Abstract
Objectives: High definition laryngoscopy (HDL) could lead to better interpretation of the pharyngeal and laryngeal mucosa than regularly used fiberoptic laryngoscopy (FOL). The primary aim of this study is to quantify the diagnostic advantage of HDL over FOL in detecting mucosal anomalies in general, in differentiating malignant from benign lesions and in predicting specific histological entities. The secondary aim is to analyse image quality of both laryngoscopes. Design: Retrospective paired analysis with multiple observers evaluating endoscopic videos simulating daily clinical practice. Setting: A tertiary referral hospital. Participants: In 36 patients, both FOL and HDL videos were obtained. Six observers were provided with additional clinical information, and 36 FOL and HDL videos were evaluated in a randomised order. Main outcome measures: Sensitivity, specificity, positive and negative predictive value and diagnostic accuracy of observers using both flexible laryngoscopes were calculated for detection of mucosal lesions in general and uncovering malignant lesions. Sensitivities were calculated for prediction of specific histological entities. Image quality (scale 1-10) was assessed for both flexible laryngoscopes. Results: HDL reached higher sensitivity compared to FOL for detection of mucosal abnormalities in general (96.0% vs 90.4%; P =.03), differentiating malignant from benign lesions (91.7% vs 79.8%; P =.03) and prediction of specific histological entities (59.7% vs 47.2%; P <.01). Image quality was judged better with HDL in comparison with FOL (mean: 8.4 vs 5.4, P <.01). Conclusions: HDL is superior to FOL in detecting mucosal anomalies in general, malignancies and specific histological entities. Image quality is considered as superior using HDL compared to FOL.
| Original language | English |
|---|---|
| Pages (from-to) | 119-125 |
| Number of pages | 7 |
| Journal | Clinical otolaryngology |
| Volume | 45 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - 1 Jan 2020 |
Keywords
- laryngeal mucosa
- laryngoscopy
- larynx
- mucous membrane
- neoplasms
- pharynx
- sensitivity and specificity
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In: Clinical otolaryngology, Vol. 45, No. 1, 01.01.2020, p. 119-125.
Research output: Contribution to journal › Article › Academic › peer-review
TY - JOUR
T1 - Differences in the diagnostic value between fiberoptic and high definition laryngoscopy for the characterisation of pharyngeal and laryngeal lesions: A multi-observer paired analysis of videos
AU - Scholman, Constanze
AU - Westra, Jeroen M.
AU - Zwakenberg, Manon A.
AU - Dikkers, Frederik G.
AU - Halmos, Gyorgy B.
AU - Wedman, Jan
AU - Wachters, Jan E.
AU - van der Laan, Bernard F. A. M.
AU - Plaat, Boudewijn E. C.
N1 - Funding Information: Boudewijn EC Plaat has a consultancy role for and has received research funding by Olympus Medical Systems. For FOL, a flexible fiberoptic rhinolaryngoscope ENF GP (Olympus Medical Systems), which was connected to a Matrix E camera processer (Xion Gmbh), and for HDL, a flexible video rhinolaryngoscope ENF VH (Olympus Medical Systems), which was coupled to a HD monitor, were used. After using FOL for examination, patients gave informed consent and were included in a prospective HD-NBI study. These patients (89%) underwent HDL as an additional examination for that study. In four patients (11%), FOL was followed by HDL due to uncertainty of the diagnosis. When a patient had a suspicious lesion, a biopsy was taken or the lesion was resected completely. The pathologist assigned the diagnosis of the biopsy. The videos were edited to acquire fragments with a maximum duration of 10?seconds by using Windows Movie Maker 2012 (Microsoft Corp.). For this study, the HDL videos were edited into videos without narrow band imaging. Furthermore, we edited the videos into comparable views of the lesion, that is we showed the lesion from the same distance in both videos and gave an overview of the place of the lesion in each video. Questionnaires were made by using Microsoft Access 2010 database (Microsoft Corp.), and patient characteristics (gender, age, intoxications, brief recap of medical history) were added to each video. Questionnaires and videos were shown in random order to each observer independently by using a HD screen (Samsung Modelcode: UE50ES6100, Softwareversion: T-MST10PDEUC-1032.0, BT?G, SAMSUNG, Seoul, South Korea). First, observers had to classify the lesion into benign or malignant after displaying the video for maximal two times, and secondly, they had to choose a diagnosis from a presented table (Table). Observers had the possibility to choose from a variety of diagnoses even if there were no cases with these diagnosis included. Thirdly, observers had to judge the image quality on a scale from zero to ten (ie 0?