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AbstractBackgroundAims/objectivesMaterials and methodsResultsConclusions and significanceIn oral cancers, tumour borders are typically defined by white light (WL). Narrow-band imaging (NBI) is an optical endoscopic technique commonly used for the larynx and for cancers of unknown primary. However, evidence for using NBI in oral cancers is insufficient.We investigated whether NBI is a better predictor of the true mucosal tumour borders than WL in oral cancers. Additionally, we examined the agreement between NBI-based Takano intrapapillary capillary loop classifications and pathology reports.In this prospective study, the tumour borders were assessed by both NBI and WL at the time of surgical resection and then compared. Pathology reports of the examined areas were used as gold standard.Forty-nine participants were included. After exclusion of 15 patients due to missing data, 34 were included in analyses. In 26.5% of the assessments, the tumour borders defined by NBI were outside the borders defined by WL. However, 55.5% of these were false-positives.The delineation of mucosal tumour borders in oral cancers by NBI was not better than that by WL in this study. Several methodological challenges may have influenced the findings of this study, similar to the limitations reported in previous studies. [ABSTRACT FROM AUTHOR]

Background: The Pink Zone Pattern (PP) sign is a typical color alteration of early gastric cancer (EGC) under magnifying endoscopic narrow-band imaging (ME-NBI). By integrating the color changes (PP sign) with the "vessel plus surface (VS)" classification system, we developed an innovative diagnostic system for EGC and named it "Pink Microsurface Microvascular (PSV)" system. Here, we aimed to elucidate the diagnostic performance of the PSV system for EGC. Methods: We conducted a single-center prospective clinical study (before-after design) consisting of 2 cross-sectional studies at 2 separate periods. In the before phase, 184 suspected lesions were evaluated using the VS system under ME-NBI; in the after phase, 183 suspected lesions were evaluated using the PSV system. We compared the diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) between the VS group and the PSV group. Results: The accuracy, sensitivity, specificity, PPV, and NPV of the VS system for EGC were 84.6%, 87.0%, 83.6%, 67.8%, and 94.2%, respectively, and those for the PSV system were 93.0%, 92.0%, 93.4%, 85.2%, and 96.6%, respectively. The accuracy, specificity, and PPV of the PSV system were superior to those of the VS system. However, the sensitivity and NPV did not significantly differ between the VS system and the PSV system. The VS system was inconclusive for 22 lesions (12.0%) and the PSV system was inconclusive for 11 lesions (6.0%). The PSV system could identify more suspicious lesions than the VS system. Conclusions: We propose a new PSV diagnostic system by combining the VS system and the PP sign. Compared with the VS system, the PSV system could identify more suspected lesions and improve the diagnostic performance of EGC. [ABSTRACT FROM AUTHOR]

AbstractBackgroundMethodResultsConclusionNarrow-band imaging (NBI) is a novel endoscopic imaging technology that improves the visibility of capillaries. The aim of this study was to evaluate the efficacy of NBI hysteroscopic excision in symptomatic post-cesarean scar diverticulum (PCSD) patients compared to conventional white light (WL) hysteroscopy.A total of 73 patients with symptomatic PCSD between January 2014 and December 2018 were enrolled. The enrolled patients were stratified into NBI and WL groups according to whether they received NBI or WL hysteroscopy. Postoperative menstrual patterns at one, six, and 12 months after the operation were collected and compared between the NBI and WL groups.A total of 32 patients underwent NBI hysteroscopy (NBI group), while 41 patients received WL hysteroscopy (WL group). The symptom-free remission rates in the NBI group were significantly higher than in the WL group at six months and 12 months post-hysteroscopy. At the final follow-up, the menstrual bleeding duration in the NBI group was significantly shorter than in the WL group.The use of NBI hysteroscopy in treating symptomatic PCSD resulted in shorter menstrual bleeding days and longer symptomatic remission compared to conventional WL hysteroscopy. [ABSTRACT FROM AUTHOR]

A 75‐year‐old female was diagnosed with a type 0‐I, moderately differentiated, early gastric carcinoma on the posterior wall of the middle gastric body during esophagogastroduodenoscopy (EGD). Several small whitish structures, referred to as white globe appearances (WGAs), were noted on the oral side outside the demarcation line of the cancerous protrusion. Although this area was flat without cancerous mucosal changes on the surface, subepithelial cancer extension was suspected. The histopathology of the resected specimen revealed that the carcinoma with submucosal invasion had significant lymphatic invasion with submucosal lateral extent along lymphatic vessels. In some areas, the carcinoma within the lymphatic vessels regressed from the submucosal layer towards the mucosal lamina propria, penetrating the muscularis mucosas. The intralymphatic carcinoma reaching just beneath the epithelium was considered to manifest WGA features during endoscopy. [ABSTRACT FROM AUTHOR]

Objectives: Vocal fold leukoplakia (VFL) is a precancerous lesion of laryngeal cancer, and its endoscopic diagnosis poses challenges. We aim to develop an artificial intelligence (AI) model using white light imaging (WLI) and narrow‐band imaging (NBI) to distinguish benign from malignant VFL. Methods: A total of 7057 images from 426 patients were used for model development and internal validation. Additionally, 1617 images from two other hospitals were used for model external validation. Modeling learning based on WLI and NBI modalities was conducted using deep learning combined with a multi‐instance learning approach (MIL). Furthermore, 50 prospectively collected videos were used to evaluate real‐time model performance. A human‐machine comparison involving 100 patients and 12 laryngologists assessed the real‐world effectiveness of the model. Results: The model achieved the highest area under the receiver operating characteristic curve (AUC) values of 0.868 and 0.884 in the internal and external validation sets, respectively. AUC in the video validation set was 0.825 (95% CI: 0.704–0.946). In the human‐machine comparison, AI significantly improved AUC and accuracy for all laryngologists (p < 0.05). With the assistance of AI, the diagnostic abilities and consistency of all laryngologists improved. Conclusions: Our multicenter study developed an effective AI model using MIL and fusion of WLI and NBI images for VFL diagnosis, particularly aiding junior laryngologists. However, further optimization and validation are necessary to fully assess its potential impact in clinical settings. Level of Evidence: 3 Laryngoscope, 134:4321–4328, 2024 [ABSTRACT FROM AUTHOR]

Background: Gastric cancer (GC) is associated with a significant global health burden and high mortality rates when diagnosed at later stages. The diagnosis often occurs at advanced stages when treatment options are limited and less effective. Early detection strategies are crucial to improving survival rates and outcomes for patients. Blue laser imaging (BLI) is an image-enhanced endoscopy technique that utilizes white light and narrow-band light to detect pathological changes in the mucosal architecture. This study aims at investigating the diagnostic performance of BLI for the detection of GC. Methods: A comprehensive search was conducted across multiple databases from inception until March 2023. Studies assessing the diagnostic efficacy of BLI for GC detection were included. The sensitivity, specificity and accuracy of BLI were calculated using pooled proportions and 95% confidence intervals (CI) with a random-effects model. Heterogeneity among the included studies was assessed using the I2 statistic. Results: Six studies were included in the pooled analysis. There were 708 patients with 380 GC lesions. Most of the lesions involved the lower two-thirds of the stomach. The pooled performance metrics of BLI for GC detection were as follows: sensitivity of 91.9% (95% CI 83.3–96.3%; I2 = 82.3%), specificity of 93.4% (95% CI 82.0–97.8%; I2 = 87.9%) and accuracy of 95.4% (95% CI 72.6–99.8%; I2 = 73.6%). Conclusion: BLI demonstrates high diagnostic efficacy for the detection of GC. BLI can be a valuable tool in clinical practice. However, large-scale, randomized controlled studies are needed to further establish the role of BLI in routine clinical practice for GC detection. [ABSTRACT FROM AUTHOR]

