The clinical utility of narrow band imaging in the surveillance of mucosa and sub-mucosa lesions in head and neck regions

Abstract

BACKGROUND

Narrow band imaging (NBI) is an emerging imaging technique for use in endoscopic examination. Different from the conventional imaging techniques which use white light imaging (WLI), the design of NBI is aimed to enhance the viewing of superficial capillaries and neo-angiogenesis in the mucosal surface. As the diagnostic value of NBI varies depending on the anatomical locations, we performed a meta-analysis on the clinical utility of NBI in head and neck cancer screening.

METHODS

Pooled sensitivity and specificity of NBI and WLI were calculated. The positive likelihood ratio (PLR), negative likelihood ratio (NLR) and the summary estimates of diagnostic odds ratio (DOR) were used to estimate the diagnostic performance. Summary receiver operating curve (SROC) was used for the comparison of clinical utility.

RESULTS

Twenty-one studies including 4880 cases (885 malignancy and 3995 controls) were analysed. When using NBI for overall diagnosis in head and neck region, a pooled sensitivity of 0.90 (95% CI: 0.88–0.92, range: 0.47 to 1.00) and a pooled specificity of 0.97 (95% CI: 0.96–0.97, range: 0.79 to 1.00) were obtained. The summary point was in the left upper quadrant of the likelihood matrix (PLR > 10 and NLR < 0.1), indicating that NBI has substantial clinical benefit in head and neck cancer screening. In comparison with conventional WLI, the use of NBI could significantly increase the diagnostic efficacy of nasopharyngeal, laryngeal, oral cavity and/or oropharyngeal carcinoma detection.

CONCLUSION

The diagnostic value of NBI varies in different anatomical locations of head and neck. In comparison with WLI, NBI offers better diagnostic value in the screening of carcinoma originating from the head and neck mucosa, and using NBI in combination with WLI is recommended in head and neck cancer screening.