Vol.:(0123456789) 1 3 Eur Arch Otorhinolaryngol DOI 10.1007/s00405-017-4515-x HEAD AND NECK Follow-up of oral and oropharyngeal cancer using narrow-band imaging and high-defnition television with rigid endoscope to obtain an early diagnosis of second primary tumors: a prospective study Giancarlo Tirelli 1  · Marco Piovesana 1  · Pierluigi Bonini 1  · Annalisa Gatto 1  · Giuseppe Azzarello 2  · Francesca Boscolo Nata 1   Received: 19 December 2016 / Accepted: 18 February 2017 © Springer-Verlag Berlin Heidelberg 2017 after treatment for OSCC or OPSCC, its performance being afected only by the learning curve and not by previous treatment or lesion site. Keywords NBI-rigid-endoscopy · Follow-up · Early detection · Second primary tumor · Radiotherapy · Learning curve Introduction Head and neck squamous cell carcinoma is a common dis- ease worldwide, with 48,330 new cases of oral and oro- pharyngeal cancer expected in the United States for 2016, and 9570 related deaths [1]. In Italy, 4500 new cases are diagnosed each year, with 3000 deaths [2]. Smoking and drinking alcohol are well-known risk factors [3], and they exert their carcinogenic efect in extended areas of the upper aerodigestive tract, which explains the possible development of multiple cancers (local recurrences and second primary tumors) according to the “feld canceri- zation” [4] phenomenon. Recent studies reported a rate of local recurrences (LR) of about 10–30%, while that of second primary tumors (SPT) is estimated between 2 and 30% [5]. Identifcation of these lesions at an early stage is essential for guaranteeing a radical resection with minimal morbidity. Unfortunately, unlike late stage cancers that are easily detectable, superfcial mucosal cancers in the early stages may be often overlooked with standard endoscopy [6]. Moreover, the efect of previous radiotherapy can result in mucosal alterations such as mucositis, edema, and fbro- sis which may act as confounding factors [7, 8]. The use of new technologies to help in the identifcation of early mucosal changes, even under the cover of a post-actinic scenario, is, therefore, crucial. Abstract Narrow-band imaging (NBI) is an optical tech- nique enhancing mucosal vasculature. The aim of this study is to assess the efectiveness of rigid NBI endoscopy in the early detection of second primaries or local recurrences after treatment for oral (OSCC) and oropharyngeal squa- mous cell carcinoma (OPSCC), its advantage over standard white-light (WL) endoscopy, and the infuence of previous radiotherapy, the learning curve, and lesion site. Between January 2013 and June 2015, 195 patients treated for OSCC or OPSCC with surgery alone (group A) or radiotherapy with or without surgery and/or chemotherapy (group B) underwent additional follow-up assessments using NBI. Sensitivity, specifcity, positive/negative predictive values (PPV and NPV), and accuracy for detecting second prima- ries or local recurrences were calculated for patients with at least two NBI assessments. The efect of previous radio- therapy was determined by test of proportions and that of the learning curve and lesion site with Fisher’s exact test. 138/195 patients were included in the analysis. NBI sen- sitivity, specifcity, PPV, NPV, and accuracy for groups A and B were 89.5 vs 100%, 85.2 vs 81.5%, 65.4 vs 69.7%, 96.3 vs 100%, and 86.3 vs 87%, respectively. The diagnos- tic gain of NBI was 88.2% in group A and 69.6% in group B. The learning curve was the main source of false posi- tives (p = 0.025), whereas radiotherapy and lesion site were uninfuential (p = NS). NBI appears useful for follow-up * Francesca Boscolo Nata francesca.boscolonata@gmail.com 1 Head and Neck Department, ENT Clinic, Azienda Sanitaria Universitaria Integrata di Trieste, Strada di Fiume 447, 34149 Trieste, Italy 2 Department of Medical Oncology, Mirano Hospital, Local Health Unit 13, Mirano, Venezia, Italy