Introduction: Narrow‐band imaging (NBI) can improve detection of lesions in the aerodigestive tract. However, its role in benign lesions of the larynx is unclear. This study aims to determine whether NBI improves the detection of scars, sulci, and nodules compared to panchromatic lighting using objective image analysis. Methods: In total, 120 vocal folds (VFs) were analyzed with and without NBI (21 normal, 15 scars, 16 sulci, and 45 nodules). Each VF image had anterior, middle, and posterior thirds analyzed for brightness using an area morphometry software (Optimas 5.1a). The middle‐third with the lesion was analyzed against surrounding VF segments for average and standard deviation (SD) in absolute grayscale. Results: The use of panchromatic light resulted in greater illumination and grayscale values than NBI. All lesions tended to be in the mid‐membranous fold. Under panchromatic light, change in brightness when comparing anterior versus middle (A–M) was +6.1% for normal, versus 6.5%, 8.1%, and 7.1% for sulci, nodules, and scars, respectively. Under NBI, they were 9.0% (normal), 12.3% (sulci), 13.7% (nodules), and 13.1% (scars). A greater SD of luminescence was observed at pathology sites (p < 0.05) when using NBI. The change in absolute grayscale at all lesion sites was greater when using NBI than when using panchromatic light (p < 0.05). Conclusion: NBI significantly enhanced the area of pathology in patients with nodules, sulci, and scars. Greater SD values in grayscale at pathologic sites were observed compared at normal sites. Thus, NBI may improve the detection of phonotraumatic lesions compared to panchromatic light. Level of Evidence: N/A Laryngoscope, 134:4066–4070, 2024 [ABSTRACT FROM AUTHOR]

Narrow‐band imaging combined with magnified endoscopy has enabled the detection of superficial squamous cell carcinoma of the head and neck (SSCCHN) that has been resected with minimally invasive treatment, preserving vocalization and swallowing functions. However, risk factors of lymph node metastasis (LNM) must be identified, as some patients with LNM have a poor prognosis. From an initial 599 patients with 700 lesions who underwent trans‐oral surgery in 27 Japanese hospitals (a nationwide registration survey), we enrolled 541 patients with 633 SSCCHNs, as indicated by central pathological diagnoses. All pathological specimens for each patient were examined using 20 pathological factors that are thought to affect the LNM of SSCCHN. In all, 24 (4.4%) of the 568 SSCCHNs exhibited LNM, and all 24 had at least one solitary nest of epithelial neoplastic cells present in the stroma, clearly separated from the intraepithelial carcinoma. Multivariate analysis also showed that tumor thickness (p = 0.0132, RR: 7.85, 95% confidence interval [CI]: 1.54–40.02), and an INFc pattern classified as infiltrating growth (INF) with unclear boundaries between tumor and non‐tumor tissues (p = 0.0003, RR: 14.47, 3.46–60.46), and tumor budding (p = 0.0019, RR: 4.35, CI: 1.72–11.01) were significantly associated with LNM. Solitary nests may be indicative of LNM. In addition, tumor thickness was revealed to be a risk factor for LNM in SSCCHNs using pT factors that do not include an invasion depth element because of the anatomical absence of the muscularis mucosae. [ABSTRACT FROM AUTHOR]

The assessment of early laryngeal cancer and pre-neoplastic lesions is subjective and depends on doctors' experience, leading to missed diagnoses in primary institutions. Our objective was to develop and validate a deep learning algorithm for the real-time identification of early laryngeal cancer and pre-neoplastic lesions, aiming to enhance diagnostic accuracy. The challenge observed in the domain of deep learning arises from overlooking contextual information. In response, we introduce in this paper a learning methodology that advances from acknowledging the surrounding context to integrating it, providing a resolution to this problem. Initially, we introduce side-aware features to capture relevant characteristics. Subsequently, we employ a rectangular selection technique for accurately determining regions of interest. To assess the effectiveness of our approach in object detection, we perform evaluations on a clinical dataset. Our deep learning approach exhibits robust performance in discriminating cancer. The images were randomly divided into training (80%), testing (10%), and validation (10%) sets. The testing was performed on a laryngoscope dataset consisting of 1123 samples. When compared with other advanced detection models, our methodology surpassed them, demonstrating superior results in laryngoscope detection, including mAP, accuracy, recall, and F1 score. In this study, we identified a learning method conducive to polyp detection in video laryngoscopy under both white-light and narrow-band imaging. The promising detection performance holds the potential to improve diagnostic proficiency and decrease the likelihood of missed diagnoses among primary otolaryngologists. [ABSTRACT FROM AUTHOR]

Abstract Laryngeal cancer exhibits a notable global health burden, with later-stage detection contributing to a low mortality rate. Laryngeal cancer diagnosis on throat region images is a pivotal application of computer vision (CV) and medical image diagnoses in the medical sector. It includes detecting and analysing abnormal or cancerous tissue from the larynx, an integral part of the vocal and respiratory systems. The computer-aided system makes use of artificial intelligence (AI) through deep learning (DL) and machine learning (ML) models, including convolution neural networks (CNN), for automated disease diagnoses and detection. Various DL and ML approaches are executed to categorize the extraction feature as healthy and cancerous tissues. This article introduces an automated Laryngeal Cancer Diagnosis using the Dandelion Optimizer Algorithm with Ensemble Learning (LCD-DOAEL) method on Biomedical Throat Region Image. The LCD-DOAEL method aims to investigate the images of the throat region for the presence of laryngeal cancer. In the LCD-DOAEL method, the Gaussian filtering (GF) approach is applied to eliminate the noise in the biomedical images. Besides, the complex and intrinsic feature patterns can be extracted by the MobileNetv2 model. Meanwhile, the DOA model carries out the hyperparameter selection of MobileNetV2 architecture. Finally, the ensemble of three classifiers such as bidirectional long short-term memory (BiLSTM), regularized extreme learning machine (ELM), and backpropagation neural network (BPNN) models, are utilized for the classification process. A comprehensive set of simulations is conducted on the biomedical image dataset to highlight the efficient performance of the LCD-DOAEL technique. The comparison analysis of the LCD-DOAEL method exhibited a superior accuracy outcome of 97.54% over other existing techniques.

Laryngeal cancer exhibits a notable global health burden, with later-stage detection contributing to a low mortality rate. Laryngeal cancer diagnosis on throat region images is a pivotal application of computer vision (CV) and medical image diagnoses in the medical sector. It includes detecting and analysing abnormal or cancerous tissue from the larynx, an integral part of the vocal and respiratory systems. The computer-aided system makes use of artificial intelligence (AI) through deep learning (DL) and machine learning (ML) models, including convolution neural networks (CNN), for automated disease diagnoses and detection. Various DL and ML approaches are executed to categorize the extraction feature as healthy and cancerous tissues. This article introduces an automated Laryngeal Cancer Diagnosis using the Dandelion Optimizer Algorithm with Ensemble Learning (LCD-DOAEL) method on Biomedical Throat Region Image. The LCD-DOAEL method aims to investigate the images of the throat region for the presence of laryngeal cancer. In the LCD-DOAEL method, the Gaussian filtering (GF) approach is applied to eliminate the noise in the biomedical images. Besides, the complex and intrinsic feature patterns can be extracted by the MobileNetv2 model. Meanwhile, the DOA model carries out the hyperparameter selection of MobileNetV2 architecture. Finally, the ensemble of three classifiers such as bidirectional long short-term memory (BiLSTM), regularized extreme learning machine (ELM), and backpropagation neural network (BPNN) models, are utilized for the classification process. A comprehensive set of simulations is conducted on the biomedical image dataset to highlight the efficient performance of the LCD-DOAEL technique. The comparison analysis of the LCD-DOAEL method exhibited a superior accuracy outcome of 97.54% over other existing techniques. [ABSTRACT FROM AUTHOR]

Background: Narrow-band imaging is an advanced endoscopic technology used to detect changes on the laryngeal tissue surface, employing a comparative approach alongside white-light endoscopy to facilitate histopathological examination. Objective: This study aimed to assess the utility and advantages of NBI (narrow-band imaging) in identifying malignant laryngeal lesions through a comparative analysis with histopathological examination. Methods: We conducted a systematic literature review, utilizing databases such as PubMed, the CNKI database, and Embase for our research. Results: We analyzed the articles by reviewing their titles and abstracts, selecting those we considered relevant based on determined criteria; in the final phase, we examined the relevant studies according to the specific eligibility criteria. Conclusions: Narrow-band imaging is an advanced endoscopic technology that demonstrates its efficacy as a tool for diagnosing malignant laryngeal lesions and comparing them to premalignant lesions. The European Society of Laryngology has implemented a standardized classification system for laryngeal lesions to enhance data correlation and organization. [ABSTRACT FROM AUTHOR]