=?very poor image quality, 10?=?excellent image quality). Each observer had a maximum of 30?seconds to judge each video. In this way, six observers assessed 72 videos (ie both FOL and HDL performed in 36 patients) which resulted in 432 observations. All six observers had at least 5?years of experience in the field of laryngology and/or head and neck oncology. Abbreviations: FOL, fiberoptic laryngoscopy; HDL, high definition laryngoscopy. Diagnosis papilloma, granulation or hemangioma The Institutional Review Board of the University Medical Centre Groningen assessed this retrospective study and judged that there was no need for approval based on the Dutch Medical Research Law (Wet medisch-wetenschappelijk onderzoek met mensen [WMO]). In this study, we included archived pharyngeal and laryngeal endoscopic videos of 51 patients collected routinely during diagnostic procedures between June 2014 and October 2017. Patient data, videos and histopathological results were assembled from the electronic patient records. Inclusion criteria were availability of both one FOL video and one HDL video of the same lesion. Both videos had to be recorded within a maximum of 3?months without treatment between both endoscopies. Videos of normal pharynges and larynges were also included in order to assess the detection rate of lesions. In total, 15 lesions were excluded because either an FOL or HDL video was not available (n?=?10), the lesion altered between the two video recordings (n?=?1), the histological diagnosis was not possible to classify (n?=?2) or the interval between the two recordings extended 3?months (n?=?2). Figure shows examples applied in our study group. For FOL, a flexible fiberoptic rhinolaryngoscope ENF GP (Olympus Medical Systems), which was connected to a Matrix E camera processer (Xion Gmbh), and for HDL, a flexible video rhinolaryngoscope ENF VH (Olympus Medical Systems), which was coupled to a HD monitor, were used. After using FOL for examination, patients gave informed consent and were included in a prospective HD-NBI study. These patients (89%) underwent HDL as an additional examination for that study. In four patients (11%), FOL was followed by HDL due to uncertainty of the diagnosis. When a patient had a suspicious lesion, a biopsy was taken or the lesion was resected completely. The pathologist assigned the diagnosis of the biopsy. The videos were edited to acquire fragments with a maximum duration of 10?seconds by using Windows Movie Maker 2012 (Microsoft Corp.). For this study, the HDL videos were edited into videos without narrow band imaging. Furthermore, we edited the videos into comparable views of the lesion, that is we showed the lesion from the same distance in both videos and gave an overview of the place of the lesion in each video. Questionnaires were made by using Microsoft Access 2010 database (Microsoft Corp.), and patient characteristics (gender, age, intoxications, brief recap of medical history) were added to each video. Questionnaires and videos were shown in random order to each observer independently by using a HD screen (Samsung Modelcode: UE50ES6100, Softwareversion: T-MST10PDEUC-1032.0, BT?G, SAMSUNG, Seoul, South Korea). First, observers had to classify the lesion into benign or malignant after displaying the video for maximal two times, and secondly, they had to choose a diagnosis from a presented table (Table). Observers had the possibility to choose from a variety of diagnoses even if there were no cases with these diagnosis included. Thirdly, observers had to judge the image quality on a scale from zero to ten (ie 0?=?very poor image quality, 10?=?excellent image quality). Each observer had a maximum of 30?seconds to judge each video. In this way, six observers assessed 72 videos (ie both FOL and HDL performed in 36 patients) which resulted in 432 observations. All six observers had at least 5?years of experience in the field of laryngology and/or head and neck oncology. Abbreviations: FOL, fiberoptic laryngoscopy; HDL, high definition laryngoscopy. Diagnosis papilloma, granulation or hemangioma Statistical analysis was performed using SPSS version 22.0 (IBM Corp.). The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy were calculated of both FOL and HDL for the detection of a mucosal lesion and of a malignant lesion in the pharynx and larynx. Sensitivities for prediction of a specific histological entity were calculated for each laryngoscope. The chi-squared test was used to analyse differences in sensitivities, specificity, PPV, NPV and diagnostic accuracy between both techniques. Furthermore, for each video the mean sensitivity of all six chosen diagnoses was calculated. Wilcoxon signed-rank test for matched pair samples was performed to compare the values of FOL and HDL and to evaluate the difference in image quality between both laryngoscopes. In this study, a P-value?<?0.05 was considered as significant. Publisher Copyright: © 2019 The Authors. Clinical Otolaryngology published by John Wiley & Sons Ltd. Copyright: Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/1/1
