Narrow Band Imaging in Detection of Early Laryngeal Malignancy

Introduction: Narrow-band imaging (NBI) is an optical image enhancement technique that uses a narrowband light spectrum to improve the mucosa's capillary surface. White-light endoscopy does not allow for the visualisation of the intraepithelial 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 larynx conducted a tertiary care centre in Tamil Nadu, from December 2021– December 2022. Patients underwent thorough history taking, clinical examination and appropriate radiological investigations and were analysed cross sectionally. Results: In the study, majority (41.7%) were in the age group of 61-70 years with a marked Male predominance (87.5%). The Symptoms, Co-morbidities the patients had, Habits like smoking and alcohol usage were also studied. The WLE diagnosis, NBI patterns and Diagnosis were compared with their respective 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% & 79%) and also it 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 one, indirect laryngoscopy is frequently utilised nowadays for the evaluation of laryngeal cancer and precancerous lesions. Even in anatomical 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(415nm & 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% & 79%) and also it provides very low false positive and zero false negative values in diagnosing the malignant lesions.