Lasers in Surgery and Medicine The Prognostic Value of Adding Narrow‐Band Imaging in Transoral Laser Microsurgery for Early Glottic Cancer: A Review Flaminia Campo, 1 Vittorio D’Aguanno, 1 Antonio Greco, 1 Massimo Ralli, 1 * and Marco de Vincentiis 2 1 Department of Sense Organs, Sapienza University of Rome, 00186, Rome, Italy 2 Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, 00186, Rome, Italy Background and Objectives: Transoral laser micro- surgery (TLM) is a universally recognized safe and minimally invasive approach for early glottic cancer. Narrow band imaging (NBI) is an optical technique working with a filtered light that reveals superficial mucosal abnormalities through the neoangiogenic pat- tern. The aim of this systematic review is to demonstrate the role of intraoperative NBI during TLM for early glottic cancer to better evaluate tumor extension and for more precise margin resection. Study Design/Materials and Methods: A systematic review of the literature following the PRISMA guide- lines was performed. A literature search was per- formed using the following keywords: TLM, NBI, and early glottic cancer. Two independent authors evalu- ated the extracted data. Data regarding status of surgical margins after TLM, local recurrence, recur- rence‐free survival, and need of additional samples following NBI were collected. Results: Five articles met inclusion criteria with a total of 577 patients undergoing TLM with intrao- perative NBI. A significant reduction of positive superficial margins was found in patients treated with (52%) and without (28.6%) intraoperative use of NBI (P< 0.05) Conclusions: Routine use of intraoperative NBI in- creases the accuracy of neoplastic superficial spreading evaluation and accuracy of mass resection during TLM for early glottic cancer. The significant reduction of super- ficial positive margins dramatically decreases the number of patients at risk and improves clinical outcomes. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc. Key words: narrow‐band imaging; NBI; early glottic cancer; transoral laser microsurgery; larynx cancer INTRODUCTION Carcinoma of the larynx is the most frequent cancer of the upper aerodigestive tract with an incidence of 130,000 new cases per year [1]; nearly 75% of these tumors are confined to the glottic area [2]. For early‐ stage glottic cancer, a definitive unimodal therapy can be achieved through transoral laser microsurgery (TLM) or radiotherapy (RT) as accepted modalities to provide optimal survival free of disease and allow maximum functional results [2]. TLM is widely used in laryngeal surgery as it is universally recognized as a safe standard management and minimally invasive approach for early glottic cancer, with excellent results for disease‐specific survival and larynx preservation in T1 and T2 patients [3]. However, the neoplastic involvement of resection margins is one of the most important factors decreasing local control of the disease [4,5]. In some cases, TLM does not allow an adequate visualization of the glottic plane and tumor boundaries, thus a clear demarcation of resection margin may be challenging. The development of more advanced endoscopic techniques, like Narrow‐Band Imaging (NBI), has considerably improved the detection and definition of tumor superficial extension in head and neck cancer [6–8]. NBI is a video endoscopic system with narrow band filters that allow for the passage of only two specific bands of the visible spectrum, corresponding to the absorption peak of hemoglobin. Thus, NBI increases the evaluation of the microvascular abnormalities associated with preneoplastic and neoplastic changes of the mucosa [8] by improving the contrast of mucosal and submucosal vessel loops and cancer foci around the lesion invisible in White Light (WL) endoscopy, due to their isochromatic and flat‐ shaped nature [9]. The diagnostic value of NBI for detection of early laryngeal cancer has been evaluated by several studies [6,10]. Many reports have shown that NBI is superior to WL imaging in diagnosis and evaluation of disease persistence/recurrence in laryngeal carcinoma [11] (Fig. 1). The use of NBI in laryngeal cancer is not © 2019 Wiley Periodicals, Inc. Accepted 5 July 2019 Published online in Wiley Online Library (wileyonlinelibrary.com). DOI 10.1002/lsm.23142 * Correspondence to: Massimo Ralli, MD, PhD, Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, Rome 00186, Italy. E‐mail: massimo.ralli@uniroma1.it Massimo Ralli and Marco de Vincentiis contributed equally to this work. Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.