Abstract
Simple SummaryLaryngeal cancer is a prevalent head and neck malignancy, with poor prognosis and low survival rates for patients with advanced disease. 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. Evidently, the investigated imaging modalities are generally unsuitable for deep margin assessment, and, therefore, inadequate to guide resection in advanced laryngeal disease. 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.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.
Highlights
With almost 40,000 cases in Europe in 2018 [1], laryngeal cancer is the second most common malignancy of the head and neck region
These studies reported on the following imaging techniques: narrow-band imaging (10), autofluorescence (3), fluorescence (2), contact endoscopy (2), and optical coherence tomography (1)
The demonstrated effectiveness of Narrow-band imaging (NBI) in the early diagnosis of laryngeal cancer has led to reasonable evidence for its application in intraoperative margin detection, inclusion of patients with T3–T4 laryngeal cancer is rare
Summary
With almost 40,000 cases in Europe in 2018 [1], laryngeal cancer is the second most common malignancy of the head and neck region. More advanced staged laryngeal squamous cell carcinoma (SCC) have been reported to have recurrence rates ranging between 25 and 50% [4] These tumors are associated with loss of laryngeal function and poor prognosis, with 5-year survival rates dropping to 40% for patients with stage IV disease [2]. Numerous studies on laryngeal cancer produce inconsistent results with regards to margin status and local control or relapse rate [7,8,9,10] This is caused by both post-resection and -fixation shrinkage of the tissue specimen and cauterization artefacts associated with laser carbonization, which hamper an adequate histological evaluation of the surgical margins in those cases [11]. A positive margin on the tissue specimen may not always indicate that there are residual tumor cells in the wound bed [12]
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