Narrow band imaging as a diagnostic tool in oral potentially malignant epithelial lesions and squamous cell carcinoma : analysis of a case series

Aim. Narrow band imaging (NBI) is a non invasive optical technique that enhances the mucosal surface texture, and mucosal and submucosal vascular mor- phology; endoscopy with NBI systems has been suc- cessfully used in detecting neoplastic and dysplastic lesions in the pharynx, larynx, upper aerodigestive tract, gastrointestinal tracts and urogenital tracts. The aim of this study was to analyze a case series of 12 patients affected by oral potentially malignant condi- tions or squamous cell carcinoma (OSCC) evaluating the correlation between the clinical appearance of the oral mucosal condition, the patterns of intraepi- thelial microvasculature of NBI and histopathology. Methods. 12 patients referred to the oral diagno- sis, ENT or maxillofacial clinical units of the DISS head and neck clinical department for mucosal dis- eases and conditions were submitted to (i) conven- tional oral examination (ii) fiberoptic videoendos- copy and/or endoscopy with NBI (Olympus CV-170 Imaging Platform®) and (iii) incisional biopsy in the relevant areas of the mucosal lesions. Demographics, risk factors and medical data were recorded; clinical pictures and endoscopic pictures collected. Surgical incisional biopsies were obtained from significant areas of the diseased mucosal sur- faces employing the clinical aspect and the NBI macroscopic and microvasculature appearance as a guidance to the biopsy area selection. Results. Three patients with leukoplakia or ver- rucous leukoplakia were observed, three with oral lichenoid lesions, one with oral erytroplakia, five with clinical suspect oral carcinoma or suspect recurrence of previous OSCC. The definitive his- topathological diagnosis were benign hyperkera- tosis and/or low grade dysplasia in patients with leukoplakia, oral lichen planus without or with fo- cal dysplasia in patients with lichenoid lesions and squamous cell carcinoma in patients with erythro- plakia or clinical suspect carcinoma. In carcinoma- tous lesions the NBI appearance of mucosal surface color and texture and the intrapapillary capillary loops (IPCL) aspect were consistent with the mi- crovasculature patterns described in the modified Takano’s classification for oral mucosa. Conclusion. While the results of NBI observa- tion in benign and inflammatory conditions are not specifically diagnostic, the NBI endoscopy could be a useful tool in identification of oral mucosal ar- eas affected by squamous cell carcinoma; the NBI macroscopic appearance of the texture and color of mucosa and the microvasculature patterns could suggest the presence of epithelial malignant disease helping in the patient case finding and in the surgi- cal management of disease.