate,which can be used to show the lesion surface structure and vascular structure clearly.In this paper,the electronic NBI laryngoscopy is compared with white light laryngocopy and enhanced CT technique used on the accuracy of diagnosis of laryngeal and hypopharyngeal lesions,in order to evaluate its value on the early diagnosis of malignant tumors and precancerous lesions of larynx and hypopharynx.Methods:From December 2016 to May 2017,95 patients were admitted to the Department of otolaryngology,head and neck surgery of Shanghai General Hospital.The pharynx and larynx were examined by electronic laryngoscope,and cervical enhancement CT was performed on each patient.Prediction of benign or malignant lesions was made according to white light endoscopy,NBI endoscopy and enhanced CT.Pathological diagnosis results was chose as the gold standard,with three kinds of diagnosis technology of accuracy,detection,sensitivity,specificity,positive predictive value and negative predictive value as the main evaluation index.Results:A total of 104 lesions were found from 95 patients including 75 males and 20 females with average age of 59.2±11.6 years.Of all these lesions,there were 26 of benign lesions,19 mild atypical hyperplasia,8 moderate dysplasia,7 severe dysplasia and carcinoma in situ while 44 infiltrating carcinoma.A total of 48 lesions were found in the hypopharynx,of which 11 were benign and 37 were malignant.A total of 56 lesions were found in the larynx,of which 36 were benign and 20 were malignant.The detection rate of white light endoscopy and NBI was 39.42% and 52.88% respectively,the accuracy rate was 78.85% and 91.35% respectively,the sensitivity was 78.85% and 96.49% respectively,and negative predictive value was 78.85% and 95.24% respectively.The difference was statistically significant(P< 0.05).The detection rate of NBI endoscopy and enhanced CT examination was 52.88% and 40.38% respectively,with the accuracy rate of 91.35% and 78.85% respectively,the sensitivity was 96.49% and 84% respectively,whose difference was statistically significant(P <0.05).In 33 cases of flat type lesions,the accuracy,detection rate,sensitivity and negative predictive value of NBI endoscopy(90.91%,54.55%,94.74% and 54.55%)were higher than white light laryngoscope(66.67%,27.27%,56.25% and 27.27%),P < 0.05,the difference was statistically significant.The accuracy,detection rate,sensitivity and negative predictive value of NBI endoscopy(90.91%,54.55%,94.74%,92.31%)were higher than that of enhanced CT examination(66.67%,30.3%,62.5%,66.67%),P <0.05,and the difference was statistically significant.In 71 cases of protruded type lesions,the difference of accuracy,detection rate,sensitivity,specificity,positive predictive value and negative predictive value is not significant(P > 0.05)either between white light laryngoscope and NBI,nor NBI and enhanced CT examination.Benign or malignant lesions were classified according to the morphology of intraepithelial papillary capillary loop(IPCL)under NBI endoscope on the basis of theory of Xiaoguang Ni.There are 7 benign and 1 mild dysplasia lesion in the 8 IPCL-type I lesions,16 benign and 2 mild dysplasia lesions in the 18 IPCL-type ? lesions.In the 16 lesions whose IPCL type were ?,2 lesions were benign according to the pathological results,while 10 lesions were mild atypical hyperplasia and 4 lesions were moderate atypical hyperplasia.In the 11 IPCL-? lesions,there was 1 of benign,6 of mild atypical hyperplasia,and 4 of moderate atypical hyperplasia.The number of severe atypical hyperplasia or carcinoma in situ was 6 while invasive carcinoma was 17 in the 23 IPCL-?a lesions.All of the 12 IPCL-?b lesions were invasive carcinoma.In the 16 IPCL-?c lesions,there existed 1 severe atypical hyperplasia or carcinoma in situ and 15 invasive carcinoma.Conclusion:Electronic laryngoscopy combined with narrow-band imaging technique can better observe the changes of mucosal surface microstructure,and it does better in the overall diagnosis of laryngeal cancer and hypopharyngeal cancer than white light endoscopy and enhanced CT.For early laryngeal and hypopharyngeal cancer,its ability to locate lesions and diagnose were better than ordinary white light laryngoscope and enhanced CT examination,which help for early diagnosing and determining the border of surgery and the site of biopsy.However,there was no significant difference in diagnosis ability between NBI and the other two methods in middle and advanced stage.When NBI technique is used in the diagnosis of larynx/hypopharynx cancer and precancerous lesions,the morphology and distribution of IPCL is one of the important observation index.We should focus on cases of IPCL-? to ?,whose morphology appears two or more variations of expansion,distortion,irregular or uneven thickness,which often suggests early malignant lesions.And it is important for the detection and treatment of early laryngeal and hypopharyngeal cancer. |
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