Validation of a classification and scoring system for the diagnosis of laryngeal and pharyngeal squamous cell carcinomas by confocal laser endomicroscopy

Sievert, Matti; Mantsopoulos, Konstantinos; Mueller, Sonja; Rupp, Robin; Eckstein, Markus; Stelzle, Florian; Oetter, Nicolai; Maier, Andreas; Aubreville, Marc; Iro, Heinrich; Goncalves, Miguel

doi:10.1016/j.bjorl.2021.06.002

Cited by 5 publications

(8 citation statements)

References 25 publications

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“…Carcinoma's important histological features generally include heterogeneous areas with necrosis, peritumoral inflammation, atypical mitosis, and epithelial beads [24]. Most proposed scoring systems for evaluating CLE images include tissue inhomogeneity as a conjectured correlation to the typical histological features [16][17][18][19]. An objective analysis of this feature has, however, to the best of our knowledge, not yet been performed.…”

Section: Discussionmentioning

confidence: 99%

“…Tissue inhomogeneity in SCC is a component of several classification systems [16][17][18][19]. In most cases, this feature appears to be reliable in identifying malignancy; however, to the best of our knowledge, an objective analysis of this parameter did not take place yet.…”

Section: Introductionmentioning

confidence: 91%

“…The images acquired by probe-based CLE reassemble histopathological tangential sections of the mucosa at the defined depth given by the probe. The reliable interpretation and classification in malignant and normal findings are not trivial, require training, and are usually aided by classification systems [16][17][18][19]. In these classification systems, capillary aberrations and tissue homogeneity play a significant role.…”

Section: Introductionmentioning

confidence: 99%

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Validity of tissue homogeneity in confocal laser endomicroscopy on the diagnosis of laryngeal and hypopharyngeal squamous cell carcinoma

Sievert

Aubreville

Gostian

et al. 2022

Eur Arch Otorhinolaryngol

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Purpose Confocal laser endomicroscopy (CLE) allows imaging of the laryngeal mucosa in a thousand-fold magnification. This study analyzes differences in tissue homogeneity between healthy mucosa and squamous cell carcinoma (SCC) via CLE. Materials and methods We included five SCC patients with planned total laryngectomy in this study between October 2020 and February 2021. We captured CLE scans of the tumor and healthy mucosa. Analysis of image homogeneity to diagnose SCC was performed by measuring the signal intensity in four regions of interest (ROI) in each frame in a total of 60 sequences. Each sequence was assigned to the corresponding histological pattern, derived from hematoxylin and eosin staining. In addition, we recorded the subjective evaluation of seven investigators regarding tissue homogeneity. Results Out of 3600 images, 1620 (45%) correlated with benign mucosa and 1980 (55%) with SCC. ROIs of benign mucosa and SCC had a mean and standard deviation (SD) of signal intensity of, respectively, 232.1 ± 3.34 and 467.3 ± 9.72 (P < 0.001). The mean SD between the four different ROIs was 39.1 ± 1.03 for benign and 101.5 ± 2.6 for SCC frames (P < 0.001). In addition, homogeneity yielded a sensitivity and specificity of 81.8% and 86.2%, respectively, regarding the investigator-dependent analysis. Conclusions SCC shows a significant tissue inhomogeneity in comparison to the healthy epithelium. The results support this feature’s importance in identifying malignant mucosa areas during CLE examination. However, the examiner-dependent evaluation emphasizes that homogeneity is a sub-criterion that must be considered in a broad context.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 91%

Section: Introductionmentioning

confidence: 99%

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Validity of tissue homogeneity in confocal laser endomicroscopy on the diagnosis of laryngeal and hypopharyngeal squamous cell carcinoma

Sievert

Aubreville

Gostian

et al. 2022

Eur Arch Otorhinolaryngol

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“…White et al first described the applicability of CLE in the head and neck region in 1999 using six healthy control tissue specimens and described its morphological similarity with corresponding H&E-stained microscopic sections [ 54 ]. This first description of CLE imaging in the head and neck area was followed by numerous in vitro [ 55 , 56 , 57 , 58 , 59 , 60 ] and in vivo studies [ 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 ] focusing on the noninvasive detection of head and neck cancer using CLE. Table 2 gives an overview of the most important in vitro and in vivo studies on CLE applications in the head and neck region over the past 23 years.…”

