PURPOSE: It is reported that NBI has completed clinical application for detecting an early stage of hypopharyngeal cancer or esophageal cancer in digestive region. However, whereas there are little reports for NBI in airway region, clinical usefulness of NBI (Narrow Band Imaging) for bronchial lesions is less understood. The purpose of this study is to clarify clinical application of NBI for endobronchial lesions.
METHODS: We performed bronchoscopy from Jan. 2006 with the purpose of endobronchial observation. Among them, when endobronchial epithelial changes were found, we performed NBI observation by pushing the switch. Total 92 patients with 124 lesions (including following lesions; 38 squamous cell carcinomas (SCC), 2 dysplasias, 8 metaplasias, 15 adenocarcinomas, 13 mediastinal cancers, 5 sarcoidosis, 18 chronic inflammations, and so on). We compared the NBI images from these lesions with histopathological findings from biopsy samples.
RESULTS: Under NBI observation, we found several particular vascular and mucosal patterns in the bronchial epithelia. We defined them as 1; IPCL (intra-epithelial capillary papillary loops), 2; abnormal tumor vessels, 3; extremely increased fine vascular networks, 4; erythema, 5; cobblestone appearance of mucosa, and so on. IPCL patterns on the surface of bronchial epithelia was revealed in 30 lesions of 38 squamous cell carcinomas. The sensitivity, specificity, PPV and PNV of IPCL for SCC were 0.79, 0.97, 0.94, and 0.91, respectively. The cobblestone appearance was specifically detected in 11 lesions of 15 adenocarcinomas. The sensitivity, specificity, PPV and PNV of cobblestone appearance for adenocarcinoma were 0.73, 0.96, 0.73, and 0.96, respectively. The abnormal tumor vessel patterns were specific for malignant lesions. In a patient with chronic inflammation, we observed erythema and edema on mucosa with slightly hyper vascular, but they seemed to be different from malignant diseases.
CONCLUSION: NBI was useful for revealing surface epithelial vessels in detail. These appearances are derived from pathological tumor growth conditions, and have a possibility to predict histological patterns.
CLINICAL IMPLICATIONS: We believe NBI may discriminate an angiogenesis patterns of bronchial epithelia accompanied with carcinogenesis.
DISCLOSURE: Yuka Miyazu, No Financial Disclosure Information; No Product/Research Disclosure Information