Efficacy of Transnasal Flexible Videoendoscopy With Narrow Band Imaging for Follow-Up of Patients After Transoral Laser Cordectomy.

BACKGROUND AND OBJECTIVES: Transoral laser surgery is the optimal surgical treatment modality for the early stages of glottic cancer. To allow for further treatment to be as effective and as minimal as possible, persistent or recurrent tumors should be detected very soon. The main aim is to minimize the risk of necessity of performing a total laryngectomy. Flexible videoendoscopy with narrow band imaging (NBI) was recommended by the European Laryngological Society as a diagnostic method for the follow-up of patients treated for laryngeal cancer. Nevertheless, the efficacy of this technique has not been extensively studied in patients after transoral laser cordectomies for vocal fold cancer. The aim of this study was to evaluate the efficacy of in-office transnasal NBI flexible videoendoscopy in the follow-up of patients after transoral laser cordectomy for glottic cancer. We also focused on describing the specific characteristics of recurrent tumor appearance. MATERIALS AND METHODS: The presented study was conceived as a prospective study. Ninety-four consecutive patients who underwent transoral laser cordectomy for severe dysplasia, Tis, T1, and T2 glottic cancer in the period from June 2010 to August 2015 were enrolled in the study. All patients were postoperatively regularly followed using transnasal videoendoscopic examinations with NBI. Whenever a suspect lesion was identified during in-office examination, its nature was proven histologically. RESULTS: We discovered 23 suspect findings in 21 patients by means of flexible videoendoscopy with NBI. Fifteen (65.2%) of them were histologically confirmed as recurrent tumors, whereas in 8 (34.8%) of them, the recurrent tumor was not proven. In two patients, the recurrent tumor was evident on computed tomography or magnetic resonance imaging, but NBI endoscopy did not reveal relapsing disease. The rest (71 patients) were considered true negative. Of the 15 recurrent tumors detected by NBI-coupled videoendoscopy, 8 (53.3%) were identified as submucosal masses with nonsignificant or no vascular changes, 4 (26.7%) were noted as the progression of leukoplakia without visible vascular changes, only 2 (13.3%) showed typical vascular changes, and, in 1 (6.7%) case, evident, significantly exophytic tumor with pathological vascularization was discovered. The sensitivity, specificity, and positive and negative predictive values of the in-office transnasal videolaryngoscopy with NBI were calculated to be 88%, 92%, 71%, and 97%, respectively. CONCLUSIONS: The results of the study demonstrate that transnasal endoscopy with NBI in an outpatient setting is an excellent method for the follow-up of patients after transoral laser cordectomy for glottic cancer. The method achieves high sensitivity, specificity, and negative predictive value and a slightly low positive predictive value. Nevertheless, we must bear in mind that recurrent tumors after previous endoscopic resection may have a completely different appearance than new tumors originating from previously untreated tissues. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.

[Endoscopic optical imaging methods in the diagnostics of the laryngeal cancer]. / Endoskopické optické zobrazovací metody v diagnostice nádoru hrtanu.

Endoscopic optical imaging methods for the detection of mucosal lesions in the ENT area have been developed for better and earlier detection of these changes. They can be divided into horizontal methods group - showing the surface of the mucous membrane (autofluorescence, photodynamic diagnosis, Narrow Band Imaging, magnifying and contact endoscopy) and vertical methods group - visualizing different layers of the mucosa (optical coherence tomography and confocal endomicroscopy). Some of them are routinely used in practice, others are used in experimental mode and their introduction into practice may be a matter of the near future. The authors present a comprehensive overview of available endoscopic optical imaging methods.

Analysis of the integration of human papillomaviruses in head and neck tumours in relation to patients' prognosis.

Integration, which leads to the disruption of the circular HPV genome, is considered as a critical, albeit not obligatory, step in carcinogenic progression. Although cervical carcinomas with extrachromosomal HPV plasmid genomes have been described, the virus is integrated in 70% of HPV16-positive cervical tumours. Limited information is available about HPV integration in head and neck tumours (HNC). In this study, we have characterised the physical status of HPV in a set of tonsillar tumour samples using different methods--the mapping of E2 integration breakpoint at the mRNA level, the 3' RACE based Amplification of Papillomavirus Oncogene Transcripts (APOT) assay and Southern blot. Furthermore, the impact of HPV integration on patients' prognosis has been evaluated in a larger set of 186 patients with head and neck cancer. Based on the analysis of E2 mRNA, HPV was integrated in the host genome in 43% of the HPV-positive samples. Extrachromosomal or mixed form was present in 57%. In fresh frozen samples, the APOT and E2 mapping results were in agreement. The results were confirmed using Southern blotting. Furthermore, the type and exact site of integration were determined. The survival analysis of 186 patients revealed HPV positivity, tumour size and lymph node positivity as factors that influence disease specific survival. However, no statistically significant difference was found in disease specific survival between patients with HPV-positive integrated vs. extrachromosomal/mixed forms of the virus.