Background and Aim: There has been no report on a direct comparison between linked color imaging (LCI) and second‐generation narrow‐band imaging (2G‐NBI) for surveillance of epithelial neoplasms in the upper gastrointestinal tract (UGIT). The aim of this study was to verify the superiority of LCI to 2G‐NBI for surveillance esophagogastroduodenoscopy and to clarify how each endoscopic system should be used. Methods: This study was conducted as an open‐label, two‐arm‐parallel (1:1), multicenter, randomized controlled trial at six institutions. Patients aged 20–85 years with a treatment history of epithelial neoplasms in the UGIT were recruited. Patients were assigned to a 2G‐NBI group and an LCI group, and esophagogastroduodenoscopy was performed with primary image‐enhanced endoscopy followed by white light imaging (WLI). The primary endpoint was the detection rate of one or more epithelial neoplasms in the primary image‐enhanced endoscopy. A WLI‐detected epithelial neoplasm was defined as a lesion that was detected in only WLI. Results: A total of 372 patients in the 2G‐NBI group and 378 patients in the LCI group were analyzed. Epithelial neoplasms in the UGIT were detected by 2G‐NBI in 18 patients (4.6%) and were detected by LCI in 20 patients (5.3%) (P = 0.87). WLI‐detected epithelial neoplasms were in 11 patients in the 2G‐NBI group (3.0%) and in 1 patient in the LCI group (0.27%) (P = 0.003). Conclusions: Linked color imaging did not show superiority to 2G‐NBI for the detection of epithelial neoplasms. Also, the percentage of WLI‐detected epithelial neoplasms in primary NBI was significantly higher than that in primary LCI. [ABSTRACT FROM AUTHOR]

Esophageal carcinoma is the sixth-leading cause of cancer death worldwide. A precursor to esophageal adenocarcinoma (EAC) is Barrett's Esophagus (BE). Early-stage diagnosis and treatment of esophageal neoplasia (Barrett's with high-grade dysplasia/intramucosal cancer) increase the five-year survival rate from 10% to 98%. BE is a global challenge; however, current endoscopes for early BE detection are costly and require extensive infrastructure for patient examination and sedation. We describe the design and evaluation of the first prototype of ScanCap, a high-resolution optical endoscopy system with a reusable, low-cost tethered capsule, designed to provide high-definition, blue-green illumination imaging for the early detection of BE in unsedated patients. The tethered capsule (12.8 mm diameter, 35.5 mm length) contains a color camera and rotating mirror and is designed to be swallowed; images are collected as the capsule is retracted manually via the tether. The tether provides electrical power and illumination at wavelengths of 415 nm and 565 nm and transmits data from the camera to a tablet. The ScanCap prototype capsule was used to image the oral mucosa in normal volunteers and ex vivo esophageal resections; images were compared to those obtained using an Olympus CV-180 endoscope. Images of superficial capillaries in intact oral mucosa were clearly visible in ScanCap images. Diagnostically relevant features of BE, including irregular Z-lines, distorted mucosa, and dilated vasculature, were clearly visible in ScanCap images of ex vivo esophageal specimens. [ABSTRACT FROM AUTHOR]

Narrow-band imaging (NBI) is a readily accessible imaging technique that enhances mucosal visualisation, allowing for a more accurate assessment of duodenal villi. However, its role in the diagnosis of coeliac disease (CD) in clinical practice remains limited. We systematically searched several databases in June 2023 for studies evaluating the diagnostic accuracy of NBI for detecting duodenal villous atrophy (VA) in patients with suspected CD. We calculated the summary sensitivity, specificity, and likelihood ratios using a bivariate random-effects model. The study followed PRISMA guidelines and was registered at PROSPERO (CRD42023428266). A total of 6 studies with 540 participants were included in the meta-analysis. The summary sensitivity of NBI to detect VA was 93% (95% CI, 81% - 98%), and the summary specificity was 95% (95% CI, 92% - 98%). The area under the summary receiver operating characteristic curve was 0.98 (95% CI, 96 - 99). The positive and negative predictive values of NBI were 94% (95% CI, 92% - 97%) and 92% (95% CI, 90% – 94%), respectively. NBI is an accurate non-invasive tool for identifying and excluding duodenal VA in patients with suspected CD. Further studies using a validated classification are needed to determine the optimal role of NBI in the diagnostic algorithm for CD. [ABSTRACT FROM AUTHOR]

Objective: To investigate the potential of deep learning for automatically delineating (segmenting) laryngeal cancer superficial extent on endoscopic images and videos. Methods: A retrospective study was conducted extracting and annotating white light (WL) and Narrow‐Band Imaging (NBI) frames to train a segmentation model (SegMENT‐Plus). Two external datasets were used for validation. The model's performances were compared with those of two otolaryngology residents. In addition, the model was tested on real intraoperative laryngoscopy videos. Results: A total of 3933 images of laryngeal cancer from 557 patients were used. The model achieved the following median values (interquartile range): Dice Similarity Coefficient (DSC) = 0.83 (0.70–0.90), Intersection over Union (IoU) = 0.83 (0.73–0.90), Accuracy = 0.97 (0.95–0.99), Inference Speed = 25.6 (25.1–26.1) frames per second. The external testing cohorts comprised 156 and 200 images. SegMENT‐Plus performed similarly on all three datasets for DSC (p = 0.05) and IoU (p = 0.07). No significant differences were noticed when separately analyzing WL and NBI test images on DSC (p = 0.06) and IoU (p = 0.78) and when analyzing the model versus the two residents on DSC (p = 0.06) and IoU (Senior vs. SegMENT‐Plus, p = 0.13; Junior vs. SegMENT‐Plus, p = 1.00). The model was then tested on real intraoperative laryngoscopy videos. Conclusion: SegMENT‐Plus can accurately delineate laryngeal cancer boundaries in endoscopic images, with performances equal to those of two otolaryngology residents. The results on the two external datasets demonstrate excellent generalization capabilities. The computation speed of the model allowed its application on videolaryngoscopies simulating real‐time use. Clinical trials are needed to evaluate the role of this technology in surgical practice and resection margin improvement. Level of Evidence: III Laryngoscope, 134:2826–2834, 2024 [ABSTRACT FROM AUTHOR]

Since the indications for endoscopic submucosal dissection have been expanded to include undifferentiated-type early gastric cancers, improvements in preoperative diagnostic ability have been an area of research. There are also concerns about the impact on the diagnosis of Helicobacter pylori infection. Based on our previous studies, in undifferentiated-type early gastric cancers, magnifying endoscopy with narrow-band imaging is useful for delineating the demarcation regardless of the tumor size. Additionally, inflammatory cell infiltration appears to be a cause of misdiagnosis, suggesting that the resolution of inflammation could contribute to the accurate diagnosis of demarcations. As such, the accuracy of demarcation in eradicated and uninfected cases is higher than that in non-eradicated cases. The common features of the endoscopic findings were discoloration under white-light imaging and a predominance of sites in the lower and middle regions. The uninfected group was characterized by smaller tumor size, flat type, more extended intervening parts in magnifying endoscopy with narrow-band imaging, and pure signet ring cell carcinoma. In contrast, the eradication and non-eradication groups were characterized by larger tumor size, depressed type, and wavy microvessels in magnifying endoscopy with narrow-band imaging. In this comprehensive review, as described above, we discuss the diagnosis of demarcation of undifferentiated-type early gastric cancers, undifferentiated-type early gastric cancers that developed following H. pylori eradication, and H. pylori-uninfected undifferentiated-type early gastric cancers, with a focus on studies with self-examination and endoscopic findings and describe the future direction.

