NBI and Laryngeal Papillomatosis: A Diagnostic Challenge: A Systematic Review

HIGHLIGHTS: ▪. Laryngeal papillomatosis (LP) is considered a benign lesion, caused by HPV low-risk subtypes 6 and 11. ▪. Narrow-band imaging (NBI) endoscopy is a useful diagnostic tool for distinguishing between benign and malignant laryngeal lesions. ▪. Laryngeal squamous cell carcinoma (LSCC) and LP show the same type V pattern according to Ni classification on NBI. ▪. Epithelial surface and clinical features of LP should be researched to determine a correct differential diagnosis between LP and LSCC. ABSTRACT: Narrow-band imaging (NBI) represents a valid aid in laryngeal squamous cell carcinoma (LSCC) diagnosis for detecting vascular changes. However, LSCC and laryngeal papillomatosis (LP) show similar vascular patterns that may lead to misdiagnosis and improper treatment. This review aims to deepen this NBI limit in order to stress a careful preoperative evaluation of laryngeal lesions. The research was carried out on PubMed, Web of Science and Scopus databases using specific keywords. The topic of research was assessed by these parameters: accuracy, sensitivity, specificity, and positive and negative predictive values. This review included only five articles: they demonstrated that NBI is better than white-light endoscopy in detecting LSCC and LP. They also reported that LP is frequently mistaken for LSCC, resulting in high rates of false positives using NBI. This is the first review that emphasized this NBI limitation in distinguishing between LP and LSCC in cases of a type V pattern of intraepithelial papillary capillary loop. Although NBI application increased the rate of early cancer detection, LP reduces NBI accuracy. This drawback may lead to misdiagnosis and improper treatment. Our advice is to be careful in cases of type V pattern on NBI and to research LP epithelial and clinical features because it could be a pitfall.