Diagnostic performance of narrow-band imaging bronchoscopy in assessing tracheobronchial cell morphological abnormalities

BACKGROUND: Narrow-band imaging (NBI) bronchoscopy increases the diagnostic accuracy of lung cancer by enhancing mucosal surface structure images. The accuracy of NBI bronchoscopy for morphological abnormalities of tracheobronchial cells is unknown. This study aims to determine the diagnostic performance of NBI bronchoscopy in assessing tracheobronchial cell morphological abnormalities in nontumor mucosal airways. METHODS: This diagnostic study was conducted at Persahabatan Hospital from March 2023 to January 2024 using consecutive sampling. Participants aged over 18 with central lesions underwent NBI bronchoscopy. NBI vascular patterns were evaluated as the index test, with the gold standard being tracheobronchial cell morphological abnormalities assessed through histopathological examination. Diagnostic metrics, including sensitivity, specificity, and area under the curve (AUC), were analyzed using IBM SPSS Statistics 26.0. RESULTS: Among the 99 analyzed subjects, 46 exhibited abnormal vascular patterns on NBI bronchoscopy. A tortuous pattern exhibited the highest sensitivity and specificity (42.8% and 91.5%, respectively), compared with dotted and abrupt-ending patterns. Specificity for dotted and abrupt-ending patterns was 90.1% and 85.9%, respectively. However, as a potential screening modality, each NBI vascular pattern demonstrated low sensitivity, ranging from 14.3% to 42.8%. Combining tortuous, abrupt-ending, and dotted patterns improved diagnostic performance, achieving an AUC of 71.0%, sensitivity of 75.0%, and specificity of 67.6%. CONCLUSION: NBI bronchoscopic vascular patterns are correlated with tracheobronchial cellular morphological abnormalities, demonstrating high specificity and moderate sensitivity.