HEAD AND NECK Role of narrow-band imaging and high-definition television in the surveillance of head and neck squamous cell cancer after chemo- and/or radiotherapy Cesare Piazza • Daniela Cocco • Luigi De Benedetto • Francesca Del Bon • Piero Nicolai • Giorgio Peretti Received: 7 December 2009 / Accepted: 10 March 2010 / Published online: 30 March 2010 Ó Springer-Verlag 2010 Abstract Narrow-band imaging (NBI) is an endoscopic technique enhancing mucosal vasculature and better iden- tifying superficial carcinomas due to their neo-angiogenic pattern. NBI accuracy is increased by combination with a high-definition television (HDTV) camera. The aim of this report was to evaluate the diagnostic improvement of NBI ± HDTV in the evaluation of head and neck squa- mous cell cancer (HNSCC) previously treated by chemo- radiotherapy (CHT-RT) or RT. A total of 390 patients affected by HNSCC were prospectively evaluated by NBI and white light (WL) endoscopy ± HDTV between April 2007 and April 2009 at a single academic institution. Among them, we focused on 59 (15%) patients who received CHT-RT or RT as part of their treatment. Of 59 patients, 13 (22%) showed adjunctive preoperative NBI findings when compared to the standard WL examination. These findings were always confirmed by intraoperative HDTV NBI, while only eight (62%) were visible with HDTV WL. Of 13 lesions, 12 received histopathologic confirmation (from carcinoma in situ to invasive carci- noma). The sensitivity of flexible NBI, HDTV WL, and HDTV NBI was 100, 66 and 100%, respectively. The specificity was 98, 100, and 98%. The positive predictive value was 92, 100, and 92%. The negative predictive value was 100, 94, and 100%. The accuracy was 98, 91, and 98%. NBI ± HDTV after CHT-RT or RT was of value in detecting tumor persistence (n = 2), early recurrences (n = 6), and metachronous tumors (n = 4). By contrast, only 1 of 59 (2%) patients was found to be false positive. Keywords Narrow-band imaging Á High-definition television Á Head and neck cancer Á Radiotherapy Á Chemotherapy Introduction The issue of post-treatment surveillance of head and neck squamous cell cancer (HNSCC) after chemo-radiotherapy (CHT-RT) or RT alone has been traditionally considered as one of the most challenging diagnostic tasks even for dedicated and experienced physicians. The increasing enrollment into organ preservation protocols of patients affected by advanced-stage diseases as well as the intro- duction of more aggressive CHT regimens and higher-dose RT protocols have further amplified the problem of dif- ferential diagnosis between local persistence or recurrence and normal post-therapeutic sequelae such as mucositis, soft tissue edema, and fibrosis. On the other hand, the importance of an early diagnosis of CHT-RT or RT failure cannot be overemphasized, as demonstrated by the number of papers supporting the negative impact of a late diagnosis of persistence and recurrence on the chance of rescue treatment and survival [1, 2]. Significant advances in the field of imaging by refine- ment of conventional anatomic studies (CT and MRI) and the introduction of 18 fluorodeoxyglucose positron emission tomography ( 18 FDG-PET) and diffusion-weighted (DW)-MRI, which are based on the concept of probing the Best Poster Award for Head and Neck Surgery at the 1st Meeting of the European Academy of ORL-HNS in collaboration with EUFOS, Congress Center Rosengarten, Mannheim, Germany, 27–30 June 2009. C. Piazza (&) Á D. Cocco Á L. De Benedetto Á F. D. Bon Á P. Nicolai Á G. Peretti Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Piazza Spedali Civili 1, 25123 Brescia, Italy e-mail: ceceplaza@libero.it 123 Eur Arch Otorhinolaryngol (2010) 267:1423–1428 DOI 10.1007/s00405-010-1236-9