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Clinical Trial
. 2012 Oct;19(11):3534-9.
doi: 10.1245/s10434-012-2351-1. Epub 2012 Apr 11.

Discrimination of benign and neoplastic mucosa with a high-resolution microendoscope (HRME) in head and neck cancer

Peter M Vila  1 , Chan W Park, Mark C Pierce, Gregg H Goldstein, Lauren Levy, Vivek V Gurudutt, Alexandros D Polydorides, James H Godbold, Marita S Teng, Eric M Genden, Brett A Miles, Sharmila Anandasabapathy, Ann M Gillenwater, Rebecca Richards-Kortum, Andrew G Sikora
Affiliations
Clinical Trial

Discrimination of benign and neoplastic mucosa with a high-resolution microendoscope (HRME) in head and neck cancer

Peter M Vila et al. Ann Surg Oncol. 2012 Oct.

Abstract

Background: The efficacy of ablative surgery for head and neck squamous cell carcinoma (HNSCC) depends critically on obtaining negative margins. Although intraoperative "frozen section" analysis of margins is a valuable adjunct, it is expensive, time-consuming, and highly dependent on pathologist expertise. Optical imaging has potential to improve the accuracy of margins by identifying cancerous tissue in real time. Our goal was to determine the accuracy and inter-rater reliability of head and neck cancer specialists using high-resolution microendoscopic (HRME) images to discriminate between cancerous and benign mucosa.

Methods: Thirty-eight patients diagnosed with head and neck squamous cell carcinoma (HNSCC) were enrolled in this single-center study. HRME was used to image each specimen after application of proflavine, with concurrent standard histopathologic analysis. Images were evaluated for quality control, and a training set containing representative images of benign and neoplastic tissue was assembled. After viewing training images, seven head and neck cancer specialists with no previous HRME experience reviewed 36 test images and were asked to classify each.

Results: The mean accuracy of all reviewers in correctly diagnosing neoplastic mucosa was 97% (95% confidence interval (CI), 94-99%). The mean sensitivity and specificity were 98% (97-100%) and 92% (87-98%), respectively. The Fleiss kappa statistic for inter-rater reliability was 0.84 (0.77-0.91).

Conclusions: Medical professionals can be quickly trained to use HRME to discriminate between benign and neoplastic mucosa in the head and neck. With further development, the HRME shows promise as a method of real-time margin determination at the point of care.

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Figures

Figure 1
Figure 1
The high-resolution microendoscope (HRME), shown in a schematic (A) and fully assembled before imaging (B).
Figure 2
Figure 2
Representative HRME Images from the oropharynx of (A) benign mucosa and (B) squamous cell carcinoma, with corresponding H+E histopathologic images. Note that HRME images are obtained parallel to the tissue surface, while the H+E sections are in cross-section.
Figure 3
Figure 3
Representative HRME Images from various sites of benign (top) and cancerous (bottom) mucosa in the (A) oral cavity, (B) oropharynx, and (C) larynx.
Figure 4
Figure 4
Results of the interpretation of HRME images of benign mucosa vs. invasive cancer for representative still images.
See this image and copyright information in PMC

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