Abstract
PurposeConfocal laser endomicroscopy (CLE) allows imaging of the laryngeal mucosa in a thousand-fold magnification. This study analyzes differences in tissue homogeneity between healthy mucosa and squamous cell carcinoma (SCC) via CLE.Materials and methodsWe included five SCC patients with planned total laryngectomy in this study between October 2020 and February 2021. We captured CLE scans of the tumor and healthy mucosa. Analysis of image homogeneity to diagnose SCC was performed by measuring the signal intensity in four regions of interest (ROI) in each frame in a total of 60 sequences. Each sequence was assigned to the corresponding histological pattern, derived from hematoxylin and eosin staining. In addition, we recorded the subjective evaluation of seven investigators regarding tissue homogeneity.ResultsOut of 3600 images, 1620 (45%) correlated with benign mucosa and 1980 (55%) with SCC. ROIs of benign mucosa and SCC had a mean and standard deviation (SD) of signal intensity of, respectively, 232.1 ± 3.34 and 467.3 ± 9.72 (P < 0.001). The mean SD between the four different ROIs was 39.1 ± 1.03 for benign and 101.5 ± 2.6 for SCC frames (P < 0.001). In addition, homogeneity yielded a sensitivity and specificity of 81.8% and 86.2%, respectively, regarding the investigator-dependent analysis.ConclusionsSCC shows a significant tissue inhomogeneity in comparison to the healthy epithelium. The results support this feature’s importance in identifying malignant mucosa areas during CLE examination. However, the examiner-dependent evaluation emphasizes that homogeneity is a sub-criterion that must be considered in a broad context.
Highlights
Squamous cell carcinoma (SCC) is considered responsible for over 90% of all pharyngeal and nearly 100% of the larynx malignancies [1]
We demonstrate a difference in tissue homogeneity given by the standard deviation (SD) of the 4 regions of interest (ROI) in the field of view of the confocal laser endomicroscopy (CLE) frames with values of 39.1 ± 1.03 and 101.5 ± 2.6 for the healthy epithelium and SCC, respectively (P < 0.001)
The identical sequences were evaluated by seven blinded raters which identified, on average, tissue inhomogeneity in 14.8% of CLE sequences recorded in healthy mucosa and 81.8% in SCC (P < 0.001) and is, in line with the objective method using the kinetic graph from the Cellvizio Software
Summary
Squamous cell carcinoma (SCC) is considered responsible for over 90% of all pharyngeal and nearly 100% of the larynx malignancies [1]. After initially being intensively studied in gastroenterology, research has expanded to other areas, such as pneumology [11], urology [12], neurosurgery [13], and the head and neck region. This method utilizes a small laser scanning probe (1–3 mm) gently applied to the area of interest. The reliable interpretation and classification in malignant and normal findings are not trivial, require training, and are usually aided by classification systems [16–19]. In these classification systems, capillary aberrations and tissue homogeneity play a significant role. Even though an 80–90% accuracy is reported in earlier publications, examiner dependency is still a major problem to broad implementation of this technique [20–22]
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