PURPOSE:Narrow band imaging (NBI) is a novel endoscopic technique that enhances blood vessel morphology within the bronchial airway mucosa. NBI works by using narrow-bandwidth filters in a red-green-blue sequential illumination system. This results in increases in the contrast between the epithelial surface and the subjacent vascular network. NBI has been shown to be useful in detecting dysplasia and malignancy within the airway by analysis of vascular networks within the airway mucosa. AIDS-related Kaposi's sarcoma typically involves the skin or GI tract, but it can involve the lungs both within the airways and in the pulmonary parenchyma. Diagnosis is typically made bronchoscopically in the setting of suspected disease, however, differentiation from chronic bronchial inflammation can be difficult, and biopsies have a low sensitivity for disease and may be associated with significant hemorrhage. We propose that vascular network analysis via NBI can assist in the diagnosis of bronchopulmonary Kaposi's Sarcoma (KS).
METHODS:Bronchoscopy was done in four patients who were suspected of having bronchopulmonary KS. Imaging was performed in all patients using both white light bronchoscopy (WLB) and NBI.
RESULTS:NBI imaging in all four patients allowed for better delineation of typical findings in Kaposi's sarcoma, and allowed for better differentiation from adjacent areas of chronic inflammation.
CONCLUSION:NBI allowed for better vascular network delineation as compared to WLB. Typical vascular telangiectasias, bizarre shaped blood vessels, and vessel disorganization were better visualized with NBI as compared to WLB in bronchopulmonary KS. More studies to better delineate the diagnostic value of NBI in endobronchial KS are warranted.
CLINICAL IMPLICATIONS:NBI bronchoscopy may be superior to WLB in the diagnosis of bronchopulmonary KS, and may be especially valuable in those instances where the diagnosis may be difficult, specifically in patients with chronic bronchitis, or parenchymal involvement is questionable.
DISCLOSURE:Joseph Cicenia, No Financial Disclosure Information; No Product/Research Disclosure Information