A practical guide to the use of Narrow Band Imaging (NBI) in the early detection of oral cancer: case series and review of the literature | Journal of Oral Medicine and Oral Surgery

Open Access

Table I

Included papers in chronological order.

Authors & year	Country	Study information	Significant findings
Yang et al. 2012 [27]	China	154 patients (130 M, 24 F) 90 buccal mucosa, 18 ventrolateral tongue, 15 retromolar, 1 FOM, 6 lip, 10 dorsal tongue, 8 gum, 6 palate 60 H-OL, 94 NH-OL	The IPCL patterns shown by NBI system can be helpful in detecting oral leukoplakia with higher grade dysplasia or invasive carcinoma.
Yang et al. 2012 [28]	China	414 patients (365M, 49 F) 12 lip, 288 buccal mucosa, 22 gum, 11 dorsal tongue, 38 ventrolateral tongue; 12 palate; 5 FOM; 26 retromolar 197 H-OL, 217 NH-OL	The NBI images of twisted elongation of IPCL and IPCL pattern destruction are indicators of high-grade dysplasia or carcinomatous lesions in oral leukoplakia.
Yang et al. 2014 [29]	China	63 patients (41 M, 22 F) 25 tongue, 19 buccal, 8 lip, 6 gum, 2 hard palate, 2 retromolar, 1 FOM 63 chronic (persisting for more than 3 weeks) non healing ulcers	NBI pattern is the only independent factor associated with the occurrence of squamous cell carcinoma in oral chronic non-healing ulcers.
Shibahara et al. 2014 [30]	Japan	137 patients (68 M, 69 F) OSCC: 35 tongue, 5 gum, buccal 9; palate 2; FOM 1 52 OSCC, 25 OL, 18 OLP, 6 OE, 6 ED, 6 other	Type III-IV IPCL patterns sensitivity and specificity for the identification of OSCC were 92.3% and 88.2% respectively
Tirelli et al. 2015 [31]	Italy	8 patients (M/F proportion unretrievable) 6 FOM, 2 anterior tongue 8 OSCC	NBI is useful in determining surgical margins for OSCC
Vu et al. 2015 [32]	Australia	95 patients (43 M, 52 F) 272 lesions: 114 buccal, 74 tongue, 34 gum, 19 lip, 18 palate, 13 FOM 93 biopsied lesions: 5 H-OL, 25 NH-OL, 43 OLP/OLL/LR, 20 other	NBI demonstrates great utility as a visualisation adjunct for detecting and monitoring OPMD
Yang et al. 2015 [33]	Taiwan	72 patients (66 M, 6 F) 2 lip, 55 buccal, 1 gum, 6 tongue, 2 palate, 2 FOM, 4 retromolar 72 OE	Twisted, elongated, and destructive patterns of NBI IPCL are linked to high-grade dysplasia, carcinoma in situ and invasive carcinoma in oral erythroplakia
Farah et al. 2016 [34]	Australia	18 patients (11 M, 7 F) 7 FOM, 2 gum, 5 tongue, 3 buccal, 1 palate 18 OSCC	Resection to NBI-defined margins will leave less dysplastic and malignant residual tissue and thereby increase ablative surgery success rates.
Tirelli et al. 2016 [35]	Italy	42 patients (M/F proportion not provided) Anatomical sites non specified 42 OSCC	NBI helps to identify the presence of dysplasia and cancer at excision margin of OSCC
Tirelli et al. 2017 [36]	Italy	77 OPSCC-OSCC; no other information provided	NBI could represent an added value in the pre-operative and intra-operative assessment of OSCC.
Tirelli et al. 2017 [37]	Italy	39 patients (25 M, 14 F) No subsite information provided 39 OSCC	NBI could allow for real-time definition of superficial tumor extension, not influenced by tumor site.
Tirelli et al. 2017 [38]	Italy	79 patients (M/F proportion not provided) No subsite information provided 79 OSCC	NBI appears useful for follow-up after treatment for OSCC. Learning curve may cause false positives
Farah et al. 2018 [39]	Australia	18 patients (11 M, 7 F) 7 FOM, 2 gum, 5 tongue, 3 buccal, 1 palate 18 OSCC	Surgical margins defined by NBI leave less potentially malignant residual tissue.