Background and Aim: Gastric intestinal metaplasia (GIM) is a high‐risk factor for the development of gastric cancer. Narrow‐band imaging (NBI) enables endoscopic grading of GIM (EGGIM). In the era of climate change, gastrointestinal endoscopists are expected to reduce greenhouse gas emissions and medical waste. Based on the diagnostic performance of NBI endoscopy, this study measured the environmental impact and reduced cost of implementing EGGIM during gastroscopy. Methods: Using NBI endoscopy in 242 patients, EGGIM classification and operative link on GIM (OLGIM) staging were prospectively performed in five different areas (lesser and greater curvatures of the corpus and antrum, and the incisura angularis). We estimated the environmental impact and cost reduction of the biopsy procedures and pathological processing if EGGIM were used instead of OLGIM. Results: The diagnostic accuracy of NBI endoscopy for GIM was 93.0–97.1% depending on the gastric area. When a high EGGIM score ≥ 5 was the cut‐off value for predicting OLGIM stages III–IV, the area under the curve was 0.862, sensitivity was 81.9%, and specificity was 90.4%. The reduction in the carbon footprint by EGGIM was −0.4059 kg carbon dioxide equivalents per patient, equivalent to 1 mile driven by a gasoline‐powered car. The cost savings were calculated to be $47.36 per patient. Conclusions: EGGIM is a reliable method for identifying high‐risk gastric cancer patients, thereby reducing the carbon footprint and medical costs in endoscopy practice. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Squamous cell papilloma with elongated villous projections may occur in the hypopharynx and present with symptoms observable on physical examination. [ABSTRACT FROM AUTHOR]

Background and Aim: Small rectosigmoid colorectal polyps (<10 mm) are prevalent, with a low prevalence of advanced neoplastic lesions. The "diagnose‐and‐leave" strategy, employing narrow band imaging (NBI), is gaining popularity for its safety and cost‐effectiveness by reducing polypectomy complications and minimizing histopathology expenses. This study assessed the diagnostic efficacy of NBI with dual focus (DF) magnification for real‐time neoplastic prediction of rectosigmoid polyps and explored the feasibility of implementing this strategy in Vietnam. Methods: In a prospective single‐center study, 307 rectosigmoid polyps from 245 patients were analyzed using three consecutive endoscopic modes: white light endoscopy (WLE), NBI, and NBI‐DF. Endoscopists assessed polyps for size, location, macroscopic shape, optical diagnosis, and confidence levels before histopathological evaluation. High confidence was assigned when the polyp exhibited all features of a single histology type. Predictions were compared with final histopathology results. Results: Of the total, 237 (77.2%) were diminutive (≤5 mm) polyps, and 18 (5.8%) were advanced neoplastic lesions. WLE + NBI and WLE + NBI + NBI‐DF exhibited significantly higher accuracy compared to WLE (88.6% and 90.2% vs 74.2%, P < 0.01). For diminutive polyps, the DF mode significantly increased the rate of high‐confidence optical diagnoses (89.1% vs 94.9%, P < 0.001). WLE + NBI + NBI‐DF demonstrated high sensitivity (90.1%), specificity (95.5%), and negative predictive value (93.4%) in high‐confidence predictions, enabling the implementation of the "diagnose‐and‐leave" strategy. This approach would have reduced 58.2% of unnecessary polypectomies without missing any advanced neoplastic lesions. Conclusion: NBI and DF modes provide accurate neoplastic predictions for rectosigmoid polyps. For diminutive polyps, DF magnification improves the confidence level of the optical diagnosis, allowing the safe implementation of the "diagnose‐and‐leave" strategy. [ABSTRACT FROM AUTHOR]

Simple Summary: Esophageal carcinoma (EC) is a major cause of cancer deaths since it is first undetectable in its early stages. Narrow-band imaging (NBI) detects EC more accurately, sensitively, and specifically than white light imaging (WLI), according to many studies. This work uses a color space connected to décor to change WLIs into NBIs, improving early EC identification. The YOLOv5 algorithm was utilized to train WLI and NBI images separately, demonstrating the versatility of sophisticated object identification approaches in medical image analysis. Based on the confusion matrix and the trained model's precision, recall, specificity, accuracy, and F1-score, the model's performance was assessed. The model was trained to reliably identify dysplasia, squamous cell carcinoma (SCC), and polyps, demonstrating a detailed and focused examination of EC pathology for a better understanding. Dysplasia cancer, a pre-cancerous stage that may increase five-year survival, was detected with higher recall and accuracy by the NBI model. Although the NBI and WLI models recognized the polyp identically, the SCC category lowered its accuracy and recall rate. The NBI model had an accuracy of 0.60, 0.81, and 0.66 in dysplasia, SCC, and polyp categories, and recall rates of 0.40, 0.73, and 0.76. In dysplasia, SCC, and polyp categories, the WLI model was 0.56, 0.99, and 0.65 accurate. Additionally, it had recall rates of 0.39, 0.86, and 0.78 in the same categories. The NBI model performs poorly due to a small collection of training pictures. Increasing the dataset can improve performance. Esophageal carcinoma (EC) is a prominent contributor to cancer-related mortality since it lacks discernible features in its first phases. Multiple studies have shown that narrow-band imaging (NBI) has superior accuracy, sensitivity, and specificity in detecting EC compared to white light imaging (WLI). Thus, this study innovatively employs a color space linked to décor to transform WLIs into NBIs, offering a novel approach to enhance the detection capabilities of EC in its early stages. In this study a total of 3415 WLI along with the corresponding 3415 simulated NBI images were used for analysis combined with the YOLOv5 algorithm to train the WLI images and the NBI images individually showcasing the adaptability of advanced object detection techniques in the context of medical image analysis. The evaluation of the model's performance was based on the produced confusion matrix and five key metrics: precision, recall, specificity, accuracy, and F1-score of the trained model. The model underwent training to accurately identify three specific manifestations of EC, namely dysplasia, squamous cell carcinoma (SCC), and polyps demonstrates a nuanced and targeted analysis, addressing diverse aspects of EC pathology for a more comprehensive understanding. The NBI model effectively enhanced both its recall and accuracy rates in detecting dysplasia cancer, a pre-cancerous stage that might improve the overall five-year survival rate. Conversely, the SCC category decreased its accuracy and recall rate, although the NBI and WLI models performed similarly in recognizing the polyp. The NBI model demonstrated an accuracy of 0.60, 0.81, and 0.66 in the dysplasia, SCC, and polyp categories, respectively. Additionally, it attained a recall rate of 0.40, 0.73, and 0.76 in the same categories. The WLI model demonstrated an accuracy of 0.56, 0.99, and 0.65 in the dysplasia, SCC, and polyp categories, respectively. Additionally, it obtained a recall rate of 0.39, 0.86, and 0.78 in the same categories, respectively. The limited number of training photos is the reason for the suboptimal performance of the NBI model which can be improved by increasing the dataset. [ABSTRACT FROM AUTHOR]

The vascular and morphological features of tumors are important predictors of the nature, grade, and stage of various cancers. However, this association has not been tested in bladder cancer. The aim of our study was to investigate the correlation between the morphological characteristics of tumor vessels and the nature, stage and grade of bladder cancer. Between November 2021 and March 2023, we prospectively collated clinical information and cystoscopy information from a series of patients with bladder cancer. Univariate and multivariate logistic regression analysis were used to identify independent risk factors for the nature, grade and stage of bladder cancer. Our analysis showed that cauliflower-like tumors, dotted vessels, and circumferential vessels were independent risk factors for bladder cancer. Reticular vessels were an independent risk factor for high-grade bladder cancer. Thick branching vessels in bladder tumors, along with a wide base, were independent risk factors for the invasion of bladder cancer into the lamina propria. Primary diagnosis, lesion location (beside the left ureteral orifice) and obscure lesion boundaries were all identified as independent risk factors for muscle invasive bladder cancer. [ABSTRACT FROM AUTHOR]

We developed an imaging technique for inspecting the inside of coal-fired boilers during operation by using a visible-light camera, which has a higher spatial resolution and depth of field than mid-infrared image sensor camera systems commonly used for imaging the inside of boilers. Two main problems are associated with the use of a visible-light camera: the low light transmittance of combustion gases in the visible spectrum and the large non-stationary variations in intensity levels. To overcome these difficulties, a narrow-band imaging technique using a bandpass filter was employed to identify the wavelength range with the highest transmittance through gases. Contrast adjustment and noise reduction via conditional averaging of the temporal images were performed during post-image processing. Results obtained from the tests of several bandpass filters indicated that bandpass filtering centered at 650 ± 5 nm is optimal for obtaining clear images. Adaptive histogram equalization was found to be more effective for contrast enhancement than other standard methods. Additionally, a clearer image can be obtained by conditionally extracting and averaging temporal images with high Pearson product-moment correlation coefficient values for the average of all images. Finally, a clear image of the inner wall of a 1000-MW-class coal-fired boiler during operation is presented to demonstrate the feasibility of the proposed method. [ABSTRACT FROM AUTHOR]

Abstract Background and Aim Small rectosigmoid colorectal polyps (

Key Clinical Message Squamous cell papilloma with elongated villous projections may occur in the hypopharynx and present with symptoms observable on physical examination.

