Narrow-band imaging for diagnosing adenoid hypertrophy in adults: A simplified grading and histologic correlation

Objectives/Hypothesis: To investigate the use of narrow-band imaging (NBI) endoscopy to detect the appearance of a light crest (LC) on the epithelial surface of the nasopharyngeal mucosa, which is suggested to be a distinctive endoscopic finding associated with the presence of adenoid hypertrophy. Study Design: Cross-sectional study. Methods: A total of 79 consecutive adults with a high suspicion of malignancy underwent NBI endoscopy and nasopharyngeal biopsy to validate the diagnostic accuracy of the novel endoscopic technique. The degree of correlation between the LC grading and the histologic examinations of lymphoid hyperplasia, including the number of mucin-producing cells and lymphoid follicles, was then assessed. Results: The appearance of an LC on NBI endoscopy correlated with the histologic evidence of lymphoid hyperplasia with a sensitivity of 92.1%, a specificity of 95.1%, a positive predictive value of 94.6%, a negative predictive value of 92.9%, a false-positive value of 4.9%, a false-negative value of 7.9%, and an accuracy of 93.7%. The screening performance of NBI endoscopy for the presence of adenoid hypertrophy is significantly superior to that of conventional endoscopy (P =.0003). The LC grading was significantly correlated with the number of mucin-producing cells and lymphoid follicles (P <.001). Conclusions: In NBI endoscopy, observation of an LC on the epithelial surface of the nasopharyngeal mucosa is a highly accurate predictor of the presence of adenoid hypertrophy.