Section: Cle On Ent Applicationsmentioning

confidence: 99%

“…From 2016 on, systemically applied fluorescein (i.v. application) was used in nearly all published CLE in vivo studies in the head and neck region and presumably provides the best tissue contrast and quality of generated CLE images [ 81 , 82 , 83 , 84 , 88 , 89 , 90 , 91 ]. Further studies have to show if other fluorescent dyes, e.g., indocyanine green, can potentially enhance tissue contrast even more.…”

Section: Cle On Ent Applicationsmentioning

confidence: 99%

Development, Implementation and Application of Confocal Laser Endomicroscopy in Brain, Head and Neck Surgery—A Review

et al. 2022

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When we talk about visualization methods in surgery, it is important to mention that the diagnosis of tumors and how we define tumor borders intraoperatively in a correct way are two main things that would not be possible to achieve without this grand variety of visualization methods we have at our disposal nowadays. In addition, histopathology also plays a very important role, and its importance cannot be neglected either. Some biopsy specimens, e.g., frozen sections, are examined by a histopathologist and lead to tumor diagnosis and the definition of its borders. Furthermore, surgical resection is a very important point when it comes to prognosis and life survival. Confocal laser endomicroscopy (CLE) is an imaging technique that provides microscopic information on the tissue in real time. CLE of disorders, such as head, neck and brain tumors, has only recently been suggested to contribute to both immediate tumor characterization and detection. It can be used as an additional tool for surgical biopsies during biopsy or surgical procedures and for inspection of resection margins during surgery. In this review, we analyze the development, implementation, advantages and disadvantages as well as the future directions of this technique in neurosurgical and otorhinolaryngological disciplines.

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Feasibility of Optical Biopsy During Endoscopic Sinus Surgery With Confocal Laser Endomicroscopy: A Pilot Study

Frenken,

Sievert,

Panuganti

et al. 2024

The Laryngoscope

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ObjectiveConfocal laser endomicroscopy (CLE) is an optical imaging technique that allows in vivo, real‐time, microscope‐like assessment of superficial lesions. Although there is substantial data on CLE use in the upper GI tract, there is limited information regarding its application in the nasal cavity and paranasal sinuses. This study aims to assess the feasibility and diagnostic metrics of CLE in the nasal cavity and paranasal sinuses regarding differentiation between healthy/benign and malignant tissue. These structures show, however, a wider variety of frequent and concomitant benign and malignant pathologies, which could pose an increased challenge for optical biopsy by CLE.MethodsWe performed CLE on a case series of six patients with various findings in the nose (three chronic rhinosinusitis, adenocarcinoma, meningoenzephalozele, esthesionneuroblastoma). Forty‐two sequences (3792 images) from various structures in the nasal cavity and/or paranasal sinuses were acquired. Biopsies were taken at corresponding locations and analyzed in hematoxylin and eosin staining as a standard of reference. Three independent examiners blinded to the histopathology assessed the sequences.ResultsHealthy and inflamed mucosa could be distinguished from malignant lesions with an accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of 84.1%, 85.4%, 83.1%, 72.5%, and 92.1%, respectively, with a substantial agreement between raters (Fleiss κ = 0.62).ConclusionThis technique shows, despite its limitations, potential as an adjunctive imaging technique during sinus surgery; however, the creation of a scoring system based on reproducible and defined characteristics in a larger more diverse population should be the focus of further research to improve its diagnostic value and clinical utility.Level of EvidenceNA Laryngoscope, 2024

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Validation of a classification and scoring system for the diagnosis of laryngeal and pharyngeal squamous cell carcinomas by confocal laser endomicroscopy

Cited by 5 publications

References 25 publications

Validity of tissue homogeneity in confocal laser endomicroscopy on the diagnosis of laryngeal and hypopharyngeal squamous cell carcinoma

Validity of tissue homogeneity in confocal laser endomicroscopy on the diagnosis of laryngeal and hypopharyngeal squamous cell carcinoma

Development, Implementation and Application of Confocal Laser Endomicroscopy in Brain, Head and Neck Surgery—A Review

Feasibility of Optical Biopsy During Endoscopic Sinus Surgery With Confocal Laser Endomicroscopy: A Pilot Study

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