Farah et al. 2018 [40]	Australia	20 patients (13 M, 7 F) 5 tongue, 7 FOM, 2 gum, 3 buccal, 1 palate, 1 maxilla, 1 mandible 20 OSCC	Resection to NBI-defined margins improves survival rates and decreases recurrence rates of OSCC
Tirelli et al. 2018 [41]	Italy	62 patients (M/F proportion not provided) 24 FOM, 22 tongue, 8 buccal, 8 palate	NBI is useful in determining surgical margins for OSCC
Guida et al. 2019 [42]	Italy	98 patients (58 M, 40 F) 106 lesions: 30 tongue, 47 buccal, 11 hard palate, 3 soft palate, 10 gum, 5 FOM 19 OSCC, 24 OD, 3 PVL, 30 OLP, 30 keratosis	NBI could help in the follow-up of patients with multiple chronic lesions such as OLP
Cozzani et al. 2019 [43]	Italy	37 patients (14 M, 23 F) No subsite information provided 37 OLP	NBI evaluation may increase the accuracy of detection of neoplastic transformation in OLP
Upadhyay et al. 2019 [44]	India	38 patients, (23 M, 15 F) No subsite information provided 31 OSCC, 1 hyperlasia/dysplasia; no other information provided	NBI sensitivity and specificity was higher than white light examination
Guida et al. 2021 [45]	Italy	84 patients (34 M, 50 F) 63 buccal, 1 FOM, 3 gum, 8 palate, 9 tongue 26 OLL, 47 OLP, 8 OLR, 3 OSCC	Interpretation of NBI should be modulated when assessing lichenoid lesions. NBI has potential to discern malignant transformation occurring in lichenoid lesions undergoing long-term follow-up, as IPCL pattern IV may be used as a clinical marker of malignancy
Deganello et al. 2021 [46]	Italy	56 patients (M-to-F ratio 1:2.6) 66% buccal, 21% gum, 9% tongue 47 OLP, 4 OD, 5 HGD/OSCC	NBI improved detection rate of OSCC in OLP patients
Nair et al. 2021 [47]	India	50 patients (41 M, 9 F) 23 buccal, 20 tongue, 3 trigonous, 1 gum, 1 hard palate, 3 lip 27 OSCC, 21 premalignant lesions, 3 normal mucosa	NBI is a highly effective tool to detect invasive carcinomas amongst suspicious lesions of the oral cavity.
de Wit et al. 2021 [48]	The Netherlands	16 patients (10 M, 6 F) 12 tongue, 3 FOM, 1 buccal 16 OSCC	NBI adequately identified the mucosal margin especially in early-stage OSCC
Ota et al. 2022 [49]	Japan	55 patients (M/F proportion not provided) 22 buccal, 1 FOM, 19 tongue, 6 hard palate, 12 gum 16 OLP, 31 OL, 13 OSCC	NBI is influenced by mucosal thickness; therefore, image interpretation is important for accurate diagnosis.
Nitro et al. 2022 [50]	Italy	20 patients (8M, 12 F) 23 buccal, 7 palate, 5 tongue, 2 gum, 2 lip 20 GVHD	There is rationale for routine use of endoscopy with NBI in patients with oral chronic Graft-versus-Host Diesease
Iandelli et al. 2023 [51]	Italy	76 patients (36 M, 40 F) No subsite information provided 76 OSCC	The presence of depapillation did not affect the intralesional pattern detected by the NBI
Mahto et al. 2024 [52]	India	38 patients (30 M, 8 F) 23 tongue, 8 buccal; no other information provided 38 OSCC	NBI can complement WL for margin assessment in OSCC but requires a long learning curve
Nilsson et al. 2024 [53]	Sweden	34 patients (18 M, 16 F) 16 tongue, 12 gum, 3 buccal, 3 FOM 49 OSCC	The delineation of mucosal tumour borders in oral cancers by NBI was not better than that by WL

ED: epithelial dysplasia F: female; FOM: floor of mouth; H: homogeneous; HGD: high grade dysplasia; LR: lichenoid reaction; M: male; NH: non-homogeneous; OE: oral erithroplakia; OL: oral leukoplakia; OLL: oral lichenoid lesion; OLP: oral lichen planus; OPSCC: oropharyngeal squamous cell carcinoma; OSCC: oral squamous cell carcinoma; PVL: proliferative verrucous leukoplakia.

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