Abstract Cronkhite‐Canada syndrome (CCS) is a rare disease characterized by gastrointestinal polyposis, skin pigmentation, alopecia, and abnormal nailfolds. Although colorectal cancer has been reported in patients with CCS, reports are limited regarding the effectiveness of the usage of image‐enhanced endoscopy in CCS lesions. Here, we report a case of CCS in which narrow‐band imaging (NBI) magnifying endoscopy was applied to detect an adenomatous component in multiple hamartomatous polyps. A 79‐year‐old female complained of taste disorder, anorexia, and weight loss over several months. Endoscopic examination revealed multiple reddened polyps in the stomach and colon, leading to a diagnosis of CCS. Narrow‐band imaging magnification showed sparse and dilated round pits on the CCS polyps. Furthermore, 12 out of the numerous colorectal CCS polyps had a coexisting light reddish elevated component with a regular distribution of microvessels and a regular reticular pattern. This pattern satisfied the criteria for Type 2A of the Japan Narrow‐band‐imaging Expert Team classification, indicating adenoma. After resection, these twelve polyps were subject to pathological analysis, which confirmed they were all hamartomatous polyps with low‐grade adenoma on the superficial layer. Immunohistochemical analysis revealed a significant increase in the Ki‐67 index and p53 staining only in the adenomatous lesions. We conclude that narrow‐band imaging magnifying endoscopy would be useful in differentiating adenoma from CCS‐related polyps, which thereby facilitates early detection and treatment of precancerous lesions.

Abstract Objectives Endoscopic submucosal dissection (ESD) enables minimally invasive resection of superficial gastrointestinal neoplasms en bloc regardless of size. The Japan narrow band imaging expert team (JNET) classification utilizes optical magnification and narrow band imaging (NBI) to predict pathology. In North America, ESD is far from ubiquitous, and regional outcomes are not widely described. To date there are no North American studies describing the application and yield of the JNET classification as applied in the practice of ESD. Methods A retrospective, single‐center, cohort analysis was performed on a prospectively maintained database of ESD procedures. Between July 2016 and February 2023, all consecutive patients treated with ESD for colorectal lesions were identified and stratified by lesion location, JNET, NBI International Colorectal Endoscopic, lateral spreading tumors, and Paris classifications. Univariate analysis was used for clinicopathological data. p

Abstract Objectives This study aimed to extract endoscopic findings for diagnosing colorectal neoplasia associated with sessile serrated lesions (SSLs), which are of significant interest. Methods To compare the magnifying narrow‐band imaging (NBI) findings with microscopic morphology, we classified SSLs into two groups: Group A SSLs included the majority of uniform SSLs and any dysplasia other than that classified as group B SSLs. Group B SSLs included SSLs with intramucosal and invasive carcinoma. We also quantitatively assessed visible vessels using ImageJ software. Results This study included 47 patients with 50 group B SSLs who underwent endoscopic resection between 2012 and 2020. The results were retrospectively compared with those of 237 patients with 311 group A SSLs that underwent endoscopic resection. Using conventional white‐light endoscopy, significantly more group B SSLs had uneven shapes and some reddening compared to group A SSLs. The diagnostic odds ratios for group B SSLs were as follows: lesions with a diameter ≥10 mm, 9.76; uneven shape, 3.79; reddening, 15.46; and visible vessels with NBI, 11.32. Regarding visible vessels with NBI, the specificity and diagnostic accuracy for group B SSLs were 94.9% and 93.1%, respectively. The percentage of the vascular tonal area of NBI images was significantly larger for group B SSLs than for group A SSLs (3.97% vs. 0.29%; p < 0.01). Conclusions SSLs with reddening and/or a diameter ≥10 mm are suspected to contain cancerous components. Moreover, visible vessels observed using magnifying NBI can serve as objective indicators for diagnosing SSLs with cancerous components with a high degree of accuracy.

Background: Narrow-band imaging is an advanced endoscopic technology used to detect changes on the laryngeal tissue surface, employing a comparative approach alongside white-light endoscopy to facilitate histopathological examination. Objective: This study aimed to assess the utility and advantages of NBI (narrow-band imaging) in identifying malignant laryngeal lesions through a comparative analysis with histopathological examination. Methods: We conducted a systematic literature review, utilizing databases such as PubMed, the CNKI database, and Embase for our research. Results: We analyzed the articles by reviewing their titles and abstracts, selecting those we considered relevant based on determined criteria; in the final phase, we examined the relevant studies according to the specific eligibility criteria. Conclusions: Narrow-band imaging is an advanced endoscopic technology that demonstrates its efficacy as a tool for diagnosing malignant laryngeal lesions and comparing them to premalignant lesions. The European Society of Laryngology has implemented a standardized classification system for laryngeal lesions to enhance data correlation and organization.

AbstractThe vascular and morphological features of tumors are important predictors of the nature, grade, and stage of various cancers. However, this association has not been tested in bladder cancer. The aim of our study was to investigate the correlation between the morphological characteristics of tumor vessels and the nature, stage and grade of bladder cancer. Between November 2021 and March 2023, we prospectively collated clinical information and cystoscopy information from a series of patients with bladder cancer. Univariate and multivariate logistic regression analysis were used to identify independent risk factors for the nature, grade and stage of bladder cancer. Our analysis showed that cauliflower-like tumors, dotted vessels, and circumferential vessels were independent risk factors for bladder cancer. Reticular vessels were an independent risk factor for high-grade bladder cancer. Thick branching vessels in bladder tumors, along with a wide base, were independent risk factors for the invasion of bladder cancer into the lamina propria. Primary diagnosis, lesion location (beside the left ureteral orifice) and obscure lesion boundaries were all identified as independent risk factors for muscle invasive bladder cancer.

Background: This review aims to compare the efficacies of fluorescence cystoscopy, narrow-band imaging (NBI), and white light cystoscopy in the treatment and diagnosis of bladder cancer. Methods: The authors searched PubMed, EMbase, Web of Science, and the Cochrane Library from January 1990 to April 2022. A total of 26 randomized controlled studies and 22 prospective single-arm studies were selected. Most patients had nonmuscle-invasive bladder cancer. The study protocol has been registered at PROSPERO. Results: In the pairwise meta-analysis, 5-aminolevulinic acid (5-ALA) reduced the short-term and long-term recurrence rates of bladder cancer compared with white light cystoscopy (WLC); however, no statistical difference was observed in intermediate-term recurrence rates (RR=0.79, 95% CI: 0.57-1.09). Hexaminolevulinic acid and NBI reduced short-term, intermediate-term, and long-term recurrence rates. The sensitivity of 5-ALA, hexaminolevulinic acid, NBI, and WLC for bladder cancer were 0.89 (95% CI: 0.81-0.94), 0.96 (95% CI: 0.92-0.98), 0.96 (95% CI: 0.92-0.98), and 0.75 (95% CI: 0.70-0.79), respectively; however, only NBI had the same specificity as WLC (0.74 vs. 0.74). Compared with WLC, 5-ALA improved the detection rate of carcinoma in situ and Ta stage bladder cancer but had no advantage in T1 stage tumors (OR=2.39, 95% CI:0.79-7.19). Hexaminolevulinic acid and NBI improved the detection rates of all nonmuscular-invasive bladder cancers. In the network meta-analysis, there was no significant difference in either recurrence or detection rates between 5-ALA, hexaminolevulinic acid, and NBI. Conclusion: Fluorescence cystoscopy and NBI are advantageous for treating and diagnosing patients with nonmuscle-invasive bladder cancer. [ABSTRACT FROM AUTHOR]

