Intra-operative point-of-procedure delineation of oral cancer margins using optical coherence tomography

Abstract

Objectives: Surgical margin status is a significant determinant of treatment outcome in oral cancer. Negative surgical margins can decrease the loco-regional recurrence by five-fold. The current standard of care of intraoperative clinical examination supplemented by histological frozen section, can result in a risk of positive margins from 5to 17 percent. In this study, we attempted to assess the utility of intraoperative optical coherence tomography (OCT) imaging with automated diagnostic algorithm to improve on the current method of clinical evaluation of surgical margin in oral cancer. Materials and methods: We have used a modified handheld OCT device with automated algorithm based diagnostic platform for imaging. Intraoperatively, images of 125 sites were captured from multiple zones around the tumor of oral cancer patients (n = 14) and compared with the clinical and pathologic diagnosis. Results: OCT showed sensitivity and specificity of 100%, equivalent to histological diagnosis (kappa, κ = 0.922), in detection of malignancy within tumor and tumor margin areas. In comparison, for dysplastic lesions, OCT-based detection showed a sensitivity of 92.5% and specificity of 68.8% and a moderate concordance with histopathology diagnosis (κ = 0.59). Additionally, the OCT scores could significantly differentiate squamous cell carcinoma (SCC) from dysplastic lesions (mild/moderate/severe; p ≤ 0.005) as well as the latter from the nondysplastic lesions (p ≤ 0.05). Conclusion: The current challenges associated with clinical examination-based margin assessment could be improved with intra-operative OCT imaging. OCT is capable of identifying *

Value of Full‐Field Optical Coherence Tomography Imaging for the Histological Assessment of Head and Neck Cancer

“…In other cases, precancerous zones were associated with infiltrating carcinoma, leading a final diagnosis of invasive carcinoma. Recently, Sunny et al described in vivo OCT imaging with the implementation of an algorithm‐based prediction to differentiate between non‐dysplastic, dysplastic, and cancerous tissue in 125 images [27,42]. The ability to grade dysplasia and more precisely high‐grade dysplasia/in situ carcinoma is needed for further clinical adoption.…”

“…Studies in head and neck cancer describe the use of OCT for ex vivo microscopic assessment of lesions [23] or in vivo imaging [24–26]. OCT was able to give information about tissue thickness and basement membrane integrity and was also able to distinguish between non‐cancerous tissues and HNSCC with sensitivity and specificity up to 100% [27].…”

The use of optical coherence tomography and convolutional neural networks to distinguish normal and abnormal oral mucosa

“…Tissue contrast does not: (1) depend upon biochemical absorbers such as in fluorescence imaging, (2) require the use of exogenous dyes or stains (requiring regulatory approval), and (3) does not require special modification of operating room ambient lighting such as in many fluorescent techniques. OCT has been shown to differentiate normal and abnormal oral mucosa . However, direct subjective interpretation of OCT images by human observers requires extensive training .…”

“…OCT has been shown to differentiate normal and abnormal oral mucosa. [4,[8][9][10][11][12][13][14][15][16] However, direct subjective interpretation of OCT images by human observers requires extensive training. [11] Since contemporary OCT systems may acquire more than 40 images/second, the overwhelming amount of data generated poses a challenge for clinical interpretation.…”

Prospective evaluation of oral premalignant lesions using a multimodal imaging system: a pilot study

“…However, it is challenging to optimally select which OPLs to biopsy and to select a biopsy location, particularly for patients with large, multifocal, or heterogeneous lesions . Several diagnostic adjuncts have been investigated to aid in OPL evaluation, including vital stains such as toluidine blue, brush biopsies, salivary tests, light‐based adjuncts such as macroscopic autofluorescence imaging (AF), and in recent years, in‐vivo microscopy techniques . Unfortunately, no adjunct has been shown to have sufficient diagnostic accuracy for high‐grade dysplasia and cancer to warrant routine use …”