Abstract
PurposeThis pilot study aimed to assess the feasibility of intraoperative assessment of safe margins with confocal laser endomicroscopy (CLE) during oropharyngeal squamous cell carcinoma (OPSCC) surgery.MethodsWe included five consecutive patients confirmed OPSCC and planned tumor resection in September and October 2020. Healthy appearing mucosa in the marginal zone, and the tumor margin, were examined with CLE and biopsy during tumor resection. A total of 12,809 CLE frames were correlated with the gold standard of hematoxylin and eosin staining. Three head and neck surgeons and one pathologist were asked to identify carcinoma in a sample of 169 representative images, blinded to the histological results.ResultsHealthy mucosa showed epithelium with uniform size and shape with distinct cytoplasmic membranes and regular vessel architecture. CLE optical biopsy of OPSCC demonstrated a disorganized arrangement of variable cellular morphology. We calculated an accuracy, sensitivity, specificity, PPV, and NPV of 86%, 90%, 79%, 88%, and 82%, respectively, with inter-rater reliability and κ-value of 0.60.ConclusionCLE can be easily integrated into the intraoperative setting, generate real-time, in-vivo microscopic images of the oropharynx for evaluation and demarcation of cancer. It can eventually contribute to a less radical approach by enabling a more precise evaluation of the cancer margin.
Highlights
The incidence of oropharyngeal squamous cell carcinoma (OPSCC) is rising in the last decades due to an increased number of infections with oncogenic human papillomavirus [1] and is currently one of the most frequent malignancies in the head and neck region [2]
The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated for each examiner
We report on the feasibility of in-vivo real-time intraoperative assessment of safe margins during tumor resection of OPSCC via confocal laser imaging
Summary
The incidence of oropharyngeal squamous cell carcinoma (OPSCC) is rising in the last decades due to an increased number of infections with oncogenic human papillomavirus [1] and is currently one of the most frequent malignancies in the head and neck region [2]. Treatment recommendations for advanced stage OPSCC suggest either primary chemoradiation therapy or primary surgery followed by risk-adapted adjuvant treatment. Both primary radiation and primary surgery proved to be therapeutic options [4]. According to the World Health Organization, squamous cell carcinoma (SCC) is classified into highly differentiated (grade 1), moderately differentiated (grade 2), and poorly differentiated (grade 3) cancer [5]. Grade 1 SCC exhibits a growth pattern that resembles a normal epithelium, whereas
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