Objective: Assessing whether the additional use of narrow‐band imaging (NBI) in transoral laser surgery (TOLS) for early laryngeal cancer improves clinical outcomes. Study Design: Randomized controlled trial, performed between September 2015 and November 2022. Setting: A tertiary referral hospital in The Netherlands. Methods: TOLS was carried out in 113 patients. The procedure was performed with white light imaging (WLI, n = 56) alone, or combined with NBI (n = 57). Patients received frequent follow‐up laryngoscopy. Resection margin status, recurrence rate, and recurrence‐free survival at 12 months, 18 months, and after study termination (maximum 86 months) were analyzed. Results: Thirty‐one cases in the WLI group had a positive resection margin, versus 16 in the NBI group (p =.002). After 12 months, the recurrence‐free survival was 92%: 87% for WLI versus 96% for NBI, p =.07. The recurrence rate was 7/56 (13%) for WLI, versus 2/57 (4%) for NBI, p =.09. After 18 months, the recurrence‐free survival was 84% for WLI versus 96% for NBI, p =.02. The recurrence rate was 9/56 (16%) for WLI, versus 2/57 (4%) for NBI, p =.02. After study termination, the recurrence‐free survival was 71% for WLI versus 83% for the NBI group (p =.08). The recurrence rate was 16/56 for WLI, versus 10/57 for NBI (p =.16). Conclusion: The additional use of NBI during TOLS significantly decreased the number of positive resection margins. Although not statistically significant at all time points, patients treated with NBI‐supported TOLS showed a lower recurrence rate and better recurrence‐free survival. Further studies in larger patient groups are needed to confirm these results. [ABSTRACT FROM AUTHOR]

Abstract Objective To explore whether narrow‐band imaging (NBI) endoscopy is accurate in the diagnosis of malignant transformation of vocal cord leukoplakia. Methods The PubMed, Embase, Cochrane Library and Web of Science databases were searched to collect data on studies reporting the use of NBI endoscopy as a diagnostic test for diagnosing vocal cord leukoplakia from January 2015 to December 2021. Study design, analysis method, and extraction results were performed according to the PRISMA guidelines. The sensitivity, specificity, pooled positive likelihood ratio (PLR), negative likelihood ratio (NLR) and area under the curve (AUC) were used to summarize the performance metrics of the meta‐analysis. Risk of bias data and the quality of the included studies was evaluated according to the Quality Assessment of Diagnostic Accuracy Studies‐2 tool (QUADAS‐2). Results Nine studies were finally included in the analysis. The results of the meta‐analysis showed that the pooled sensitivity and specificity of NBI endoscopy for diagnosing leukoplakia lesions were 0.76 (95% CI: 0.72–0.8) and 0.93 (95% CI: 0.91–0.95), respectively. The PLR and NLR were 10.09 (95% CI: 6.53–15.59) and 0.22 (95% CI: 0.13–0.38), respectively. The comprehensive diagnostic odds ratio (DOR) was 54.96 (95% CI: 24.32–124.17), and the area under the curve was 0.9584. The eight articles had a low risk of bias risk and one article was unclear. Conclusion NBI likely has good accuracy for diagnosing malignant transformation of vocal cord leukoplakia. However, multicenter studies and large samples are still needed.

Esophageal carcinoma is the sixth-leading cause of cancer death worldwide. A precursor to esophageal adenocarcinoma (EAC) is Barrett’s Esophagus (BE). Early-stage diagnosis and treatment of esophageal neoplasia (Barrett’s with high-grade dysplasia/intramucosal cancer) increase the five-year survival rate from 10% to 98%. BE is a global challenge; however, current endoscopes for early BE detection are costly and require extensive infrastructure for patient examination and sedation. We describe the design and evaluation of the first prototype of ScanCap, a high-resolution optical endoscopy system with a reusable, low-cost tethered capsule, designed to provide high-definition, blue-green illumination imaging for the early detection of BE in unsedated patients. The tethered capsule (12.8 mm diameter, 35.5 mm length) contains a color camera and rotating mirror and is designed to be swallowed; images are collected as the capsule is retracted manually via the tether. The tether provides electrical power and illumination at wavelengths of 415 nm and 565 nm and transmits data from the camera to a tablet. The ScanCap prototype capsule was used to image the oral mucosa in normal volunteers and ex vivo esophageal resections; images were compared to those obtained using an Olympus CV-180 endoscope. Images of superficial capillaries in intact oral mucosa were clearly visible in ScanCap images. Diagnostically relevant features of BE, including irregular Z-lines, distorted mucosa, and dilated vasculature, were clearly visible in ScanCap images of ex vivo esophageal specimens.

Gastric reactive hyperplasia (RH) is a common benign lesion of the gastric mucosa that can be resolved by conservative treatment without endoscopic intervention. Some RH lesions are indistinguishable from low-grade intraepithelial neoplasia (LGIN) lesions of gastric mucosa under endoscopy. The aim of this study was to investigate the morphological features of RH lesions under magnifying endoscopy combined with narrow-band imaging (ME-NBI). A retrospective study of 653 patients with superficial suspicious lesions of gastric mucosa was performed. According to the pathological results of biopsies, the final included lesions were divided into the RH group (n = 88) and LGIN group (n = 138). We analysed the microvascular and microsurface patterns of these lesions under ME-NBI, extracted the most significant combination of endoscopic features of RH lesions, and evaluated their diagnostic performance. ME-NBI characteristics that could distinguish RH lesions from LGIN lesions after univariate analysis were included in multivariate logistic regression. The results showed that ten characteristics, including intervening part (IP) length homogeneity, type III gastric pit pattern and homogeneity of marginal crypt epithelium (MCE), were statistically significant. Receiver operating characteristic (ROC) analysis showed that the triad of these features was the best combination for diagnosing RH lesions with an AUC of 0.886 (95% confidence interval; 0.842–0.929), the sensitivity of 85.5% and specificity of 79.5%. The triad of IP length homogeneity, type III pit pattern and MCE homogeneity under ME-NBI helps endoscopists to identify gastric RH lesions, thereby avoiding unnecessary biopsy and repeat endoscopy due to misjudgment of neoplastic lesions. [ABSTRACT FROM AUTHOR]

Background: Sessile serrated lesions (SSLs) are precursors of colon cancer, especially in cases of large, right colon. However, they are difficult to not only detect, but only clarify the margin of the lesion, which can lead to the poor endoscopic treatment outcomes. Aims: This study evaluated the usefulness of acetic acid spray with narrow-band imaging (A-NBI) for the better visualization of the margin of SSLs. Methods: From January 2013 to March 2022, patients with superficial elevated polyps suspected of being SSLs ≥ 10 mm with an endoscopic diagnosis that had been endoscopically resected at Hiroshima City Hiroshima Citizens Hospital were enrolled. Endoscopic images with white-light imaging (WLI), narrow-band imaging (NBI), indigo-carmine (IC), and A-NBI were recorded in each lesion and were randomly arranged and assessed by 10 endoscopists. We compared the visibility score (1 to 4) and color differences (ΔE) between inside and outside of the lesions among WLI, NBI, IC, and A-NBI. Results: Forty-one lesions in 33 cases were included, and a total of 164 images were evaluated. As for the visibility score, most of the lesions were scored as 1 or 2 on WLI, whereas most were scored 4 on A-NBI. The median ΔE of A-NBI was also significantly higher than that of WLI, NBI, or IC (20.5 vs. 8.3 vs. 8.2 vs. 12.3, P < 0.01). A significant correlation was observed between the color difference and visibility score (r = 0.53, P < 0.01). Conclusions: A-NBI may be a useful modality for identifying the margin of SSLs. [ABSTRACT FROM AUTHOR]

Objectives: Gastric signet ring cell carcinoma is a rare and highly malignant adenocarcinoma, which is characterized by early metastasis, rapid progression and poor prognosis. Several studies have shown that early-stage gastric signet ring cell carcinoma may have equal or better prognosis than other types of gastric cancer. However, most of the early-stage lesions are difficult to detect by endoscopy. We aim to illustrate the difficulty of early detection of gastric signet ring cell carcinoma with mucosal atrophy. Methods: The endoscopic and pathological features of two female cases were analyzed by upper gastrointestinal white light endoscopy combined with narrow-band imaging and endoscopic biopsy. Results: Two female cases were diagnosed with early-stage gastric signet ring cell carcinoma with atrophic background mucosa occurring in the middle and lower part of the stomach. Both lesions less than 2.0 cm in diameter were surgically removed and identified as intramucosal adenocarcinoma. Conclusion: We can roughly identify the demarcation of the lesion by combining white light endoscopy and narrow-band imaging, and slightly irregular microsurface and microvascular pattern of the lesion were found via magnifying endoscopic observation, but the demarcation can hardly be accurately identified. [ABSTRACT FROM AUTHOR]