Distinct patterns of intratumoral immune cell infiltrates in patients with HPV-associated compared to non-virally induced head and neck squamous cell carcinoma.

Human papillomavirus (HPV) infection is one of the most important etiologic causes of oropharyngeal head and neck squamous cell carcinoma (HNSCC). Patients with HPV-positive HNSCC were reported to have a better clinical outcome than patients with HPV-negative cancers. However, little is known about the possible causes of different clinical outcomes. In this study, we analyzed a detailed immune profile of tumor samples from HNSCC patients with respect to their HPV status. We analyzed the characteristics of immune cell infiltrates, including the frequency and distribution of antigen-presenting cells and naïve, regulatory and effector T cells and the cytokine and chemokine levels in tumor tissue. There was a profound difference in the extent and characteristics of intratumoral immune cell infiltrates in HNSCC patients based on their HPV status. In contrast to HPV-negative tumor tissues, HPV-positive tumor samples showed significantly higher numbers of infiltrating IFNγ+ CD8+ T lymphocytes, IL-17+ CD8+ T lymphocytes, myeloid dendritic cells and proinflammatory chemokines. Furthermore, HPV-positive tumors had significantly lower expression of Cox-2 mRNA and higher expression of PD1 mRNA compared to HPV-negative tumors. The presence of a high level of intratumoral immune cell infiltrates might play a crucial role in the significantly better response of HPV-positive patients to standard therapy and their favorable clinical outcome. Furthermore, characterization of the HNSCC immune profile might be a valuable prognostic tool in addition to HPV status and might help identify novel targets for therapeutic strategies, including cancer immunotherapy.

The role of narrow band imaging in the detection of recurrent laryngeal and hypopharyngeal cancer after curative radiotherapy.

Narrow band imaging is considered a significant improvement in the possibility of detecting early mucosal lesion of the upper aerodigestive tract. Early detection of mucosal neoplastic lesions is of utmost importance for patients survival. There is evidence that, especially in patients previously treated by means of curative radiotherapy or chemoradiotherapy, the early detection rate of recurrent disease is quite low. The aim of this study was to prove whether the videoendoscopy coupled with NBI might help detect recurrent or secondary tumors of the upper aerodigestive tract. 66 patients previously treated by means of RT or CRT with curative intent were enrolled in the study. All patients underwent transnasal flexible videoendoscopy with NBI mode under local anesthesia. When a suspicious lesion was identified in an ambulatory setting, its nature was proved histologically. Many of these changes were not identifiable by means of conventional white light (WL) endoscopy. The accuracy, sensitivity, specificity, and positive and negative predictive value of the method are very high (88%, 92%, 76%, 96%, and 91%, resp.). Results demonstrate that outpatient transnasal endoscopy with NBI is an excellent method for the follow-up of patients with carcinomas of the larynx and the hypopharynx primarily treated with radiotherapy.

The role of NBI HDTV magnifying endoscopy in the prehistologic diagnosis of laryngeal papillomatosis and spinocellular cancer.

Narrow band imaging (NBI) HDTV (high definition television) magnifying endoscopy is considered to be superior for the accurate display of the microvascular patterns of superficial mucosal lesions. Observation of changes in intraepithelial papillary capillary loops (IPCL) can help distinguish benign from malignant lesions as part of an "optical biopsy." However, IPCL changes in papillomas may be mistaken for spinocellular cancer (SCC). The aim of the study was to determine whether observing microvascular changes alone is sufficient for discriminating between laryngeal SCC and papillomatosis. An additional aim was to identify associated characteristics that could clarify the diagnosis. The study included 109 patients with a suspected laryngeal tumor or papilloma. HDTV NBI magnifying endoscopy was performed during direct laryngoscopy. It was possible to visualize IPCL changes in 82 out of 109 patients (75.2%). In 71 (86.6%) patients, the diagnosis was correctly determined. In 4 (4.9%) cases, the diagnosis of SCC was expressed on the basis of finding pathologic IPCL, but histology did not demonstrate malignancy. To achieve a correct diagnosis using HDTV NBI magnifying endoscopy, it is important not only to observe changes in the shape of IPCL but also to note possible papillary structures with central-axis capillaries typical of papillomatosis.