Narrow band imaging in endoscopic evaluation of the larynx

Narrow band imaging (NBI) is a novel endoscopic technique using filtered wavelengths in order to enhance the microvascular abnormalities associated with the preneoplastic and neoplastic changes of the mucosal lining of the upper aerodigestive tract. The present review is focused on the use of NBI in the management of patients with laryngeal cancer.

The larynx and hypopharynx represent an ideal site for NBI application because their thin, nonkeratinized, stratified squamous epithelium permits optimal visualization of the subtle neoangiogenic changes associated with precancerous and neoplastic diseases, including benign processes like recurrent respiratory papillomatosis. These abnormal vascular patterns have been recently described in great detail and demonstrated to be useful diagnostic tools in different settings of laryngeal cancer management: from preoperative diagnosis and staging to intraoperative evaluation of microsurgical margins and posttreatment follow-up. Particularly intriguing is the capacity of NBI to properly distinguish postactinic changes from persistent/recurrent disease.

From different institutions in several countries, NBI continues to receive confirmations of its validity as an ancillary diagnostic tool for endoscopic evaluation of oncologic patients. This also holds true for laryngeal and hypopharyngeal neoplastic diseases.