TY - JOUR
T1 - Operative margin control with high-resolution optical microendoscopy for head and neck squamous cell carcinoma
AU - Miles, Brett A.
AU - Patsias, Alexis
AU - Quang, Timothy
AU - Polydorides, Alexandros D.
AU - Richards-Kortum, Rebecca
AU - Sikora, Andrew G.
N1 - Publisher Copyright:
© 2015 The American Laryngological, Rhinological and Otological Society, Inc.
PY - 2015/10/1
Y1 - 2015/10/1
N2 - Objectives/Hypothesis High-resolution microendoscopy (HRME) provides real-time visualization of the mucosal surface in the upper aerodigestive tract. This technology allows noninvasive discrimination of benign and neoplastic epithelium and has potential applications for intraoperative margin detection. Study Design Single institution, prospective, feasibility trial (phase I) of in vivo optical imaging. Methods The study was conducted on patients with squamous cell carcinoma of the upper aerodigestive tract. High-resolution microendoscopy images obtained during surgery were correlated with histopathologic diagnosis to determine the ability of HRME to differentiate between benign and malignant mucosa. Blinded reviewers evaluated HRME images and made determinations of the status of the mucosa. Accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and interrater agreement between multiple raters were calculated to determine the accuracy of HRME imaging. Results The mean accuracy of reviewers in differentiating neoplastic or benign mucosa was 95.1% (95% confidence interval [CI], 94%-96 %). Sensitivity and specificity were 96% (95% CI, 94%-99 %) and 95% (95 % CI, 90%-99 %), respectively. The NPV was 98% (95% CI, 97%-99%), and PPV was 91% (95% CI, 85%-98%). The Fleiss kappa statistic for interrater reliability was 0.81, with a standard error of 0.014 and a 95% CI (0.78-0.84). Conclusion High-resolution microendoscopy allows real-time discrimination between benign and neoplastic mucosa. High levels of sensitivity and specificity can be obtained with this technology when interrogating mucosal surfaces. Despite several technical limitations, HRME shows promise as a technique for intraoperative margin control and platform for molecular imaging technologies.
AB - Objectives/Hypothesis High-resolution microendoscopy (HRME) provides real-time visualization of the mucosal surface in the upper aerodigestive tract. This technology allows noninvasive discrimination of benign and neoplastic epithelium and has potential applications for intraoperative margin detection. Study Design Single institution, prospective, feasibility trial (phase I) of in vivo optical imaging. Methods The study was conducted on patients with squamous cell carcinoma of the upper aerodigestive tract. High-resolution microendoscopy images obtained during surgery were correlated with histopathologic diagnosis to determine the ability of HRME to differentiate between benign and malignant mucosa. Blinded reviewers evaluated HRME images and made determinations of the status of the mucosa. Accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and interrater agreement between multiple raters were calculated to determine the accuracy of HRME imaging. Results The mean accuracy of reviewers in differentiating neoplastic or benign mucosa was 95.1% (95% confidence interval [CI], 94%-96 %). Sensitivity and specificity were 96% (95% CI, 94%-99 %) and 95% (95 % CI, 90%-99 %), respectively. The NPV was 98% (95% CI, 97%-99%), and PPV was 91% (95% CI, 85%-98%). The Fleiss kappa statistic for interrater reliability was 0.81, with a standard error of 0.014 and a 95% CI (0.78-0.84). Conclusion High-resolution microendoscopy allows real-time discrimination between benign and neoplastic mucosa. High levels of sensitivity and specificity can be obtained with this technology when interrogating mucosal surfaces. Despite several technical limitations, HRME shows promise as a technique for intraoperative margin control and platform for molecular imaging technologies.
KW - HRME
KW - diagnostic
KW - frozen section
KW - head and neck cancer
KW - squamous cell carcinoma
KW - surgical margins
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U2 - 10.1002/lary.25400
DO - 10.1002/lary.25400
M3 - Article
C2 - 26059758
AN - SCOPUS:84942832030
SN - 0023-852X
VL - 125
SP - 2308
EP - 2316
JO - Laryngoscope
JF - Laryngoscope
IS - 10
ER -