Comments on “Comparison of White Light With Narrow Band Imaging Using Flexible Laryngoscopy for the Detection of Local Recurrences After (Chemo)Radiation for Pharyngeal or Laryngeal Cancer: A Randomised Controlled Trial”The paper by Scholman et al. [1] is the first randomized trial to compare white light (WL) and narrow band imaging (NBI) in detecting local recurrence during the follow-up of patients treated with (chemo)radiation for pharyngeal and laryngeal cancer.The results differ substantially from those found in literature. Specifically, the authors reported no advantage in recurrence detection with the use of NBI.We agree with the authors that this discrepancy could be explained by the low number of recurrences in their cohort. However, we believe that the limited experience of the clinician performing NBI examination may have impacted the results. In fact, the authors stated, “using NBI to differentiate between pathological IPCLs and disturbed blood vessel patterns after (chemo)radiation is challenging”. Conversely, previous literature has clearly shown that post-radiotherapy (RT) vascular patterns can be mistaken for recurrence during the first six months of NBI use due to the presence of a steep learning curve [2, 3]. After this period, a trained eye can distinguish post-RT areas by their ill-defined margins and relatively low density, offering a diagnostic advantage of over 60%, with a statistically significant difference between WL and NBI in recurrence diagnosis [3, 4]. This has led to the inclusion of NBI in the latest United Kingdom National Multidisciplinary Guidelines as a screening investigation during follow-up [3].The main advantage of using NBI in follow-up is the early detention of recurrences, including at dysplastic stages, when WL examination and radiologic imaging are unable to diagnose them. Moreover, NBI functions as an “optical biopsy”, selecting patients who warrant a biopsy under general anesthesia, thereby limiting costs, diagnostic time, and patient stress. In our opinion, the timing of laryngoscopy - scheduled every six months in this study - could have negatively impacted early diagnosis. Between two examinations, cancer can grow and become visible, both with WL and NBI, with NBI use in the follow-up seemingly no more advantageous than WL.According to NCCN guidelines, a complete head and neck exam, including fiberoptic examination, should be scheduled every 1-3 months in the first year [5].Therefore, we agree with the authors’ statement “A larger multicenter study with more frequent use of NBI is needed for definitive conclusions”.In conclusion, we believe that the creation of a dedicated team to optimize the NBI learning curve and the proper timing of follow-up examinations are advisable in order to fully understand NBI utility during follow-up.