Interobserver agreement of confocal laser endomicroscopy for detection of head and neck neoplasia

Moore, Charles; Mehta, Vikas; Ma, Xiaomeng; Chaudhery, Shabnum; Shi, Runhua; Moore-Medlin, Tara; Lian, Timothy; Nathan, Cherie Ann O.

doi:10.1002/lary.25646

Cited by 22 publications

(22 citation statements)

References 21 publications

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“…Because there is no specific training programme for head and neck cancer, we had to opt for the use of the training programme available for the oesophagus, despite its limitations when extrapolated to the mucosa of the larynx. Moore et al reported an accuracy, sensitivity, specificity, PPV, and NPV of 100% using a similar methodical approach: 29 offline images and 6 video sequences 27 . Oetter et al 17 investigated the value of pCLE in the classification of lesions of the oral mucosa and suggested a classification and scoring system to facilitate the interpretation of these images by examiners without prior experience in this technique.…”

Section: Discussionmentioning

confidence: 99%

Probe-based confocal laser endomicroscopy in detecting malignant lesions of vocal folds

Goncalves

Aubreville

Müller

et al. 2019

Acta Otorhinolaryngol Ital

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Probe-based confocal laser endomicroscopy (CLE) is an innovative technique for real-time, non-invasive analysis of the surface epithelium. While being successfully used for diagnosis by experts, this method has not yet been established in clinical routine, partly due to the lack of standards and criteria for classifying various lesions. Our aim was to determine the diagnostic value and inter-rater reliability of CLE in detecting malignant lesions of the vocal cords. 58 video sequences were extracted from the probe-based CLE (GastroFlex probe with a Cellvizio ® laser system) examinations of 3 patients with squamous cell carcinomas and 4 patients with benign alterations of the vocal folds. Two ENT surgeons, who were blinded to the histological result, were asked to identify the sequences representing a carcinoma. We showed an accuracy, sensitivity, specificity, PPV and NPV of 91.38-96.55%, 100%, 87.8-95.2%, 77.27-89.47% and 100%, respectively, with an inter-rater reliability of k = 0.89 ("almost perfect agreement"). Probe-based CLE is a promising method for diagnosis and assessment of vocal fold lesions in vivo. Our results suggest that, with adequate training, the diagnostic value of this technique can be improved and potentially provide important information during oncological surgery. KEY WORDS: Confocal laser endomicroscopy • Laryngeal cancer • Non-invasive histological imaging • Vocal folds RIASSUNTO L'endomicroscopia confocale laser (CLE) tramite sonda è una tecnica innovativa per l'analisi in tempo reale non invasiva dell'epitelio di superficie. Mentre il suo uso diagnostico ha avuto successo tra gli specialisti, questo metodo non si è ancora affermato nella routine clinica, in parte anche per la mancanza di regole e criteri per la classificazione delle varie lesioni. Il nostro obiettivo era quello di determinare il valore diagnostico e l'affidabilità tra valutatori CLE nel rilevamento delle lesioni maligne delle corde vocali. Sono state estratte 58 sequenze video dagli esami CLE tramite sonda (sonda GastroFlex con un sistema laser Cellvizio ®) di 3 pazienti con carcinoma squamocellulare e di 4 pazienti con alterazioni benigne delle corde vocali. A due chirurghi ORL, in cieco per l'esame istologico, è stato chiesto di identificare le sequenze riguardanti un carcinoma.

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Section: Discussionmentioning

confidence: 99%

Probe-based confocal laser endomicroscopy in detecting malignant lesions of vocal folds

Goncalves

Aubreville

Müller

et al. 2019

Acta Otorhinolaryngol Ital

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“…OCT can delineate the internal structure of tissue by analyzing back-scattered light obtained from a tissue using an optical interferometer [45]. Moreover, pCLE can observe the tissue structure and vasculature of oral mucosa lesions in real time [46]. Therefore, ALA-PDD in combination with OCT and pCLE might clarify alternatives of cell metabolism and the tissue structure of oral mucosa lesions, thereby improving the diagnostic accuracy.…”

