title: Narrow band imaging improves observer reliability in evaluation of upper aerodigestive tract lesions.
abstract: Visualization by endoscopy is essential in the diagnosis of upper aerodigestive tract lesions. Recent studies showed that narrow band imaging (NBI) increases the diagnostic potential of conventional white light imaging (WLI) by highlighting the superficial vessels. The objective of this study was to evaluate whether the use of NBI would influence inter- and intraobserver agreement while making diagnostic decisions using rigid endoscopy of the upper aerodigestive tract.
  
  
  
  Retrospective study.
  
  
  
  One hundred routinely collected pictures of laryngeal, hypopharyngeal, and oropharyngeal lesions were used. Rigid endoscopies and patient data collection were performed according to standard protocol. Twelve observers, grouped in different levels of experience, assessed all lesions twice with a 2 to 4 week interval. Fleiss and Cohen's kappa (κ) values were calculated to assess inter- and intraobserver agreement.
  
  
  
  Overall interobserver agreement increased from κ = 0.34 to κ = 0.40 by adding NBI to WLI (WLI and WLI + NBI, respectively). In experienced observers, an improvement from κ = 0.39 to κ = 0.43 was observed; in less-experienced observers an improvement from κ = 0.30 to κ = 0.37 was observed. Overall intraobserver agreement increased from moderate (κ = 0.54) to substantial (κ = 0.63) with addition of NBI. Intraobserver agreement for less-experienced observers improved remarkably when WLI was combined with NBI (κ = 0.51 vs. κ = 0.67).
  
  
  
  Addition of NBI during rigid endoscopies of the upper aerodigestive tract led to improvement of both inter- and intraobserver agreement.
  
  
  
  4 Laryngoscope, 126:2276-2281, 2016.
authors.affiliation: Department of Otorhinolaryngology/Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. m.a.zwakenberg@umcg.nl.
authors.forename: Manon A
authors.initials: MA
authors.lastname: Zwakenberg
authors.affiliation: Department of Otorhinolaryngology/Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Frederik G
authors.initials: FG
authors.lastname: Dikkers
authors.affiliation: Department of Otorhinolaryngology/Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Jan
authors.initials: J
authors.lastname: Wedman
authors.affiliation: Department of Otorhinolaryngology/Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Gyorgy B
authors.initials: GB
authors.lastname: Halmos
authors.affiliation: Department of Otorhinolaryngology/Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Bernard F A M
authors.initials: BF
authors.lastname: van der Laan
authors.affiliation: Department of Otorhinolaryngology/Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Boudewijn E C
authors.initials: BE
authors.lastname: Plaat
mesh_terms: D002983:Clinical Competence; D004945:Esophagoscopy / Q000379:methods / Q000706:statistics & numerical data*; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging*; D006801:Humans; D008027:Light; D062048:Narrow Band Imaging / Q000379:methods / Q000706:statistics & numerical data*; D015588:Observer Variation; D015203:Reproducibility of Results; D012189:Retrospective Studies
keywords: Laryngoscopy; interrater reliability; intrarater reliability; narrow band imaging; observer agreement; observer reliability