Systematic Intraoperative Application of Confocal Endomicroscopy for Early Detection and Resection of Squamous Cell Carcinoma of the Head and Neck&lt;subtitle&gt;A Preliminary Report&lt;/subtitle&gt;&lt;alt-title&gt;Intraoperative Confocal Endomicroscopy for HNSCC&lt;/alt-title&gt;

Pogorzelski, Benjamin; Hanenkamp, U; Goetz, Martin; Kießlich, Ralf; Gosepath, Jan

doi:10.1001/archoto.2012.213

Cited by 36 publications

(11 citation statements)

References 14 publications

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“…In our study, five criteria were defined, taking into account the findings and expertise of our workgroup in the field of CLE. Furthermore, they were selected by correlating our findings to a number of valuable studies on tissue morphology of squamous cell cancer (SCC) in CLE imaging [3, 13, 23–26, 30]. …”

Section: Discussionmentioning

confidence: 99%

“…Recent studies showed promising results regarding a transfer of this imaging method to the area of the head and neck with a sufficient differentiation of pathological lesions to physiological tissue in the upper gastrointestinal tract like pharynx, larynx and the esophagus [3, 24–26]. Furthermore, preliminary results regarding CLE examinations in the oral cavity showed potentials for detecting cancerous lesions even in their early forms.…”

Section: Discussionmentioning

confidence: 99%

“…This number is expected to rise substantially over the next years [1]. Ten percent of all cancer cases are neoplasms of the head and neck area, of which more than 90 % are classified as squamous cell carcinomas (HNSCCs) [2, 3]. Main risk factors for Squamous Cell Carcinomas (SCC) of the oral cavity are the consumption of tobacco or alcohol [4].…”

Section: Introductionmentioning

confidence: 99%

“…Confocal laser endomicroscopy (CLE) was recently introduced as a novel technique allowing in vivo microscopic evaluation of the tissue during the ongoing examination in real time by providing an optical biopsy [3, 13]. This biomedical method could enable an in vivo diagnosis and can be reproduced almost indefinitely without iatrogenic damage to the patient and the need for additional human resources.…”

Section: Introductionmentioning

confidence: 99%

“…Also preliminary results for a CLE diagnosis of oral cancer are promising [3, 13, 19–26]. Transferring first experimental results of CLE in the human oral cavity into a valid and evidence based clinical setting is an essential step for this imaging tool on its way from bench to bedside [27].…”

Section: Introductionmentioning

confidence: 99%

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Development and validation of a classification and scoring system for the diagnosis of oral squamous cell carcinomas through confocal laser endomicroscopy

et al. 2016

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BackgroundConfocal laser endomicroscopy (CLE) is an optical biopsy method allowing in vivo microscopic imaging at 1000-fold magnification. It was the aim to evaluate CLE in the human oral cavity for the differentiation of physiological/carcinomatous mucosa and to establish and validate, for the first time, a scoring system to facilitate CLE assessment.MethodsThe study consisted of 4 phases: (1) CLE-imaging (in vivo) was performed after the intravenous injection of fluorescein in patients with histologically confirmed carcinomatous oral mucosa; (2) CLE-experts (n = 3) verified the applicability of CLE in the oral cavity for the differentiation between physiological and cancerous tissue compared to the gold standard of histopathological assessment; (3) based on specific patterns of tissue changes, CLE-experts (n = 3) developed a classification and scoring system (DOC-Score) to simplify the diagnosis of oral squamous cell carcinomas; (4) validation of the newly developed DOC-Score by non-CLE-experts (n = 3); final statistical evaluation of their classification performance (comparison to the results of CLE-experts and the histopathological analyses).ResultsExperts acquired and edited 45 sequences (260 s) of physiological and 50 sequences (518 s) of carcinomatous mucosa (total: 95 sequences/778 s). All sequences were evaluated independently by experts and non-experts (based on the newly proposed classification system). Sensitivity (0.953) and specificity (0.889) of the diagnoses by experts as well as sensitivity (0.973) and specificity (0.881) of the non-expert ratings correlated well with the results of the present gold standard of tissue histopathology. Experts had a positive predictive value (PPV) of 0.905 and a negative predictive value (NPV) of 0.945. Non-experts reached a PPV of 0.901 and a NPV of 0.967 with the help of the DOC-Score. Inter-rater reliability (Fleiss` kappa) was 0.73 for experts and 0.814 for non-experts. The intra-rater reliability (Cronbach’s alpha) of the experts was 0.989 and 0.884 for non-experts.ConclusionsCLE is a suitable and valid method for experts to diagnose oral cancer. Using the DOC-Score system, an accurate chair-side diagnosis of oral cancer is feasible with comparable results to the gold standard of histopathology—even in daily clinical practice for non-experienced raters.

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