| [Background]Nasopharyngeal carcinoma(NPC)is a common malignant tumor that occurs in the epithelial tissue of the nasopharynx.The disease has a higher incidence rate in southern China and is the most common type of head and neck tumor.Although the exact mechanism of occurrence is not fully understood,current research suggests that the disease may be related to genetic factors,Epstein-Barr virus(EBV)infection,and environmental factors.Due to the hidden location of the nasopharynx and the lack of obvious early symptoms,the proportion of early diagnosis of NPC is low.However,early recognition and diagnosis of NPC through simple and effective tests is crucial for improving patient prognosis.Early-stage NPC patients who receive radical radiotherapy have high survival rates and better prognosis.[Objective]The aim of this study is to explore the application value and clinical significance of narrow-band imaging(NBI)endoscopic technology in the early diagnosis of nasopharyngeal carcinoma.We will investigate the relationship between mucosal vascular morphology under NBI endoscopy and nasopharyngeal carcinoma,compare the diagnostic results of NBI endoscopy and conventional white light endoscopy in the early diagnosis of nasopharyngeal carcinoma,and evaluate the effectiveness of NBI endoscopic technology,providing valuable reference for clinical medicine.[Methods]A total of 404 patients suspected of nasopharyngeal carcinoma and meeting the inclusion criteria were collected from May 2020 to January 2023 in the Department of Otorhinolaryngology,Guangzhou Medical University Affiliated Third Hospital.All cases were divided into flat type and raised type according to the morphology of the lesion,with223 cases of flat type and 181 cases of raised type.An electronic nasopharyngoscope was used for examination,and the mucosal vascular morphology in the nasopharynx under NBI mode was classified into 6 types,including follicular structure,normal dendritic vessel,dilated trunk-like vessel,dot-like vessel,twisted line-like vessel,and non-specific vessel,to explore the relationship between mucosal vascular morphology and nasopharyngeal carcinoma and to predict its benignity or malignancy.Partial tissue was obtained for pathological diagnosis from all cases.Based on the pathological diagnosis as the gold standard,the sensitivity,specificity,positive predictive value,negative predictive value,accuracy,and area under the curve of white light mode,NBI mode,and white light+NBI mode were calculated,and the efficacy of the three modes in the early diagnosis of nasopharyngeal carcinoma in flat type cases,raised type cases,and overall cases was compared.Statistical analysis was performed using R 4.0.2 software to evaluate the application value and clinical significance of these three modes in the early diagnosis of nasopharyngeal carcinoma.[Results]A total of 404 patients were included in this study,including 199 males(49.3%)and205 females(50.7%),with an age range of 14 to 87 years and a mean age of 42.14±14.61 years.There were 370 cases of benign lesions(91.6%)and 34 cases of malignant lesions(8.4%),all of which were non-keratinizing undifferentiated carcinomas.There were 223 cases of flat lesions(55.2%)and 181 cases of elevated lesions(44.8%).The distribution of vascular morphology types in 404 patients collected in this study under NBI mode is as follows: follicular-like structures: 173 cases,all of which were benign lesions;normal branching vessels: 176 cases,of which one case was diagnosed as malignant tumor by pathological examination,and 175 cases were benign lesions;enlarged stem-like vessels: 8 cases,all of which were malignant tumors;dotted vessels: 11 cases,of which 2 cases were diagnosed as malignant tumors by pathological examination,and 9 cases were benign lesions;twisted vessel-like structures: 25 cases,of which 22 cases were diagnosed as malignant tumors by pathological examination,and 3 cases were benign lesions;and no specific vessels: 11 cases,of which one case was diagnosed as malignant tumor by pathological examination,and 10 cases were benign lesions.In flat lesions,narrow band imaging(NBI)mode had higher specificity(99.1%),positive predictive value(83.30%),and accuracy(98.7%)than white light endoscopy mode(93.4%,33.3%,91.9%)and white light+NBI mode(92.5%,38.5%,92.4%),with statistically significant differences(P<0.05).NBI mode and white light+NBI mode had sensitivity(90.9%)and negative predictive value(99.5%)for diagnosis of nasopharyngeal carcinoma(NPC),which were higher than those of white light mode(63.6%,98.0%),but without statistical significance(P>0.05).In flat lesions,AUC values for diagnosis of NPC were 0.785,0.950,and 0.917 for white light mode,NBI mode,and white light+NBI mode,respectively.NBI mode had the highest AUC value,and both NBI mode and white light+NBI mode had good diagnostic performance,while white light mode had the lowest AUC value and moderate diagnostic performance.In the case of elevated lesions,NBI mode had higher specificity(99.4%)and accuracy(96.7%)for the diagnosis of nasopharyngeal carcinoma compared to white light mode(66.5%,70.2%)and white light+NBI mode(66.5%,70.7%)with statistically significant differences(P<0.05).White light+NBI mode had higher sensitivity(100%)and positive predictive value(100%)for the diagnosis of nasopharyngeal carcinoma compared to white light mode(95.7%)and NBI mode(78.3%),but the differences were not statistically significant(P>0.05).There were no significant in negative.The AUC values for the diagnosis of nasopharyngeal carcinoma in lesions for white light mode,NBI mode,and white light+NBI mode were 0.811,0.888,and 0.832,respectively.NBI mode had the highest AUC value,indicating better diagnostic efficacy compared to white light mode,which had the lowest AUC value.The diagnostic efficacy of white light+NBI mode was moderate.In general cases,narrow-band imaging endoscopy mode has higher specificity(99.20%),positive predictive value(90.30%)and accuracy(97.77%)than white light endoscopy mode(81.90%,30.20%,82.18%)and white light+narrow-band imaging endoscopy mode(81.40%,32.40%,82.67%),with statistically significant differences(P<0.05).The sensitivity of NBI mode for the diagnosis of nasopharyngeal carcinoma(NPC)(82.4%)is lower than that of white light mode(85.3%)and white light+NBI mode(97.1%),with no statistically significant difference(P>0.05).There is no significant difference in negative predictive value.The AUC values of white light mode,NBI mode and white light+NBI mode for the diagnosis of NPC are 0.836,0.908 and 0.892,respectively.The NBI mode has the highest AUC value,and both NBI mode and white light+NBI mode have good diagnostic efficiency.The AUC value of the white light mode is the lowest,and the diagnostic efficiency is generally moderate.[Conclusion]1.Narrow-band imaging endoscopy is beneficial for the early diagnosis of nasopharyngeal carcinoma due to the visualization of lesion vascular morphology.2.Narrow-band imaging endoscopy overall performs better than white light mode in the diagnosis of nasopharyngeal carcinoma.Particularly in flat lesions with no apparent changes in lesion morphology,narrow-band imaging endoscopy has significant advantages over ordinary white light endoscopy in diagnosing nasopharyngeal carcinoma.3.In protruding lesions with no specific blood vessels observed under narrow-band imaging endoscopy,using narrow-band imaging endoscopy alone may lead to misdiagnosis.Combining white light imaging with narrow-band imaging endoscopy can compensate for its deficiencies. |
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