In our study, we confirmed this relationship as flexible endoscopy findings in two of our patients were classified as suspicious, but the examination in WL and NBI HDTV revealed another previously undetected lesion on the mucosa of the larynx.
Biopsy of the lesion demonstrated the presence of cancerous pathology. On one hand, the larynx and hypopharynx can be addressed with much greater freedom of movement with the videoendoscope; on the other hand, we often feel safer if we can evaluate the patient with greater ease under general anesthesia. RT or CRT can lead to substantial stiffness in soft tissues, which is unfavorable in terms of direct laryngoscopy.
When good exposure of the observed area is obtained, magnifying endoscopy with HDTV becomes an undisputable advantage. The mucosal surface can be observed in close-up view and also under higher magnification. Nevertheless, it is necessary to consider endoscopic approaches as supplementary methods and probably it would be better to determine the effectiveness and accuracy of the NBI method by merging the results of both approaches [ 18 ].
The negative histological results of the four patients marked as suspicious in videoendoscopic examination should be comprehensively understood. A considerable number of the patients had surgical attempts to treat the disease endoscopically before definitive RT or CRT. The disease in these patients may have a tendency to submucosal growth and thus may partially conceal the image of microvascular changes.
Secondly, it should be kept in mind that even the subjective difficulties of the patient hoarseness, pain, and discomfort when swallowing may lead to a clinical suspicion, which might affect the indication criteria for a diagnostic procedure under general anesthesia. The area of the larynx and hypopharynx is less accessible to inspection than, for example, the mucosa of the oral cavity or oropharynx, so physicians tend to be more cautious about possible tumor recurrence.
In our case, we cannot explain these FP findings by the early phase of learning curve of this method, since the cases were seen throughout the whole course of the study, not only at its beginning. Nonaka published a description of the different character of the microvascular changes IPCL in chronic inflammatory processes [ 23 ]. In accordance with his conclusions, we observed in irradiated patients general changes in IPCL, but these were diffuse not clearly demarcated and had lower density.
The frequency of the detection of cancer in our study remained high, despite the fact that we primarily focused on the area targeted by curative RT and we did not include mucosal lesions from areas other than larynx and hypopharynx.
Outpatient office based transnasal videoendoscopic testing was proven as a valid examination of the larynx and hypopharynx even in the presence of late RT-related side effects of treatment.
The results of the study demonstrate that transnasal endoscopy with NBI in outpatient settings is an excellent method for the follow-up of patients with carcinomas of the larynx and the hypopharynx primarily treated with RT or CRT. It is probably the most significant improvement in the optical diagnostics of recurrent or secondary disease in head and neck cancer patients over the past several decades. A wider availability of the method is still questionable, especially with regard to the relatively high frequency of follow-up visits and costs of the equipment.
The authors declare that there is no conflict of interests regarding the publication of this paper. This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Special Issues. Academic Editor: Jan Betka. Received 07 Feb Revised 08 Jun Accepted 09 Jun Published 30 Jun Abstract Narrow band imaging is considered a significant improvement in the possibility of detecting early mucosal lesion of the upper aerodigestive tract. Material and Methods The presented study was conceived as a prospective study. Frequency of follow-up visits Year of follow-up 1 2 3 4 Frequency of videoendoscopic evaluation Every 3 months Every 3 months Every 4 months Every 6 months Frequency of follow-up visits without NBI Every 6—8 weeks Every 8—12 weeks Every 4 months Every 6 months.
Table 1. Table 2. Table 3. Table 4. Table 5. Figure 1. Figure 2. Late RT-related changes of the laryngopharyngeal mucosa. Note diffuse and regular distribution of IPCL. Figure 3. Figure 4. Figure 5. Time to diagnosis of recurrence —months, —number of patients. References E. Rennemo, U.
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However, esophageal cancers other than 0-II type i. Third, video recording of less-air observation was conducted by experienced endoscopists.
