Klimza H, Jackowska J, Tokarski M, Piersiala K, Wierzbicka M
Department of Otolaryngology, Head and Neck Surgery, Poznań University of Medical Sciences, Poznań, Poland.
Student Research Group at the Department of Otolaryngology, Head and Neck Surgery Poznań University of Medical Sciences, Poznań, Poland.
PLoS One. 2017 Jun 29;12(6):e0180590. doi: 10.1371/journal.pone.0180590. eCollection 2017.
It is crucial to find a balance between functional and oncological outcome when choosing an adequate method for the management of vocal fold leukoplakia. Therefore, a detailed examination is a milestone in the decision-making process.
To examine whether narrow-band imaging (NBI) can be helpful in vocal fold assessment in the case of leukoplakia and how to overcome the "umbrella effect"- understood as the submucosal vascular pattern hidden under the plaque.
Prospective cohort of 41 consecutive patients. Inclusion criteria: vocal fold leukoplakia, no previous procedures (surgery, radiotherapy), and preoperative endoscopy with an optical filter for NBI. Two groups: "suspicious" and "normal", according to the submucosal microvascular pattern of peripheral regions of the mucosa surrounding the plaque, were distinguished. Patients were qualified for a full-thickness or partial-thickness biopsy, respectively. Criteria defining suspected characters were well-demarcated brownish areas with scattered brown spots corresponding to type IV, Va, Vb, and Vc NI classifications.
In 22/41 (53.7%) patients with "suspected" microvascular pattern, full-thickness biopsy was performed. Moderate and severe dysplasia was revealed in 15 type IV and 7 type Va NI patients. In 19/41 (46.3%) patients with proper NBI vessel pattern treated by partial-thickness biopsy, hyperkeratosis was diagnosed. There was a strong correlation between the NBI pattern and final histology: Chi2 (2) = 41.0 (p = 0.0000).
The results demonstrate that NBI endoscopic assessment of the submucosal microvascular pattern of mucosa surrounding the plaque can be an effective method to categorise the risk in vocal fold leukoplakia prior to treatment.
在选择合适的方法治疗声带白斑时，在功能和肿瘤学结果之间找到平衡至关重要。因此，详细检查是决策过程中的一个里程碑。
研究窄带成像（NBI）在声带白斑病例的评估中是否有帮助，以及如何克服“伞状效应”——即斑块下隐藏的黏膜下血管模式。
对41例连续患者进行前瞻性队列研究。纳入标准：声带白斑、既往无手术（手术、放疗）史，术前使用NBI滤光片进行内镜检查。根据斑块周围黏膜周边区域的黏膜下微血管模式，分为“可疑”和“正常”两组。患者分别接受全层或部分厚度活检。定义可疑特征的标准为边界清晰的褐色区域，伴有散在褐色斑点，对应IV型、Va型、Vb型和Vc型NI分类。
22/41（53.7%）微血管模式“可疑”的患者接受了全层活检。15例IV型和7例Va型NI患者显示中度和重度发育异常。19/41（46.3%）微血管模式正常的患者接受部分厚度活检，诊断为角化过度。NBI模式与最终组织学之间存在强相关性：卡方检验（2）=41.0（p = 0.0000）。
结果表明，NBI内镜评估斑块周围黏膜的黏膜下微血管模式可作为治疗前对声带白斑风险进行分类的有效方法。