Y1 - 2020/1/1
N2 - Objectives: High definition laryngoscopy (HDL) could lead to better interpretation of the pharyngeal and laryngeal mucosa than regularly used fiberoptic laryngoscopy (FOL). The primary aim of this study is to quantify the diagnostic advantage of HDL over FOL in detecting mucosal anomalies in general, in differentiating malignant from benign lesions and in predicting specific histological entities. The secondary aim is to analyse image quality of both laryngoscopes. Design: Retrospective paired analysis with multiple observers evaluating endoscopic videos simulating daily clinical practice. Setting: A tertiary referral hospital. Participants: In 36 patients, both FOL and HDL videos were obtained. Six observers were provided with additional clinical information, and 36 FOL and HDL videos were evaluated in a randomised order. Main outcome measures: Sensitivity, specificity, positive and negative predictive value and diagnostic accuracy of observers using both flexible laryngoscopes were calculated for detection of mucosal lesions in general and uncovering malignant lesions. Sensitivities were calculated for prediction of specific histological entities. Image quality (scale 1-10) was assessed for both flexible laryngoscopes. Results: HDL reached higher sensitivity compared to FOL for detection of mucosal abnormalities in general (96.0% vs 90.4%; P =.03), differentiating malignant from benign lesions (91.7% vs 79.8%; P =.03) and prediction of specific histological entities (59.7% vs 47.2%; P <.01). Image quality was judged better with HDL in comparison with FOL (mean: 8.4 vs 5.4, P <.01). Conclusions: HDL is superior to FOL in detecting mucosal anomalies in general, malignancies and specific histological entities. Image quality is considered as superior using HDL compared to FOL.
AB - Objectives: High definition laryngoscopy (HDL) could lead to better interpretation of the pharyngeal and laryngeal mucosa than regularly used fiberoptic laryngoscopy (FOL). The primary aim of this study is to quantify the diagnostic advantage of HDL over FOL in detecting mucosal anomalies in general, in differentiating malignant from benign lesions and in predicting specific histological entities. The secondary aim is to analyse image quality of both laryngoscopes. Design: Retrospective paired analysis with multiple observers evaluating endoscopic videos simulating daily clinical practice. Setting: A tertiary referral hospital. Participants: In 36 patients, both FOL and HDL videos were obtained. Six observers were provided with additional clinical information, and 36 FOL and HDL videos were evaluated in a randomised order. Main outcome measures: Sensitivity, specificity, positive and negative predictive value and diagnostic accuracy of observers using both flexible laryngoscopes were calculated for detection of mucosal lesions in general and uncovering malignant lesions. Sensitivities were calculated for prediction of specific histological entities. Image quality (scale 1-10) was assessed for both flexible laryngoscopes. Results: HDL reached higher sensitivity compared to FOL for detection of mucosal abnormalities in general (96.0% vs 90.4%; P =.03), differentiating malignant from benign lesions (91.7% vs 79.8%; P =.03) and prediction of specific histological entities (59.7% vs 47.2%; P <.01). Image quality was judged better with HDL in comparison with FOL (mean: 8.4 vs 5.4, P <.01). Conclusions: HDL is superior to FOL in detecting mucosal anomalies in general, malignancies and specific histological entities. Image quality is considered as superior using HDL compared to FOL.
KW - laryngeal mucosa
KW - laryngoscopy
KW - larynx
KW - mucous membrane
KW - neoplasms
KW - pharynx
KW - sensitivity and specificity
UR - http://www.scopus.com/inward/record.url?scp=85076169410&partnerID=8YFLogxK
U2 - https://doi.org/10.1111/coa.13476
DO - https://doi.org/10.1111/coa.13476
M3 - Article
C2 - 31747481
SN - 1749-4478
VL - 45
SP - 119
EP - 125
JO - Clinical otolaryngology
JF - Clinical otolaryngology
IS - 1
ER -