Although the feasibility of this observation by less experienced endoscopists should be evaluated in the future, the technique can be mastered easily. Fourth, mild magnification was used to adjust the focus for observation under less-air condition.
Using mild magnification under the standard-air condition is not feasible because when the scope is at the center of the esophageal lumen, the mucosal surface would be out of focus. Furthermore, attempting to adjust the distance for mild magnification would necessitate close observation of the circumferential mucosa, which would extend the procedure time.
Thus, the adjustment of focus applied in this study will no longer be required in the future. Fifth, this observation process may extend the examination by 1 or 2 min. Sixth, in the present study, NBI was used for all cases as virtual chromoendoscopy. The present study has demonstrated that the NBI with less air improved or maintained the visibility of brownish area compared with the NBI with standard air in flat type esophageal SCCs.
This less-air NBI technique may facilitate the detection of SCC in the esophagus, and further studies are necessary in the future for the assessment of the detection.
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Development of a compact terahertz time-domain spectrometer for the measurement of the optical properties of biological tissues. J Biomed Opt. Download references. We would like to thank Julie Rose, from Editage www. I TI also would like to express my gratitude to my family for their moral support and warm encouragements.
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This study was approved by the Institutional Review Board of Osaka International cancer institute no. Informed consent was acquired by the opt-out method. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Additional file 1: Video. Recorded video image using narrow band imaging NBI under less-air following standard-air condition.
A superficial esophageal squamous cell carcinoma, 13 mm in size, is located at the right wall of the upper thoracic esophagus. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.
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Received : 24 March Accepted : 10 November Published : 19 November Diagnosis of colorectal tumorous lesions by magnifying endoscopy. Lambert, R. Magnification and chromoscopy with the acetic acid test.
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Biometrics 33 , — Bland, J. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1 , — Download references. Funding for the present study was provided by Jingjiang City key talent research project. The authors appreciate the expert technical assistance from the Department of Gastroenterology of the First Affiliated Hospital of Nanjing Medical University. We also thank Chunyan Wu and Yu Zheng for participating in data interpretation and graphic drawing.
You can also search for this author in PubMed Google Scholar. All authors read and approved the final manuscript. Correspondence to Yong Ji or Feng Gao. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Skip to main content Thank you for visiting nature. Download PDF. Subjects Cancer prevention Colon cancer. Abstract This prospective study was aimed to evaluate the clinical value of narrow-band imaging NBI , magnification endoscopy with narrow-band imaging NBIME and magnification endoscopy with acetic acid enhancement and narrow-band imaging AA-NBIME in the diagnosis of small colorectal polyps. Introduction Colorectal cancer CRC is the third most common cancer and the fourth leading cause of cancer death in the world 1.
Results Clinical characteristics of participants A total of polyps were identified and analyzed in patients. Table 1 Clinical characteristics.
Full size table. Table 3 Diagnostic performance of optical diagnosis of colorectal neoplastic polyps by three modalities for the expert group.
Table 4 Diagnostic performance of optical diagnosis of colorectal neoplastic polyps by three modalities for the non-expert group. Table 5 Diagnostic accuracy of small colorectal polyps between the expert group and non-expert group for different modalities. Table 6 Kappa statistics of interobserver agreement for diagnosis among three modalities for experts and non-experts. Discussion It is widely accepted that most colorectal carcinomas appear to arise from adenomas 2 , and the removal of adenomatous polyps by colonoscope has already result in significant reductions in the incidence of CRC 3.
Endoscopic procedure and therapy 1. Figure 1. Full size image. Figure 2. References 1. Article Google Scholar 2. Article Google Scholar 4. Article Google Scholar 7. Article Google Scholar 8. Article Google Scholar Acknowledgements Funding for the present study was provided by Jingjiang City key talent research project. View author publications. Ethics declarations Competing interests The authors declare no competing interests.
Additional information Publisher's note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. About this article. Cite this article Sha, J. Copy to clipboard.
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