Klimza Hanna, Jackowska Joanna, Piazza Cesare, Banaszewski Jacek, Wierzbicka Malgorzata
Poznan University of Medical Sciences, Department of Otolaryngology, Head and Neck Surgery, Poznan, Poland.
Poznan University of Medical Sciences, Department of Otolaryngology, Head and Neck Surgery, Poznan, Poland.
Braz J Otorhinolaryngol. 2019 Mar-Apr;85(2):228-236. doi: 10.1016/j.bjorl.2018.01.004. Epub 2018 Mar 1.
Trans-oral laser microsurgery is an established technique for the treatment of early and moderately advanced laryngeal cancer.
The authors intend to test the usefulness of narrow-band imaging in the intraoperative assessment of the larynx mucosa in terms of specifying surgical margins.
Forty-four consecutive T1-T2 glottic cancers treated with trans-oral laser microsurgery Type I-VI cordectomy were presented. Suspected areas (90 samples/44 patients) were biopsied under the guidance of narrow-band imaging and white light and sent for frozen section.
Our study revealed that 75 of 90 (83.3%) white light and narrow-band imaging-guided samples were histopathologically positive: 30 (40%) were confirmed as carcinoma in situ or invasive carcinoma and 45 (60%) as moderate to severe dysplasia. In 6 patients mucosa was suspected only in narrow-band imaging, with no suspicion under white light. Thus, in these 6 patients 18/90 (20%) samples were taken. In 5/6 patients 16/18 (88.8%) samples were positive in frozen section: in 6/18 (33.3%) carcinoma (2 patients), 10/18 (66.6%) severe dysplasia was confirmed (3 patients). In 1 patient 2/18 (11.1%) samples were negative in frozen section. Presented analysis showed, that sensitivity, specificity and accuracy of white light was 79.5%, 20% and 71.1% respectively, while narrow-band imaging was 100%, 0.0% and 85.7%, respectively.
The intraoperative use of narrow-band imaging proved to be valuable in the visualization of suspect areas of the mucosa. Narrow-band imaging confirms the suspicions undertaken in white light and importantly, it showed microlesions beyond the scope of white light.
经口激光显微手术是治疗早期和中晚期喉癌的一种成熟技术。
作者旨在测试窄带成像在明确手术切缘方面对喉黏膜术中评估的有用性。
呈现44例接受经口激光显微手术I - VI型声带切除术治疗的连续T1 - T2声门癌患者。在窄带成像和白光引导下对可疑区域（90个样本/44例患者）进行活检，并送冰冻切片检查。
我们的研究显示，90个白光和窄带成像引导下的样本中，75个（83.3%）经组织病理学检查呈阳性：30个（40%）被确认为原位癌或浸润癌，45个（60%）为中重度发育异常。6例患者仅在窄带成像下怀疑有黏膜病变，白光下未发现可疑。因此，在这6例患者中取了18/90（20%）个样本。5/6例患者中，16/18（88.8%）个样本冰冻切片检查呈阳性：18个样本中有6个（33.3%）为癌（2例患者），10/18（66.6%）为重度发育异常（3例患者）。1例患者的18个样本中有2个（11.1%）冰冻切片检查为阴性。分析显示，白光的敏感性、特异性和准确性分别为79.5%、20%和71.1%，而窄带成像分别为100%、0.0%和85.7%。
术中使用窄带成像被证明在可视化黏膜可疑区域方面具有价值。窄带成像证实了白光下的可疑病变，重要的是，它还显示了白光范围之外的微小病变。