Section: Issues and Future Perspectivesmentioning

confidence: 99%

Non-Invasive Diagnostic System Based on Light for Detecting Early-Stage Oral Cancer and High-Risk Precancerous Lesions—Potential for Dentistry

Tatehara

Satomura

2020

Cancers

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Oral health promotion and examinations have contributed to the early detection of oral cancer and oral potentially malignant disorders, leading to the adaptation of minimally invasive therapies and subsequent improvements in the prognosis/maintenance of the quality of life after treatments. However, the accurate detection of early-stage oral cancer and oral epithelial dysplasia is particularly difficult for conventional oral examinations because these lesions sometimes resemble benign lesions or healthy oral mucosa tissues. Although oral biopsy has been considered the gold standard for accurate diagnosis, it is deemed invasive for patients. For this reason, most clinicians are looking forward to the development of non-invasive diagnostic technologies to detect and distinguish between cancerous and benign lesions. To date, several non-invasive adjunctive fluorescence-based detection systems have improved the accuracy of the detection and diagnosis of oral mucosal lesions. Autofluorescence-based systems can detect lesions as a loss of autofluorescence through irradiation with blue-violet lights. Photodynamic diagnosis using 5-aminolevulinic acid (ALA-PDD) shows the presence of very early oral cancers and oral epithelial dysplasia as a red fluorescent area. In this article, currently used fluorescence-based diagnostic methods are introduced and discussed from a clinical point of view.

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“…Low sensitivity was reported when sections had positive or close final margins and was mainly explained by incorrect sampling of the tumor bed or in resected specimens compared with final standard histology. Today, alternative intraoperative methods to improve tumor margins in head and neck surgery, such as Raman spectroscopy or endomicroscopy, are under investigation in preclinical and clinical studies [7,13,14]. In addition to their technical capabilities, these methods must also be considered according to the duration of the procedure, tumor location, and procedure cost.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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Background and Objectives In head and neck surgery, intraoperative and postoperative evaluation of tumor margins is achieved by histopathological assessment, which is a multistep process. Intraoperative analysis of tumor margins to obtain a preliminary diagnosis is usually carried out on frozen sections. Analysis of frozen sections is challenging due to technical difficulties in processing. Full‐field optical coherence tomography (FFOCT) provides ex vivo images of fresh tissue samples at a microscopic scale without tissue processing. The objectives of our study were to define the diagnostic criteria required to interpret head and neck FFOCT images and to evaluate the reliability of a histological diagnosis made on an “optical biopsy” produced by head and neck FFOCT imaging compared with conventional histology. Study Design/Materials and Methods First, we established an atlas of comparative images (FFOCT/standard histology) and defined the diagnostic criteria based on FFOCT images. Two pathologists subsequently performed a blinded review on 57 FFOCT images (32 patients). Specificity and sensitivity were measured by comparison with the standard histological diagnosis. The primary endpoint was major concordance, defined as two classifications leading to the same therapeutic decision (treatment/no treatment). Results Pathologists identified four main criteria for tissue diagnosis on FFOCT images: heterogeneous cell distribution, stromal reaction, coiling, and keratinization abnormalities. The correlation study showed good results, with sensitivity from 88% to 90% and specificity from 81% to 87%, regardless of whether the FFOCT image review was performed by a pathologist with or without previous experience in optical imaging. Conclusions Our results demonstrate that FFOCT images can be used by pathologists for differential diagnosis, and that high‐resolution FFOCT imaging can provide an assessment of microscopic architecture in head and neck tissues without tissue processing requirements. Lasers Surg. Med. © 2020 Wiley Periodicals, Inc.

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Interobserver agreement of confocal laser endomicroscopy for detection of head and neck neoplasia

Abstract: NA. Laryngoscope, 126:632-637, 2016.

Cited by 22 publications

References 21 publications

Probe-based confocal laser endomicroscopy in detecting malignant lesions of vocal folds

Probe-based confocal laser endomicroscopy in detecting malignant lesions of vocal folds

Non-Invasive Diagnostic System Based on Light for Detecting Early-Stage Oral Cancer and High-Risk Precancerous Lesions—Potential for Dentistry

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

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