Discrimination of Benign and Neoplastic Mucosa with a High-Resolution Microendoscope (HRME) in Head and Neck Cancer

Abstract

Background The efficacy of ablative surgery for head and neck squamous cell carcinoma (HNSCC) depends critically on obtaining negative margins. While intraoperative "frozen section" analysis of margins is a valuable adjunct, it is expensive, time-consuming, and highly dependent on pathologist expertise. Optical imaging has potential to improve the accuracy of margins by identifying cancerous tissue in real time. Our aim was to determine the accuracy and inter-rater reliability of head and neck cancer specialists using high-resolution microendoscopic (HRME) images to discriminate between cancerous and benign mucosa. Methods Thirty-eight patients diagnosed with HNSCC were enrolled in this single-center study. HRME was used to image each specimen after application of proflavine, with concurrent standard histopathologic analysis. Images were evaluated for quality control, and a training set containing representative images of benign and neoplastic tissue was assembled. After viewing training images, seven head and neck cancer specialists with no prior HRME experience reviewed 37 test images and were asked to classify each. Results The mean accuracy of all reviewers in correctly diagnosing neoplastic mucosa was 97 percent (95% Cl = 94–99%). The mean sensitivity and specificity were 98 percent (97–100%) and 92 percent (87–98%), respectively. The Fleiss kappa statistic for inter-rater reliability was 0.84 (0.77–0.91). Conclusions Medical professionals can be quickly trained to use HRME to discriminate between benign and neoplastic mucosa in the head and neck. With further development, the HRME shows promise as a method of real-time margin determination at the point of care.

Fluorescence confocal endomicroscopy of the cervix: pilot study on the potential and limitations for clinical implementation

“…A dichroic mirror allows for efficient separation of excitation and emission light and thus good contrast and comparably high image quality may be achieved. [21][22][23][24] The high imaging contrast of fluorescence endomicroscopy is paired with a limited imaging depth of about 50 μm owing to the finite permeation of the fluorophore dye.…”

Axial response of high-resolution microendoscopy in scattering media

“…The simplicity, low cost, and real-time imaging performance of the HRME system have led to its use by several research groups in laboratory studies [11][12][13][14][15][16][17][18][19][20][21][22][23][24] and in vivo clinical investigations [25][26][27][28]. However, the imaging properties of the HRME system have not been fully characterized; in particular, the axial imaging range and sensitivity to out-of-focus light have to the best of our knowledge, not been quantitatively studied.…”

Assessment of the sensitivity and specificity of tissue-specific-based and anatomical-based optical biomarkers for rapid detection of human head and neck squamous cell carcinoma

“…Fluorescence endoscopy relies on contrast agents for staining and imaging cell nuclei [6,7]. Time-domain Optical coherence tomography (OCT) system requires a Michelson interferometer to sample lesions in z-direction [8].…”