Alessia Aloisi1, Yukio Sonoda1, Ginger J Gardner1, Kay J Park2, Sarah L Elliott3, Qin C Zhou4, Alexia Iasonos4, Nadeem R Abu-Rustum5. 1. Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA. 2. Pathology Department, Memorial Sloan Kettering Cancer Center, New York, NY, USA. 3. Department of Obstetrics and Gynecology, Stamford Hospital, Stamford, CT, USA. 4. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA. 5. Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA. abu-rusn@mskcc.org.
Abstract
BACKGROUND: Narrow band imaging (NBI) is an optic filtration enhancement for endoscopy that uses two wavelengths of light (415 and 540 nm) to highlight superficial microvascular patterns. It has been successfully utilized to improve identification of lesions with abnormal vasculature, which is associated with endometriosis and endometrial cancer. Case studies suggest it may also facilitate surgical staging of gynecologic cancer, which is critical in determining appropriate adjuvant therapies. A technology that enhances the ability to identify metastatic disease during minimally invasive surgery (MIS) could make an important difference in patient outcomes. METHODS: A prospective comparative study was conducted to evaluate patients with clinical indication for diagnostic or operative laparoscopy. All received white light imaging followed by NBI during the same procedure. Suspicious lesions were examined and photographed, using both modalities, before excision. The two techniques were compared. Positive predictive value, negative predictive value, and diagnostic accuracy in identifying histologically confirmed metastatic lesions were assessed, using appropriate statistical methods. RESULTS: Of 124 patients enrolled in the study, 94 were evaluable; 30 did not undergo MIS and were therefore excluded. A significantly higher number of peritoneal abnormalities were identified with NBI versus white light imaging (P = 0.0239). However, no statistically significant difference (P = 0.18, patient level) was observed in identification of histologically confirmed metastatic disease. CONCLUSIONS: NBI imaging provides a unique contrast between peritoneal surface and microvascular patterns. However, the results of this study suggest that NBI-enhanced laparoscopy does not provide superior detection of peritoneal surface malignancy compared with standard white light high-definition laparoscopy.
BACKGROUND: Narrow band imaging (NBI) is an optic filtration enhancement for endoscopy that uses two wavelengths of light (415 and 540 nm) to highlight superficial microvascular patterns. It has been successfully utilized to improve identification of lesions with abnormal vasculature, which is associated with endometriosis and endometrial cancer. Case studies suggest it may also facilitate surgical staging of gynecologic cancer, which is critical in determining appropriate adjuvant therapies. A technology that enhances the ability to identify metastatic disease during minimally invasive surgery (MIS) could make an important difference in patient outcomes. METHODS: A prospective comparative study was conducted to evaluate patients with clinical indication for diagnostic or operative laparoscopy. All received white light imaging followed by NBI during the same procedure. Suspicious lesions were examined and photographed, using both modalities, before excision. The two techniques were compared. Positive predictive value, negative predictive value, and diagnostic accuracy in identifying histologically confirmed metastatic lesions were assessed, using appropriate statistical methods. RESULTS: Of 124 patients enrolled in the study, 94 were evaluable; 30 did not undergo MIS and were therefore excluded. A significantly higher number of peritoneal abnormalities were identified with NBI versus white light imaging (P = 0.0239). However, no statistically significant difference (P = 0.18, patient level) was observed in identification of histologically confirmed metastatic disease. CONCLUSIONS: NBI imaging provides a unique contrast between peritoneal surface and microvascular patterns. However, the results of this study suggest that NBI-enhanced laparoscopy does not provide superior detection of peritoneal surface malignancy compared with standard white light high-definition laparoscopy.
Authors: Mustafa Ozturk; Mustafa Ulubay; Ibrahim Alanbay; Uğur Keskin; Emre Karasahin; Müfit Cemal Yenen Journal: J Obstet Gynaecol Res Date: 2015-10-13 Impact factor: 1.730
Authors: Thomas Schnelldorfer; Roger L Jenkins; Desmond H Birkett; Valena J Wright; Lori Lyn Price; Irene Georgakoudi Journal: Surg Endosc Date: 2015-07-21 Impact factor: 4.584