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Laparoscopic Narrow Band Imaging for Detection of Occult Cancer Metastases: A Pilot Study
*Thomas Schnelldorfer1, Roger L Jenkins1, Desmond H Birkett1, *Valena J Wright1, *Lori Lyn Price2, *Irene Georgakoudi3
1Lahey Hospital & Medical Center, Burlington, MA;2Tufts Clinical and Translational Science Institute, Boston, MA;3Tufts University, Medford, MA
Objective: To evaluate the feasibility and effectiveness of laparoscopic narrow band imaging (NBI) compared to standard white-light laparoscopy for detection of peritoneal cancer metastases.
Design: A randomized, controlled feasibility trial with crossover design evaluating adult patients with gastrointestinal or gynecologic malignancies who have a clinical indication for diagnostic laparoscopy.
Setting: A tertiary care medical center.
Patients: Twenty-two patients were randomized to white-light followed by NBI laparoscopy (n=11) or NBI followed by white-light laparoscopy (n=11) using the Olympus Evis Exera II system. Three patients were excluded from analysis.
Main Outcome Measure: Feasibility of NBI laparoscopy.
Results: In all of the 19 study patients the abdominal cavity was sufficiently illuminated. The enhanced contrast of microvasculature and organ surface pattern was appreciated. Eight of the 19 patients (42%) were found to have metastases of the peritoneal surface seen on white-light and NBI equally. Two of the overall 60 suspicious-appearing nodules seen on white-light imaging were not visible on NBI. The median number of metastases detected per patient by the two methods was not significantly different (p=0.50). Twenty-seven benign-appearing nodules were identified and visualized equally with both methods. The median diameter of all the nodules identified was 2mm (range 1 to 50mm).
Conclusions: The information from this feasibility study demonstrated that NBI with the Olympus Evis Exera II system provides adequate illumination of the abdominal cavity and a unique contrast that enhances microvasculature and architectural surface pattern. The results suggest that NBI laparoscopy might not be superior in detecting peritoneal metastases compared to standard white-light laparoscopy, but might provide a technology that could be applied for other abdominal pathologies.
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