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Prospective Comparative Study of Laparoscopic Narrow Band Imaging (NBI) Versus Standard Imaging in Gynecologic Oncology.

ABSTRACT: BACKGROUND:Narrow band imaging (NBI) is an optic filtration enhancement for endoscopy that uses two wavelengths of light (415 and 540 nm) to highlight superficial microvascular patterns. It has been successfully utilized to improve identification of lesions with abnormal vasculature, which is associated with endometriosis and endometrial cancer. Case studies suggest it may also facilitate surgical staging of gynecologic cancer, which is critical in determining appropriate adjuvant therapies. A technology that enhances the ability to identify metastatic disease during minimally invasive surgery (MIS) could make an important difference in patient outcomes. METHODS:A prospective comparative study was conducted to evaluate patients with clinical indication for diagnostic or operative laparoscopy. All received white light imaging followed by NBI during the same procedure. Suspicious lesions were examined and photographed, using both modalities, before excision. The two techniques were compared. Positive predictive value, negative predictive value, and diagnostic accuracy in identifying histologically confirmed metastatic lesions were assessed, using appropriate statistical methods. RESULTS:Of 124 patients enrolled in the study, 94 were evaluable; 30 did not undergo MIS and were therefore excluded. A significantly higher number of peritoneal abnormalities were identified with NBI versus white light imaging (P = 0.0239). However, no statistically significant difference (P = 0.18, patient level) was observed in identification of histologically confirmed metastatic disease. CONCLUSIONS:NBI imaging provides a unique contrast between peritoneal surface and microvascular patterns. However, the results of this study suggest that NBI-enhanced laparoscopy does not provide superior detection of peritoneal surface malignancy compared with standard white light high-definition laparoscopy.

SUBMITTER: Aloisi A

PROVIDER: S-EPMC6091884 | biostudies-literature | 2018 Apr

REPOSITORIES: biostudies-literature

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Prospective Comparative Study of Laparoscopic Narrow Band Imaging (NBI) Versus Standard Imaging in Gynecologic Oncology.

Aloisi Alessia A Sonoda Yukio Y Gardner Ginger J GJ Park Kay J KJ Elliott Sarah L SL Zhou Qin C QC Iasonos Alexia A Abu-Rustum Nadeem R NR

Annals of surgical oncology 20180116 4

<h4>Background</h4>Narrow band imaging (NBI) is an optic filtration enhancement for endoscopy that uses two wavelengths of light (415 and 540 nm) to highlight superficial microvascular patterns. It has been successfully utilized to improve identification of lesions with abnormal vasculature, which is associated with endometriosis and endometrial cancer. Case studies suggest it may also facilitate surgical staging of gynecologic cancer, which is critical in determining appropriate adjuvant therap ...[more]

PMID: 29340992

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Project description:BACKGROUND:The prognostic value of positive surgical margins after transoral laser microsurgery (TOLM) is still under debate. In case of positive superficial margins, some experts recommend a second-look surgery (SL) and some recommend wait and watch approach with close observation. Narrow band imaging (NBI) is an advanced imaging system used to enhance visualization of mucosal vascular pattern. In laryngology, NBI is used to improve the detection of premalignant, dysplastic and malignant lesions. AIM:To assess the usefulness of NBI imaging in guiding clinical decision making regarding follow-up plan and SL after TOLM. MATERIALS AND METHODS:A prospective cohort of 127 patients was divided into three groups based on the histology results and NBI vascular pattern of the mucosa. Group A (24/127, 18.90%) consisted of patients with suspicious vascular pattern in NBI or/and with positive deep margin. Group B (52/127, 40.94%) consisted of patients with positive or uncertain superficial margins and non-suspicious vascular pattern in NBI. Group C (51/127, 40.15%) had non-suspicious vascular NBI pattern and all negative margins. RESULTS:After the first TOLM procedure, 9/24 (37.5%) patients had positive deep margins, 1/24 (4.2%) had uncertain deep margin and 1/24 patient (4.2%) had both positive deep margin and suspicious vascular pattern in NBI. The remaining 13 cases in Group A had a suspicious NBI finding only during the first follow-up. All of the 24 patients (Group A) underwent a second look surgery. The final histology after SL showed squamous cell carcinoma in 10/24 (41.7%) patients. All 10 patients had suspicious vascular pattern in NBI and one patient had both a positive deep margins after the first TOLM and positive NBI finding. None of Group B and C subjects developed an early recurrence. CONCLUSIONS:Our study provides evidence that NBI imaging will be a useful adjunct to margin status after TOLM and will facilitate clinical decision-making regarding performing the SL in patients with positive or uncertain superficial surgical margins in the first TOLM procedure. However, additional investigation with more subjects is required at this time to further validate this technique and change the standard of care.

Project description:BackgroundIn recent years, two new narrow-band imaging (NBI) classifications have been proposed: The NBI international colorectal endoscopic (NICE) classification and Japanese NBI expert team (JNET) classification. Most validation studies of the two new NBI classifications were conducted in classification setting units by experienced endoscopists, and the application of use in different centers among endoscopists with different endoscopy skills remains unknown.AimTo evaluate clinical application and possible problems of NICE and JNET classification for the differential diagnosis of colorectal cancer and precancerous lesions.MethodsSix endoscopists with varying levels of experience participated in this study. Eighty-seven consecutive patients with a total of 125 lesions were photographed during non-magnifying conventional white-light colonoscopy, non-magnifying NBI, and magnifying NBI. The three groups of endoscopic pictures of each lesion were evaluated by the six endoscopists in randomized order using the NICE and JENT classifications separately. Then we calculated the six endoscopists' sensitivity, specificity, accuracy, positive predictive value, and negative predictive value for each category of the two classifications.ResultsThe sensitivity, specificity, and accuracy of JNET classification type 1 and 3 were similar to NICE classification type 1 and 3 in both the highly experienced endoscopist (HEE) and less-experienced endoscopist (LEE) groups. The specificity of JNET classification type 1 and 3 and NICE classification type 3 in both the HEE and LEE groups was > 95%, and the overall interobserver agreement was good in both groups. The sensitivity of NICE classification type 3 lesions for diagnosis of SM-d carcinoma in the HEE group was significantly superior to that in the LEE group (91.7% vs 83.3%; P = 0.042). The sensitivity of JNET classification type 2B lesions for the diagnosis of high-grade dysplasia or superficial submucosal invasive carcinoma in the HEE and LEE groups was 53.8% and 51.3%, respectively. Compared with other types of JNET classification, the diagnostic ability of type 2B was the weakest.ConclusionThe treatment strategy of the two classification type 1 and 3 lesions can be based on the results of endoscopic examination. JNET type 2B lesions need further examination.

Dataset Information

Prospective Comparative Study of Laparoscopic Narrow Band Imaging (NBI) Versus Standard Imaging in Gynecologic Oncology.

Publications

Prospective Comparative Study of Laparoscopic Narrow Band Imaging (NBI) Versus Standard Imaging in Gynecologic Oncology.

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