Application Of Narrow-band Imaging Endoscopy In The Guidance Of Laryngeal Malignant Lesion Biopsy

Objective:To investigate the guiding role of narrow-band imaging(NBI)endoscopy in laryngeal malignant lesion biopsy process.Methods : From February 2013 to January 2014, there are 113 patients who had reported throat discomfort or foreign body sensation, hoarseness or not, blood-stained sputum from the otolaryngology head and neck surgery of the Tianjin Union Medical Center enrolled in this study. All of them were found to have Laryngeal neoplasms under electronic nasopharyngolaryngoscope and were suspected of laryngeal malignant lesions and needed to take a biopsy pathological examination. They were randomly divided into two groups. 58 cases in white light mode group did throat examinations in the white light mode. After representative images recorded, the laryngeal tumor biopsies were taken and sent for pathological examination.55 cases in NBI mode group did throat examinations in the NBI mode. After representative images recorded, the laryngeal tumor biopsies were taken and sent for pathological examination. According to the biopsy results, all of the cases were performed the corresponding surgical operation treatment. And their resected tissue from the operation were sent for pathologic examination. Regard the results of the examinations as gold standards. Calculate the detection rates of malignant lesions biopsies and correct detection rates of biopsies of two groups respectively and compare them statistically. And then compare the endoscopic features of laryngeal lesions under white light endoscopy and NBI endoscopy in NBI mode group.Results:(1)Of the 58 cases in the white light mode group, the histopathologic results of biopsy samples are as follow: 32 cases of malignant lesions, 26 cases of benign lesions; the histopathologic results of surgical resection tissue are as follow: 45 cases of malignant lesions, 13 cases of benign lesions. Of the 55 cases in the NBI mode group, the histopathologic results of biopsy samples are as follow: 42 cases of malignant lesions, 13 cases of benign lesions; the histopathologic results of surgical resection tissue are as follow: 44 cases of malignant lesions, 11 cases of benign lesions.(2)The detection rate of malignant lesions biopsy of the white light mode groupwas 71.1%(32/45),lower than 95.4%(42/44) of the NBI mode group. The difference between them was statistically significant(χ2=7.75,P<0.05);The correct detection rate of biopsy of the white light mode group was 77.6%(45/58), lower than 96.4%(53/55)of the NBI mode group,the difference was statistically significant(χ2=7.09,P<0.05).(3)In the NBI mode group, compare the endoscopic features of mucosal morphology and mucosal microvascular morphology of the same lesion under two different modes. Combined with the histopathologic results, it found that under NBI,the endoscopic features of malignant lesion(according to surgical histopathologic results) generally are that the IPCL have brownish speckles or present distorted uneven distribution on the tumor surface. The bigger and clearer the speckles are, the more irregular the arrangement is, the greater the likelihood of malignancy will be.Some IPCL present tortuous, irregular distortion. And to some IPCL, the structure has been dissolved. They are replaced by new tumor vessels. However, the changes of the microvessels morphology of malignant lesion in white light mode are not as clear as in the NBI mode. Whatever in the white light mode or the NBI mode, the endoscopic features of simple hyperplasia lesions are that the surface is covered with white pseudo membrane. The endoscopic features of papillary epithelioma are that IPCL have small, sparse distributed, brownish speckles under NBI.The endoscopic features of polyp are that the IPCL on the mucosa is invisible under NBI.Conclusions: Combining with the biological characteristics of throat tumors,narrow-band imaging endoscopy can differentiate the mucosal morphology and the mucosal surficial capillary morphology of lesions from the normal tissue more distinctly than the traditional endoscopy by its special optical effect. It can obviously improve detection rate and correct detection rate of the laryngeal malignant lesion biopsy through identifying the abnormal IPCL, locating the malignant lesions,determining the biopsy site. In a word, narrow-band imaging endoscopy can play a guiding role of targeted biopsy, reduce the misdiagnosis and missed diagnosis of laryngeal malignant lesions, has very high value in clinical application.