Matti Sievert1, Nicolai Oetter2, Marc Aubreville3, Florian Stelzle2, Andreas Maier3, Markus Eckstein4, Konstantinos Mantsopoulos1, Antoniu-Oreste Gostian1, Sarina K Mueller1, Michael Koch1, Abbas Agaimy4, Heinrich Iro1, Miguel Goncalves5. 1. Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, University Hospital, Waldstraße 1, 91054 Erlangen, Germany. 2. Department of Maxillofacial Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, University Hospital, Erlangen, Germany. 3. Pattern Recognition Lab, Computer Science, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany. 4. Institute of Pathology, Friedrich-Alexander-Universität Erlangen-Nürnberg, University Hospital, Erlangen, Germany. 5. Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, University Hospital, Waldstraße 1, 91054 Erlangen, Germany. Electronic address: mgoncalves@ukaachen.de.
Abstract
OBJECTIVE: This pilot study aimed to assess the feasibility of intraoperative assessment of safe margins with Confocal Laser Endomicroscopy (CLE) during planned partial or total laryngectomy. METHODS: Eight patients with confirmed larynx squamous cell carcinoma (SCC) and planned partial or total laryngectomy were included in this study in March 2020. Two head and neck surgeons and one pathologist were asked to classify carcinoma or healthy epithelium in a sample of 94 representative sequences (5.640 images), blinded to the histological results (H&E staining). RESULTS: Healthy mucosa areas showed epithelium with cells of uniform size and shape with distinct cytoplasmic membranes and regular vessel architecture. CLE optical biopsy of SCC demonstrated a disorganized arrangement of variable cellular morphology. We calculated an accuracy, sensitivity, specificity, PPV, and NPV of 80.1%, 72.3%, 87.9%, 85.7%, and 76.1%, respectively. A distinct transition between healthy appearing tissue and suspicious lesions could also be detected. CONCLUSION: CLE can be easily integrated into the intraoperative setting, generate real-time, in-vivo microscopic images of the larynx for evaluation and demarcation of cancer. If validated in further studies, CLE could eventually contribute to a less radical approach by enabling a more precise evaluation of the cancer margin.
OBJECTIVE: This pilot study aimed to assess the feasibility of intraoperative assessment of safe margins with Confocal Laser Endomicroscopy (CLE) during planned partial or total laryngectomy. METHODS: Eight patients with confirmed larynx squamous cell carcinoma (SCC) and planned partial or total laryngectomy were included in this study in March 2020. Two head and neck surgeons and one pathologist were asked to classify carcinoma or healthy epithelium in a sample of 94 representative sequences (5.640 images), blinded to the histological results (H&E staining). RESULTS: Healthy mucosa areas showed epithelium with cells of uniform size and shape with distinct cytoplasmic membranes and regular vessel architecture. CLE optical biopsy of SCC demonstrated a disorganized arrangement of variable cellular morphology. We calculated an accuracy, sensitivity, specificity, PPV, and NPV of 80.1%, 72.3%, 87.9%, 85.7%, and 76.1%, respectively. A distinct transition between healthy appearing tissue and suspicious lesions could also be detected. CONCLUSION: CLE can be easily integrated into the intraoperative setting, generate real-time, in-vivo microscopic images of the larynx for evaluation and demarcation of cancer. If validated in further studies, CLE could eventually contribute to a less radical approach by enabling a more precise evaluation of the cancer margin.
Authors: Matti Sievert; Konstantinos Mantsopoulos; Sarina K Mueller; Markus Eckstein; Robin Rupp; Marc Aubreville; Florian Stelzle; Nicolai Oetter; Andreas Maier; Heinrich Iro; Miguel Goncalves Journal: Acta Otorhinolaryngol Ital Date: 2022-02-07 Impact factor: 2.618
Authors: Matti Sievert; Marc Aubreville; Antoniu-Oreste Gostian; Konstantinos Mantsopoulos; Michael Koch; Sarina Katrin Mueller; Markus Eckstein; Robin Rupp; Florian Stelzle; Nicolai Oetter; Andreas Maier; Heinrich Iro; Miguel Goncalves Journal: Eur Arch Otorhinolaryngol Date: 2022-02-28 Impact factor: 3.236