Objective To evaluate the value of narrow-band imaging (NBI) laryngoscopy combined with laryngopharyngeal reflux scale in the diagnosis of laryngeal malignant tumors and precancerous lesions. Methods A cross-sectional study was conducted on 96 patients (87 males and 9 females) with suspected laryngeal cancer or precancerous lesions under white light laryngoscope from December 2021 to April 2022. All patients were examined and compared with under white light mode and NBI mode of laryngoscopy as well as scored with reflux sign scale (reflux finding score, RFS). The reflux symptom index (RSI) scale was scored under the guidance of the same professional physician. White light mode, NBI mode, white light mode combined with throat reflux scale and NBI mode combined with throat reflux scale were used to evaluate the benign and malignant lesions. The pathological results of biopsy or operation were confirmed and regarded as diagnostic criteria. The accuracy, sensitivity and specificity in white light mode, NBI mode, white light mode combined RSI, and NBI mode combined RSI were compared, and the diagnostic effectiveness of the 4 Methods were analyzed and compared using receiver operating characteristic (ROC) pairing analysis and ROC curve analysis. Results Among the 96 patients, 20 cases were benign lesions, 33 cases were precancerous lesions and 43 cases were malignant lesions. The accuracy, sensitivity, and specificity was 71.88%, 60.47% and 81.13%, respectively, for the white light mode; was 92.71%, 90.70% and 94.34%, respectively in the NBI mode, was 83.33%, 81.40% and 84.91%, respectively, for white light mode combined with RSI; and was 92.71%, 95.35% and 90.57%, respectively for NBI mode combined with RSI. The average score of RFS corresponding to the 3 pathological grades (benign, precancerous and malignant lesions) were 4.20±0.68, 5.85±2.32 and 9.49±2.56 in white light mode, 4.50±0.92, 6.70±2.67 and 10.77±2.18 in NBI mode, and the score of RSI was 9.10±1.77, 10.88±2.22 and 12.40±2.86, respectively. The average score of RFS of NBI classification I-Vc were 4.31±0.61, 4.67±1.25, 6.23±3.07, 7.27±2.26, 10.16±2.68, 11.06±2.07 and 11.33±1.70, respectively. The average score of RSI was 9.08±1.59, 9.50±1.89, 10.15±2.32, 11.73±2.72, 12.21±2.67, 12.53±3.17 and 15.33±3.70, respectively. The accuracy, sensitivity and specificity of NBI mode were significantly higher than those of white light mode (P < 0.05); And so were white light model combined with laryngopharyngeal reflux scale than white light model (P < 0.05), but there was no statistical difference in specificity; There were no statistical differences in accuracy, sensitivity and specificity between NBI model and laryngopharyngeal reflux scale. The AUC difference between white light model and NBI, white light model and white light model combined with laryngeal reflux scale were -0.094 (95%CI: -0.167~-0.020) and -0.111 (95%CI: -0.178~-0.044), respectively (P < 0.05), which were statistically significant. Conclusion The diagnostic value of NBI model and white light model combined with laryngeal reflux scale is higher than that of white light model in laryngeal carcinoma and precancerous lesions.

White light imaging (WLI) is the most common endoscopic technique used for screening of gastrointestinal diseases. However, despite the advent of a new processor that offers sufficient clear illumination and other advanced developments in endoscopic instrumentation, WLI alone is inadequate for detecting all gastrointestinal diseases with abnormalities in mucosal discoloration and morphological changes to the mucosal surface. The recent development of image-enhanced endoscopy (IEE) has dramatically improved the detection of gastrointestinal diseases. Texture and colour enhancement imaging (TXI) is a new type of IEE that enhances brightness, surface irregularities, such as elevations or depressions, and subtle colour changes. TXI with two modes, namely modes 1 and 2, can selectively enhance brightness in dark areas of an endoscopic image and subtle tissue differences such as slight morphological or colour changes while simultaneously preventing over-enhancement. Several clinical studies have investigated the efficacy of TXI for detecting and visualizing gastrointestinal diseases, including oesophageal squamous cell carcinoma (ESCC), Barret’s epithelium, gastric cancer, gastric mucosal atrophy and intestinal metaplasia. Although TXI is often more useful for detecting and visualizing gastrointestinal diseases than WLI, it remains unclear whether TXI outperforms other IEEs, such as narrow-band imaging (NBI), in similar functions, and whether the performance of TXI modes 1 and 2 are comparable. Therefore, large-scale prospective studies are needed to compare the efficacy of TXI to WLI and other IEEs for endoscopic evaluation of patients undergoing screening endoscopy. Here, we review the characteristics and efficacy of TXI for the detection and visualization of gastrointestinal diseases.Key MessagesTXI mode 1 can improve the visibility of gastrointestinal diseases and qualitative diagnosis, especially for diseases associated with colour changes.The enhancement of texture and brightness with TXI mode 2 enables the detection of diseases, and is ideal for use in the first screening of gastrointestinal tract.

Background A new image-enhanced endoscopy method called texture and colour enhancement imaging (TXI) enhances brightness, surface irregularities, and subtle colour changes in endoscopic images. However, it is unclear whether TXI and narrow-band imaging (NBI) with third-generation high-vision transnasal ultrathin endoscopy are advantageous over white-light imaging (WLI) for detecting atrophy, intestinal metaplasia, map-like redness and gastric cancer. We investigated to compare the endoscopic efficacy for evaluation of gastritis between TXI and NBI with high-vision transnasal endoscopy and clarified the endoscopic efficacy of TXI and NBI compared to WLI.Methods We enrolled 60 patients who underwent high-vision transnasal endoscopy as part of a health check-up from March to November 2021 and randomized patients into two groups (the WLI-NBI group and the WLI-TXI group) using the minimization method based on Helicobacter pylori infection status, age and sex. Colour differences determined using the International Commission on Illumination 1976 (L∗, a∗, b∗) colour space was compared between WLI and TXI or NBI.Results No significant differences were observed in colour differences surrounding atrophy, intestinal metaplasia and map-like redness between NBI and TXI (p = .553, .057 and .703, respectively). Endoscopic scores based on the Kyoto classification of gastritis for atrophy, intestinal metaplasia, and map-like redness were similar between WLI and TXI. In contrast, NBI identified intestinal metaplasia at a significantly greater rate than WLI (p = .018). Further, colour differences surrounding atrophy and intestinal metaplasia on TXI and NBI were significantly greater than those on WLI (atrophy: TXI vs WLI p = .003, NBI vs WLI p

Duodenal neuroendocrine tumors (NETs) are rare subepithelial tumors that arise from the neuroendocrine cells beneath the epithelial layer. However, an accurate histopathological diagnosis is difficult when tissue samples are obtained using conventional endoscopic forceps biopsy alone. This study aimed to evaluate the magnifying endoscopy with narrow-band imaging (ME-NBI) findings of duodenal NETs. We retrospectively analyzed a database of 22 duodenal NETs from 21 patients who underwent ME-NBI between January 2011 and June 2022. The ME-NBI, endosonographic, and histopathologic findings of duodenal NETs were analyzed. Nineteen lesions were located in the bulb, two were located in the superior duodenal angle, and one was located in the second portion of the duodenum. Eighteen lesions (82%) had IIa morphology, and nine (41%) had central depression on the surface. On endoscopic ultrasonography, almost all lesions (20/22, 91%) were located in the second and/or third layers, and the median tumor size was 6 mm. During ME-NBI, the microsurface pattern was regular in 18 lesions (82%) and absent in 4 (18%). The microvascular pattern was regular in 17 lesions (77%), irregular in 4 (18%), and absent in 1 (5%). Thickened subepithelial vessels were observed in 15 (68%) lesions. There was no difference in tumor size according to the presence or absence of thickened subepithelial vessels (6.1 ± 1.8 mm vs. 5.9 ± 3.8 mm, p = 0.860). In conclusion, the characteristic ME-NBI findings of duodenal NETs were regular microsurface and microvascular patterns and the presence of thickened subepithelial vessels. These ME-NBI features may be useful for differentiating duodenal NETs from other duodenal subepithelial lesions. [ABSTRACT FROM AUTHOR]

