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 using white light imaging (WLI), the design of NBI 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 here preformed 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 analyzed. When using NBI for overall diagnosis in head and neck region, a pooled sensitivity of 0.90 (95% CI: 0.88-0.92) ranged from 0.47 to 1.00 and a pooled specificity of 0.97 (95% CI: 0.96-0.97) ranged from 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 had substantial clinical benefit in head and neck cancer screening. In comparison with the 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 the WLI, NBI offers better diagnostic value in the screening of carcinoma originating from the head and neck mucosa and the use of NBI in complement with the conventional WLI in head and neck cancer screening is recommended.