| ObjectiveTo investigate the diagnostic efficacy of NBI(narrow-band imaging)laryngoscope combined with laryngopharyngeal reflux scale(reflux finding score,RFS/reflux symptom index,RSI)in space occupying lesions of larynx(SOLL)and the correlation between narrow band endoscopic vascular Ni classification,the average score of RFS and pathological results of space occupying lesions of larynx.Methods1.Object of studyA total of 120 patients who met the inclusion and exclusion criteria in the outpatient Department of Otolaryngology,the First Affiliated Hospital of Army Medical University from December 2021 to June 2022 were selected as the research objects.2.Inspection methodAll patients were examined for laryngeal lesions using the white light imaging(WLI)mode and narrow-band imaging mode of narrow-band imaging laryngoscope,the pictures were collected.The patient was scored on the laryngopharyngeal reflux score(RFS/RSI),with reference to the Ni classification according to morphology and lesion boundaries of intrapapillary capillary loop(IPCL),The vascular Ni classification criteria proposed by IPCL morphology and lesion boundary were used to classify laryngeal lesions in all patients under NBI mode.3.Statistical parameterBiopsy of space occupying lesions of larynx was taken in the narrow-band imaging mode for all enrolled patients,and the final pathological results were used as the gold standard for diagnosis.The detection rate,accuracy,sensitivity,specificity,positive predictive value and negative predictive value of four methods(white light imaging mode,narrow-band imaging mode,white light imaging mode combined with laryngopharyngeal reflux scale and narrow-band imaging mode combined with laryngopharyngeal reflux scale)in the diagnosis of space occupying lesions of larynx were calculated.4.Interpretation of resultChi-square test was used to evaluate the statistical differences in the detection rate,accuracy,sensitivity and specificity of the four methods.Kappa test was used to evaluate the consistency between Ni classification and pathological results.Paired t test and nonparametric rank sum test were used to evaluate the statistical association between the mean RFS score and Ni classification and pathological results.Analyze the diagnostic effectiveness of the four methods using ROC pairing analysis and draw ROC curves.No statistical difference was found in AUC comparison between other methods.Results1.Baseline dataA total of 120 patients who met the inclusion and exclusion criteria were selected as the research objects,including 107 males and 13 females,aged 25-84 years,with an average age of 59.3±10.8 years.The final pathological diagnosis of 120 patients showed that 56 patients had malignant lesions,including 15 cases of carcinoma in situ and 41 cases of invasive carcinoma.There were 64 cases of non-malignant lesions,including 40 cases of precancerous lesions(PL).There were 24 cases of benign lesions.2.Comparison of the diagnostic efficacy of benign lesionsThe detection rate of white light imaging mode and narrow-band imaging mode was17.50%and 18.33%,the accuracy rate was 91.67%and 97.50%,the sensitivity was 87.50%and 91.67%,the specificity was 92.71%and 98.96%,respectively.The positive predictive value was 75.00%and 95.65%,and the negative predictive value was 96.74%and 97.94%.The detection rate of white light imaging mode combined with laryngopharyngeal reflux scale and narrow-band imaging mode combined with laryngopharyngeal reflux scale were17.50%and 18.33%,the accuracy rate was 94.17%and 98.33%,the sensitivity was 87.50%and 91.67%,the specificity was 95.83%and 100.00%,respectively.The positive predictive value was 84.00%and 100.00%,and the negative predictive value was 96.84%and 97.96%.There were significant differences in the accuracy and specificity between the narrow-band imaging mode and the white light imaging mode,and the white light imaging mode combined with the laryngopharyngeal reflux scale and the white light imaging mode(P<0.05),but no significant differences in the detection rate and sensitivity were found(P>0.05).There was no significant difference in the detection rate,accuracy,sensitivity and specificity between the narrow-band imaging mode combined with the laryngopharyngeal reflux scale and the narrow-band imaging mode(P>0.05).3.Comparison of the diagnostic efficacy of precancerous lesionsThe detection rate of white light imaging mode and narrow-band imaging mode were24.17%and 30.83%,the accuracy rate was 73.33%and 92.50%,the sensitivity was 72.50%and 92.50%,the specificity was 73.75%and 92.50%,respectively.The