Purpose: Otoendoscopy represents the initial non-invasive diagnostic cornerstone for external and middle ear disorders. Recently, new techniques of enhanced imaging such as narrow-band imaging (NBI) have been introduced but their role as a potential aid in otological practice remains unproven. In this pictorial review, we want to present the potential application of this endoscopic method, highlight its limitations, and give some hints regarding its future implementation. Methods: Representative cases of external and/or middle ear pathologies were selected to illustrate the role of NBI in this regard. Results: NBI may represent a useful aid in the otological work-up, in the differential diagnosis of ear tumor-like masses, and, possibly, in the prognosis of tympanic perforations. For other ear disorders, instead, this technique does not seem to add anything to the standard clinical practice. Conclusions: NBI might prove useful in the assessment of selected external and middle ear disorders but its role must be prospectively validated. [ABSTRACT FROM AUTHOR]

Objective: To explore whether narrow‐band imaging (NBI) endoscopy is accurate in the diagnosis of malignant transformation of vocal cord leukoplakia. Methods: The PubMed, Embase, Cochrane Library and Web of Science databases were searched to collect data on studies reporting the use of NBI endoscopy as a diagnostic test for diagnosing vocal cord leukoplakia from January 2015 to December 2021. Study design, analysis method, and extraction results were performed according to the PRISMA guidelines. The sensitivity, specificity, pooled positive likelihood ratio (PLR), negative likelihood ratio (NLR) and area under the curve (AUC) were used to summarize the performance metrics of the meta‐analysis. Risk of bias data and the quality of the included studies was evaluated according to the Quality Assessment of Diagnostic Accuracy Studies‐2 tool (QUADAS‐2). Results: Nine studies were finally included in the analysis. The results of the meta‐analysis showed that the pooled sensitivity and specificity of NBI endoscopy for diagnosing leukoplakia lesions were 0.76 (95% CI: 0.72–0.8) and 0.93 (95% CI: 0.91–0.95), respectively. The PLR and NLR were 10.09 (95% CI: 6.53–15.59) and 0.22 (95% CI: 0.13–0.38), respectively. The comprehensive diagnostic odds ratio (DOR) was 54.96 (95% CI: 24.32–124.17), and the area under the curve was 0.9584. The eight articles had a low risk of bias risk and one article was unclear. Conclusion: NBI likely has good accuracy for diagnosing malignant transformation of vocal cord leukoplakia. However, multicenter studies and large samples are still needed. [ABSTRACT FROM AUTHOR]

Objective: Narrow‐band imaging (NBI), which highlights epithelial intrapapillary capillary loops (IPCLs) classified into five patterns (0 toIV) with increasing correlation to malignancy, has demonstrated effectiveness for detection of oral squamous cell carcinoma (OSCC). Lack of standardised procedures limits its use for routine inspection of oral lichenoid lesions including oral lichen planus (OLP), oral lichenoid lesion (OLL) and oral lichenoid reaction (OLR). The aim of this study was to analyse IPCL patterns of such lesions, assessing correlations with histopathological outcomes. Materials and Methods: A multicentre, retrospective study was performed on 84 patients who underwent NBI and subsequent biopsy for suspected OLP/OLL/OLR. Patients were examined with Evis Exera III NBI system. Recorded NBI video endoscopies were evaluated to assess IPCL patterns and correlated with histopathological outcomes. Results: No significant differences were detected among OLP/OLL/OLR on NBI inspection. All lichenoid lesions were significantly related to low‐grade (0‐II) IPCL patterns, clearly distinguishable from OSCC, showing pattern IV (p < 0.05). Conclusions: NBI cannot discern among OLP/OLL/OLR lesions. Interpretation should be modulated when assessing lichenoid lesions. NBI has potential to discern malignant transformation occurring in lichenoid lesions undergoing long‐term follow‐up, as IPCL pattern IV may be used as a clinical marker of malignancy arising in chronic inflammatory lesions. [ABSTRACT FROM AUTHOR]

The aim of the study was comparing the diagnostic role of the white light (WL) endoscopy, video laryngostroboscopy (VLS), and narrow-band imaging (NBI) in the evaluation of the benign vocal fold lesions. From March 2018 to June 2019, a total of 118 cases were enrolled in this study. Ninety-eight patients were suspected with vocal fold nodules, cysts, polyps, and sulcus vocalis and 20 patients without a history of dysphonia. Each patient was examined by WL, VLS, and NBI endoscopy. Recorded images and videos were analyzed and scored by three otorhinolaryngologists who had at least 3 years of experience in phoniatrics field. The evaluation results were compared between the methods and the physicians. A total of 118 cases were grouped by their confirmed diagnosis, vocal fold nodules (n = 28), vocal fold cyst (n = 24), vocal fold polyp (n = 9), and sulcus vocalis (n = 37). When the correct diagnosis rates of the physicians were compared, the statistical significance was found between the physicians in the WL and VLS method (P = 0.014, P = 0.027). No statistically significant difference was found among physicians in NBI method (P = 0.368). The difference between the diagnostic methods was found to be statistically significant in reaching the accurate diagnosis for benign vocal fold lesions (P < 0.001). While the difference between NBI-WL and VLS-WL was statistically significant (P < 0.001 and P < 0.001). The difference between NBI-VLS was not statistically significant while evaluating the vocal fold nodules, cysts, and sulcus vocalis separately (P = 0.102, P = 0.026, P = 0.157). Otherwise, it was statistically significant (P = 0.002) while evaluating total benign lesions in the study. The difference between NBI-VLS combination and VLS, NBI-VLS combination and VLS-WL combination were statistically significant (P < 0.001 and P = 0.001). This study showed that NBI assessments have similar accuracy and sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) to VLS and have a higher value than WL endoscopy in reaching the diagnosis for benign vocal fold lesions. Therefore, NBI can be accepted as a promising approach to identify benign laryngeal lesions due to its optical properties. [ABSTRACT FROM AUTHOR]

Objective: To analyse the effectiveness of narrow-band imaging in determining the severity of inflammation in ulcerative colitis patients in relation to histological activity. Method: The cross-sectional study was conducted at Kafrelsheikh University Hospital, Egypt, from June 2021 to May 2022, and comprised patients regardless of age and gender who had ulcerative colitis and visited the endoscopy unit. After taking detailed history, the patients were subjected to physical examination and laboratory tests which included complete blood count, international normalised ratio, erythrocyte sedimentation rate and faecal calprotectin. Colonoscopy with narrow-band imaging, biopsy and histopathological assessment were done as part of clinical evaluation. Data was analysed using SPSS 20. Result: Of the 100 patients, 55(55%) were male and 45(45%) were females. The overall mean age was 33.72±10.29 years (range: 11-56 years). There were 73(73%) patients who were married, 12(12%) had positive family history and 19(19%) were smokers. Besides, 18(18%) patients received biological therapy. There was significant positive correlation between histopathological and endoscopic scores (p

Abstract A 61‐year‐old Helicobacter pylori‐positive female with gastroesophageal reflux disease has undergone surveillance endoscopy every year for 13 years at Tokyo Medical University Hospital. At the first surveillance in 2009, conventional white light endoscopy showed a 10‐mm whitish slightly depressed lesion at the lesser curvature of the gastric cardia. This lesion gradually increased in size to 15 mm over the 13‐year observational period. Indigo carmine chromoendoscopy, narrow band imaging, and texture and color enhancement imaging in both mode 1 and mode 2 clearly emphasized the presence of a depressed whitish mucosa around the gastric mucosa compared with white light imaging. None of the three image‐enhanced endoscopy techniques showed any abnormality in the vascular or structural pattern. Pathological findings showed squamous epithelium without atypia and revealed no evidence of malignancy in the stomach. We thus report a case of gastric squamous metaplasia without gastric neoplastic lesion in the gastric cardia whose lesions were endoscopically observed to change the size for more than 10 years and whose lesions were endoscopically evaluated with a texture and color enhancement imaging mode 1 and mode 2 and narrow band imaging.