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Influence of prior laryngeal surgery on the diagnostic value of laryngeal endoscopy
18 April 2018 (online)
The possibilities of endoscopic diagnosis in the head and neck area have been expanded in recent years through technological developments. In clinical practice, high-resolution white-light endoscopy, preferably with digital magnification and narrow band imaging (NBI), has prevailed as the standard technique in endoscopic diagnosis. Data on the influence of previous laryngeal operations on the diagnostic value of laryngeal endoscopy are not available in the national and international literature.
We performed a blinded assessment of endoscopic images of laryngeal lesions in white light and NBI mode through three ENT specialists. 170 lesions were recorded preoperatively with a flexible endoscope and 144 lesions intraoperatively with a rigid endoscope. These observers had to differentiate between potentially malignant and benign lesions. In 65 lesions, the larynx had previously undergone surgery. The sensitivity and specificity of the assessment in white light and NBI mode were averaged for all three observers and calculated separately for the previously operated or non-operated patients. Histology served as the gold standard.
The averaged sensitivity and specificity were higher in the evaluation in NBI mode compared to white light and higher in previously non-operated lesions compared to operated ones. The added benefit of NBI in terms of averaged sensitivity was statistically significant. In the group of preoperative recordings the sensitivity of the pre-operated patients increased from 63.9% in the white light mode to 86.1% in the NBI mode and the specificity from 95.0% to 96.7%.
Overall, it was shown that previous laryngeal operations are a relevant factor influencing endoscopic diagnosis and that the use of NBI in this subgroup may be beneficial.