Department of Otolaryngology Head and Neck Surgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China.
Department of Otolaryngology Head and Neck Surgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China.
Am J Otolaryngol. 2021 May-Jun;42(3):102904. doi: 10.1016/j.amjoto.2021.102904. Epub 2021 Jan 8.
To explore the diagnostic value and the correlation between histological diagnosis and the Ni classification under narrow band imaging (NBI) for vocal fold leukoplakia (VFL) and early glottic cancer.
A total of 91 patients with 119 vocal fold lesions were selected from January 2017 to May 2020. All these patients were subsequently examined by white light imaging (WLI) and NBI endoscopy, and then all lesions were classified by the Ni classification according to the characteristics of intraepithelial papillary capillary loop (IPCL) observed. The gold standard of diagnosis was histopathological results. Eventually, the chi-square and kappa test were applied, respectively, to evaluate the diagnostic value of NBI endoscopy and the consistency of Ni classification and pathological results.
The accuracy and sensitivity of NBI endoscopy were significantly higher than that of WLI endoscopy (P < 0.05). For the diagnosis of precancerous lesions under the NBI, the sensitivity, specificity, positive and negative predictive value were 69.6% (16/23), 90.6% (87/96), 64.0% (16/25) and 92.6% (87/94), which for malignant lesions were 84.4% (65/77), 92.9% (39/42), 95.6% (65/68) and 76.5% (39/51). Moreover, for patients with low-grade intraepithelial neoplasia (mild and moderate dysplasia), type IV lesions accounted for the most (69.6 vs 30.4%; χ = 36.961, P < 0.001). For high-grade intraepithelial neoplasia or carcinoma in situ, type Va lesions were predominant (χ = 30.526, P < 0.001), while type Vb and Vc lesions were dominant in invasive carcinoma (χ = 64.373, P < 0.001). Besides, the kappa test revealed that there was a high consistency between Ni classification and pathological diagnosis (Kappa = 0.667, P < 0.001).
The Ni classification can improve the diagnosis accuracy of vocal fold lesions which enables clear visualization of mucosal microvasculature. This is essential for the early diagnosis of VFL and early glottic cancer during routine endoscopic examination.
探讨窄带成像（NBI）下声带白斑（VFL）和早期声门癌的组织学诊断与 Ni 分类的相关性。
选取 2017 年 1 月至 2020 年 5 月期间的 91 例 119 处声带病变患者，所有患者均经白光成像（WLI）和 NBI 内镜检查，根据观察到的上皮内乳头状毛细血管袢（IPCL）的特征，采用 Ni 分类进行分类。诊断的金标准为组织病理学结果。最终，分别采用卡方检验和 Kappa 检验评估 NBI 内镜的诊断价值和 Ni 分类与病理结果的一致性。
NBI 内镜的准确性和灵敏度明显高于 WLI 内镜（P<0.05）。在 NBI 下对癌前病变的诊断中，灵敏度、特异度、阳性预测值和阴性预测值分别为 69.6%（16/23）、90.6%（87/96）、64.0%（16/25）和 92.6%（87/94），对恶性病变分别为 84.4%（65/77）、92.9%（39/42）、95.6%（65/68）和 76.5%（39/51）。此外，对于低级别上皮内瘤变（轻度和中度异型增生）患者，IV 型病变占比最大（69.6%比 30.4%；χ²=36.961，P<0.001）。对于高级别上皮内瘤变或原位癌，Va 型病变占主导地位（χ²=30.526，P<0.001），而浸润性癌中则以 Vb 和 Vc 型病变为主（χ²=64.373，P<0.001）。此外，Kappa 检验显示 Ni 分类与病理诊断具有高度一致性（Kappa=0.667，P<0.001）。
Ni 分类可提高声带病变的诊断准确性，使黏膜微血管清晰可见，这对于常规内镜检查中 VFL 和早期声门癌的早期诊断至关重要。
