Narrow band imaging in detection of early laryngeal malignancy

Abstract Introduction Narrow-band imaging (NBI) is an optical image enhancement technique that uses a narrow band light spectrum to improve the mucosa’s capillary surface. White-light endoscopy (WLE) does not allow for the visualisation of the intra-epithelial blood vasculature’s organisation. This method has provided a lot of interest because it is quick, real-time, and enables the examination of a larger mucosal area. NBI recently demonstrated increased specificity (87–92%) and sensitivity (61–91%) in early detection of laryngeal malignancy. In this study, we aim to determine the effectiveness and limitation of narrow-band imaging in detecting laryngeal malignancy and determine the extent of resection margin in case of excision biopsy in suspicious mucosal lesions of the larynx. Materials and methods A prospective study of 47 cases of clinically suspicious malignant lesions of the larynx conducted at a tertiary care centre in Tamil Nadu, from December 2021 to December 2022. Patients underwent thorough history taking, clinical examination, and appropriate radiological investigations and were analysed cross sectionally. Results In the study, the majority (41.7%) were in the age group of 61 to 70 years, with a marked male predominance (87.5%). The symptoms, co-morbidities the patients had, and habits like smoking and alcohol usage were also studied. The WLE diagnosis, NBI patterns, and diagnosis were compared with their respective histopathological examination (HPE) findings, and it was found that NBI has a high sensitivity (91%) and high specificity (93.2%) when compared with white light endoscopy (83% and 79%); it also provides very low false positive and zero false negative values in diagnosing the malignant lesions. Conclusion The laryngeal squamous cell carcinoma (SCC) is the most common malignant tumour in the head and neck region. Although direct laryngoscopy under general anaesthesia with biopsy remains the gold standard indirect laryngoscopy is frequently utilised nowadays for the evaluation of laryngeal cancer and precancerous lesions. Even in anatomically challenging situations, a flexible endoscope enables a complete examination of the larynx and to visualise the hidden areas in the larynx. NBI is a revolutionary optical approach that uses narrow band width filters (415 nm and 540 nm) in video endoscopic systems to improve the diagnostic ability of endoscopes in classifying the tissues and also for visualising the intra-papillary capillary loop (IPCL) pattern. NBI has a high sensitivity (91%) and high specificity (93.2%) when compared with white light endoscopy (83% and 79%) and also provides very low false positive and zero false negative values in diagnosing the malignant lesions.