Abstract
Optical coherence tomography (OCT) is a new imaging modality that uses near-infrared light to produce cross-sectional images of tissue with a resolution approaching that of light microscopy. We have previously reported use of OCT imaging of the vocal folds (VFs) during direct laryngoscopy with a probe held in contact or near-contact with the VFs. This aim of this study was to develop and evaluate a novel OCT system integrated with a surgical microscope to allow hands-free OCT imaging of the VFs, which could be performed simultaneously with microscopic visualization. We performed a prospective evaluation of a new method of acquiring OCT images of the VFs. An OCT system was successfully integrated with a surgical microscope to permit noncontact OCT imaging of the VFs of 10 patients. With this novel device we were able to identify VF epithelium and lamina propria; however, the resolution was reduced compared to that achieved with the standard contact or near-contact OCT. Optical coherence tomography is able to produce high-resolution images of vocal fold mucosa to a maximum depth of 1.6 mm. It may be used in the diagnosis of VF lesions, particularly early squamous cell carcinoma, in which OCT can show disruption of the basement membrane. Mounting the OCT device directly onto the operating microscope allows hands-free noncontact OCT imaging and simultaneous conventional microscopic visualization of the VFs. However, the lateral resolution of the OCT microscope system is 50 microm, in contrast to the conventional handheld probe system (10 microm). Although such images at this resolution are still useful clinically, improved resolution would enhance the system's performance, potentially enabling real-time OCT-guided microsurgery of the larynx.
Highlights
Optical coherence tomography (OCT) is a new imaging modality that combines low coherence light and interferometry to produce cross-sectional images of tissue structures
Images of normal or nearly normal vocal folds were obtained in each case, but images could not be obtained in areas of exophytic squamous cell carcinoma (SCC), especially if the lesions were friable and bleeding
In this report we have focused on the preliminary evaluation of a novel OCT system, in which the OCT scanner has been integrated with a surgical microscope to permit noncontact OCT imaging of the vocal folds, and attempted to define the potential advantages and limitations of such a device
Summary
Optical coherence tomography (OCT) is a new imaging modality that combines low coherence light and interferometry to produce cross-sectional images of tissue structures. Our group has previously reported our experience with OCT imaging using a handheld probe held in contact or near-contact with the mucosal surface under examination in 1) normal larynges2; 2) laryngeal cancer3; 3) the oral cavity and oropharynx4; 4) the nasal cavity[5]; and 5) the pediatric[6] and neonatal[7] airways. The contact or near-contact OCT system has obtained excellent images, which have provided detailed information on the layered structure of the mucosa from various sites of the upper aerodigestive tract (UADT) in a noninvasive manner. The line of demarcation between these two layers represents the basement membrane, the disruption of which is diagnostic for malignancy.[3,8] Other investigators have used a similar handheld probe OCT system to image the vocal folds.[9,10,11,12,13]
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