Intraoperative assessment of laryngeal pathologies with optical coherence tomography integrated into a surgical microscope

Englhard, Anna S.; Betz, Tom; Volgger, Veronika; Lankenau, Eva; Ledderose, Georg; Stepp, Herbert; Homann, Christian; Betz, Christian

doi:10.1002/lsm.22632

Cited by 15 publications

(13 citation statements)

References 34 publications

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“…Based upon system configuration, various low coherent near-infrared light sources are used, including super luminescent diodes (SLD) [8] and swept vertical cavity surface emitting lasers (VCSELs) [11]. Various OCT probes and hand piece designs-including microscopes, rigid endoscopes, and flexible endoscopesallow for forward viewing [8,[12][13][14][15][16][17][18][19][20][21][22][23][24][25], side viewing [11,[26][27][28][29][30][31][32], or rotary viewing [33,34]. Using a TD system with a forward facing probe, Sergeev et al first demonstrated the feasibility of using endoscopic OCT to image the mucosa of various organs, including the larynx [17].…”

Section: Introductionmentioning

confidence: 99%

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Computational analysis of six optical coherence tomography systems for vocal fold imaging: A comparison study

et al. 2019

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Objectives There have been many advancements in laryngeal imaging using optical coherence tomography (OCT), with varying system design and probes for use in research, office, and operating room settings. We evaluated the performance of six distinct OCT systems in imaging porcine vocal folds (cords) using computational image processing and segmentation. Methods Porcine vocal folds were scanned using six OCT systems. Imaging system and probe performance were quantitatively assessed for signal penetration, layer differentiation, and epithelium (EP) measurement. Fitted exponential decay curves with corresponding α constant and intensity thresholding segmentation were utilized to quantify the aforementioned parameters. Results The smallest average α constant and deepest signal penetration was of the SS‐OCT 1700 nm 90 kHz microscope system (α = −1.74), followed by the SS‐OCT 1310 nm 200 kHz VCSEL microscope system (α = −1.99), and SS‐OCT 1310 nm 50 kHz rigid forward viewing endoscope system (α = −2.23). The EP was not readily visualized for three out of six systems, but was detected using automated segmentation. Average EP thickness (mean ± SD) was calculated as 55.79 ± 31.86 μm which agrees favorably with previous literature. Conclusion Comparisons of OCT systems are challenging, as they encompass different probe design, optical path, and lasers, depending on application. Practical evaluation of different systems using computer based quantitative image processing and segmentation revealed basic, constructive information, such as EP measurements. To further validate the comparisons of system performance with clinical usability, in vivo human laryngeal imaging will be conducted. Further development of automated image processing and segmentation can be useful in rapid analysis of information. Lasers Surg. Med. 51:412–422, 2019. © 2019 Wiley Periodicals, Inc.

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Section: Introductionmentioning

confidence: 99%

“…Advancements in image acquisition speed and phase stability of laryngeal endoscopic OCT has allowed for acquisition of functional information during phonation and vocal fold vibration . Furthermore, OCT imaging systems have been integrated into surgical microscopes for hands‐free image acquisition during direct laryngoscopy .…”

Section: Introductionmentioning

confidence: 99%

Computational analysis of six optical coherence tomography systems for vocal fold imaging: A comparison study

et al. 2019

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“…CE requires topical staining and is only able to clearly image the superficial layers of the epithelium [45]. Previous ex vivo and probe-based in vivo diagnostic efforts using OCT for laryngeal cancer have demonstrated the technique's performance in distinguishing normal from cancerous tissue [52,[56][57][58][59]. Nevertheless, its maximum penetration depth of~2 mm restricts its use to peripheral margin assessment.…”

Section: Discussionmentioning

confidence: 99%

Current Intraoperative Imaging Techniques to Improve Surgical Resection of Laryngeal Cancer: A Systematic Review

Lauwerends

Galema

Hardillo

et al. 2021

Cancers

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Laryngeal cancer is a prevalent head and neck malignancy, with poor prognosis and low survival rates for patients with advanced disease. Treatment consists of unimodal therapy through surgery or radiotherapy in early staged tumors, while advanced stage tumors are generally treated with multimodal chemoradiotherapy or (total) laryngectomy followed by radiotherapy. Still, the recurrence rate for advanced laryngeal cancer is between 25 and 50%. In order to improve surgical resection of laryngeal cancer and reduce local recurrence rates, various intraoperative optical imaging techniques have been investigated. In this systematic review, we identify these technologies, evaluating the current state and future directions of optical imaging for this indication. Narrow-band imaging (NBI) and autofluorescence (AF) are established tools for early detection of laryngeal cancer. Nonetheless, their intraoperative utility is limited by an intrinsic inability to image beyond the (sub-)mucosa. Likewise, contact endoscopy (CE) and optical coherence tomography (OCT) are technically cumbersome and only useful for mucosal margin assessment. Research on fluorescence imaging (FLI) for this application is sparse, dealing solely with nonspecific fluorescent agents. Evidently, the imaging modalities that have been investigated thus far are generally unsuitable for deep margin assessment. We discuss two optical imaging techniques that can overcome these limitations and suggest how they can be used to achieve adequate margins in laryngeal cancer at all stages.

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“…The OCT examination of the VFs is a promising approach, due to the high-resolution of the images [57][58][59][60][61][62]. Imaging the different layers of the VFs, the OCT surpassed the US imaging [59,62].…”

Section: Measurements On the Vfsmentioning

confidence: 99%

Imaging the Vocal Folds: A Feasibility Study on Strain Imaging and Elastography of Porcine Vocal Folds

et al. 2019

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Vocal folds are an essential part of human voice production. The biomechanical properties are a good indicator for pathological changes. In particular, as an oscillation system, changes in the biomechanical properties have an impact on the vibration behavior. Subsequently, those changes could lead to voice-related disturbances. However, no existing examination combines biomechanical properties and spatial imaging. Therefore, we propose an image registration-based approach, using ultrasound in order to gain this information synchronously. We used a quasi-static load to compress the tissue and measured the displacement by image registration. The strain distribution was directly calculated from the displacement field, whereas the elastic properties were estimated by a finite element model. In order to show the feasibility and reliability of the algorithm, we tested it on gelatin phantoms. Further, by examining ex vivo porcine vocal folds, we were able to show the practicability of the approach. We displayed the strain distribution in the tissue and the elastic properties of the vocal folds. The results were superimposed on the corresponding ultrasound images. The findings are promising and show the feasibility of the suggested approach. Possible applications are in improved diagnosis of voice disorders, by measuring the biomechanical properties of the vocal folds with ultrasound. The transducer will be placed on the vocal folds of the anesthetized patient, and the elastic properties will be measured. Further, the understanding of the vocal folds’ biomechanics and the voice forming process could benefit from it.

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Intraoperative assessment of laryngeal pathologies with optical coherence tomography integrated into a surgical microscope

Cited by 15 publications

References 34 publications

Computational analysis of six optical coherence tomography systems for vocal fold imaging: A comparison study

Computational analysis of six optical coherence tomography systems for vocal fold imaging: A comparison study

Current Intraoperative Imaging Techniques to Improve Surgical Resection of Laryngeal Cancer: A Systematic Review

Imaging the Vocal Folds: A Feasibility Study on Strain Imaging and Elastography of Porcine Vocal Folds

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