positive predictive value was 58.00%and 86.05%,the negative predictive value was 84.29%and 96.10%,respectively.The detection rate of white light imaging mode combined with laryngopharyngeal reflux scale and narrow-band imaging mode combined with laryngopharyngeal reflux scale were26.67%and 28.33%,the accuracy rate was 85.83%and 92.50%,the sensitivity was 78.05%and 85.00%,the specificity was 89.87%and 96.25%,respectively.The positive predictive value and negative predictive value were 80.00%and 91.89%,88.75%and 92.77%,respectively.The detection rate,accuracy,sensitivity and specificity of narrow-band imaging mode and white light imaging mode,white light imaging mode combined with laryngopharyngeal reflux scale and white light imaging mode were statistically different(P<0.05),and the accuracy of narrow-band imaging mode combined with laryngopharyngeal reflux scale and narrow-band imaging mode was statistically different(P<0.05).No statistical difference was found in the rest(P>0.05).4.Comparison of the diagnostic efficacy of malignant lesionsThe detection rate of white light imaging mode and narrow-band imaging mode was29.17%and 41.67%,the accuracy rate was 76.67%and 91.67%,the sensitivity was 62.50%and 89.29%,the specificity was 89.06%and 93.75%,respectively.The positive predictive value was 83.33%and 92.59%,the negative predictive value was 73.08%and 90.91%,respectively.The detection rate of white light imaging mode combined with laryngopharyngeal reflux scale and narrow-band imaging mode combined with laryngopharyngeal reflux scale were40.00%and 45.00%,the accuracy rate was 88.33%and 92.50%,the sensitivity was 85.71%and 96.43%,the specificity was 90.63%and 89.06%,respectively.The positive predictive value and negative predictive value were 88.89%and 88.52%,87.88%and 96.61%,respectively.The detection rate,accuracy,sensitivity and specificity of narrow-band imaging mode and white light imaging mode,white light imaging mode combined with laryngopharyngeal reflux scale and white light imaging mode were statistically different(P<0.05),and the accuracy of narrow-band imaging mode combined with laryngopharyngeal reflux scale and narrow-band imaging mode was statistically different(P<0.05).No statistical difference was found in the rest(P>0.05).5.ROC curve analysis of four diagnostic methodsThe curve AUC of white light imaging mode,narrow band imaging mode,white light imaging mode combined with laryngopharyngeal reflux scale,and narrow band imaging mode combined with laryngopharyngeal reflux scale are 0.807(95%CI:0.729-0.886),0.898(95%CI:0.840-0.957),0.917(95%CI:0.862-0.973),0.939(95%CI:0.892-0.987),respectively.The AUC difference between white light model and NBI,white light model and white light model combined with laryngeal reflux scale were-0.091(95%CI:-0.157～-0.025),-0.110(95%CI:-0.171～-0.049),respectively(P<0.05),which were statistically significant,which were statistically significant.6.Statistical association of RFS scale score,Ni classification and pathological outcomeAmong the 120 patients enrolled,the Ni classification results were Type I in 14 cases,TypeⅡin 8 cases,TypeⅢin 17 cases,TypeⅣin 26 cases,TypeⅤa in 25 cases,TypeⅤb in 23 cases,and TypeⅤc in 7 cases.Ni classification was highly consistent with pathological results(Kappa=0.841,P<0.05).The mean score of RFS in the narrow-band imaging mode was higher than that in the white imaging mode(t=10.470,P<0.05).The mean score of RFS showed a gradual upward trend with the increase of pathological grade(?~2=70.117;?~2=72.474,P<0.05),and the mean score of RFS increased gradually with the increase of Ni classification(?~2=75.716,P<0.05).Conclusion1.Compared with pure white light imaging mode,narrow-band imaging model and white light imaging mode combined with laryngopharyngeal reflux scale has higher diagnostic value for space occupying lesions of larynx,especially precancerous lesions and malignant lesions.2.It has not been found that narrow-band imaging mode combined with laryngopharyngeal reflux scale has significant advantages in the diagnosis of space occupying lesions of larynx compared with narrow-band imaging alone.3.There is a high consistency between the Ni classification and the pathological results of space occupying lesions of larynx on narrow-band imaging,and the mean score of RFS has a positive trend between the Ni classification and the pathological results,indicating that laryngopharyngeal reflux may be related to the pathogenesis of space occupying lesions of larynx,especially laryngeal cancer and precancerous lesions. |
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