Contact Endoscopy Research Articles

Novel Endoscopic Imaging Techniques Toward In Vivo Observation of Living Cancer Cells in the Gastrointestinal Tract

It is now possible to perform microscopic imaging of living cells from both normal mucosa and malignant tissue in the gastrointestinal tract. Endocytoscopy is a catheter-type contact endoscope that has more than 1000-fold magnifying power and can pass through the working channel of the straight-view endoscope. In esophageal cells, the nucleus, cell body, and even the nucleolus were clearly distinguished with high-resolution images comparable with those of conventional cytology. This novel technology has the potential to provide histologic diagnoses during endoscopic examinations, similar to those obtained currently by conventional histology techniques.

Contact endoscopy during cholecystectomy: A new technique for staging laparoscopy in gallbladder cancers

Background and study aims: Contact endoscopy is a technique allowing detailed magnified imaging of living epithelium, used extensively to assess tissues of gynecological and laryngeal origan. We used this technique during cholecystectomy to investigate its potential value for staging laparoscopy in gallbladder cancer.Patients and methods: Eight patients with gallbladder cancer, four with mucosal hyperplasia, two with benign polyps and nine with gallstones were evaluated. During surgery, the lens of the contact endoscope (8715AA, 5.5 mm in diameter with a 0° angle) was placed in contact with the serosa of the gallbladder and observations were performed at magnifications of 60 × and 150 ×.Results: Enlarged color images of the subserosal layer of the gallbladder were obtained. In normal mucosa, a fine vascular network with flowing erythrocytes was observed in the subserosal layer. Subserosal fat appeared as tortoiseshell‐like markings, shown histologically to be clumps of fat cells surrounded by fine fibrous tissue. A gap between the deep vessels and the superficial vessels in the subserosal fat was also observed. The same findings were detected in gallbladder cancer patients where invasion was limited to the muscular layer. However, in patients with advanced gallbladder cancer, with invasion beyond the muscular layer, both the vessel gap and the fat tissue markings were absent. There was also encasement of the vessels and decreased intravascular flow of erythrocytes.Conclusions: The contact endoscope can be useful in differentiating between early and advanced gallbladder cancer and has some potential for use in staging laparoscopy for gallbladder cancer.

Rigid telescopy and contact endoscopy in the diagnosis and surgery of Reinke’s oedema: Clinical and histological assessment

We focussed our attention on the use of both rigid telescopy and contact endoscopy in order to assess their effectiveness in the diagnosis and surgery of Reinke's oedema. Changes were observed in a sample of 40 patients, suffering from different stages of Reinke's oedema, who had undergone microlaryngoscopies. For the first time during our laryngological praxis, we discussed a number of parameters that appeared to be significant in the monitoring and detailed evaluation of this vocal fold disease. With contact endoscopy, during the early stages of the disease, the cells and nuclei of normal squamous layered epithelium continued to display uniform morphological features. The appearance of epithelial changes helps to distinguish between different stages of Reinke's oedema, which can be associated with severe inflammation or keratinisation. With latter-stage oedemas, the following was observed: various changes in the blood vessels of the glottis, which when viewed through the endoscope have an unusual "loop-like" or "branching" appearance, as well as elongated and varicose blood vessels, and the build-up of erythrocytes inside atypical capillaries. Both endoscope techniques are non-invasive and very appropriate for precisely diagnosing Reinke's oedema within a relatively short period of time. Rigid telescopy has the advantage of enabling the systematic observation of many details in the large area of both vocal fold mucosae, particularly when access to the larynx is difficult. This enables dynamic monitoring and immediate pathology consultations inside the operating theatre. The special contribution of contact endoscopy is that, both in vivo and in situ, it allows a detailed scanning and mapping to be performed of all cell changes and ofvascularisation throughout the entire mucosa surface. Video-assisted telescopy does not permit a completely first-rate surgical resection of Reinke's oedema, because of unsatisfactory control or insufficient stability of the instrument during the operation using the one-handed method.

Making a diagnosis of different lesions of vocal fold mucosa by contact endoscopy: The first usage in our clinical practice

During laryngomicroscopy, the superficial layers of vocal fold epithelium can be examined in vivo and in situ by contact endoscopy. Methylene blue is applied initially to stain the epihelial cells of the vocal folds. When in contact with mucosal tissue, this endoscope provides 60 and 150 times magnification and clear visualization of cellular patterns of the superficial epithelial layers. For the first time in our laryngological clinical practice, we confirmed a number of previosly established parametars such as regularity and arrangement of the epithelium, nucleus contour, and nucleus-cytoplasm ratio, what all enable recognition and easy evaluation of different clinical conditions such as chronic laryngitis, Reinke's edema, papiloma dysplasia or vocal fold carcinoma. The advantage of contact endoscopy in vivo and in situ allows for detailed scan and mapping of all cell changes of the whole mucosa surface. All these features definitely classify the contact endoscopy into additional diagnostic methods in laryngology.

In vivo real-time diagnosis of nasopharyngeal carcinoma in situ by contact rhinoscopy

Nasopharyngeal dysplasia or nasopharyngeal carcinoma in situ (NPCIS) lesions have rarely been reported. Timely diagnosis of the preinvasive lesion may improve prognosis. Contact endoscopy has been documented to accurately differentiate normal cells of the nasopharynx from malignant cells and allows a real-time diagnosis of primary and recurrent nasopharyngeal carcinoma (NPC) in a clinical setting. However, the role of contact endoscopy in the diagnosis of NPCIS is unknown. The superficial cells of the nasopharynx in a patient with NPCIS were examined in vivo under local anaesthesia by use of a contact rhinoscope. The contact endoscopic findings were correlated with the histologic findings of the biopsy. The atypical cells of the lesion were magnified and visualized under contact endoscopy. Histopathologic analysis of the biopsied tissue confirmed the presence of NPCIS staining positively for Epstein-Barr virus (EBV)-encoded RNA (EBER). No cell-free EBV DNA was detected in the sera of the patient. Contact endoscopy can accurately identify the atypical cells of a tiny preinvasive lesion in the nasopharynx in a clinical setting, which may not be evident in routine imaging examination.

Technology Insight: laser-scanning confocal microscopy and endocytoscopy for cellular observation of the gastrointestinal tract

Recent advances in endoscopic imaging technology have enabled the visualization of early-stage cancer and its precursors in the gastrointestinal tract. Chromoendoscopy, magnifying endoscopy, endoscopic optical coherent tomography, spectroscopy, and various combinations of these technologies, are all important for the recognition of small and unclear lesions. To observe cancer cells in vivo, two types of ultra-high magnifying endoscope--'laser-scanning confocal endoscopy series' and 'contact endoscopy series'--that have a maximum of more than 1,000x magnifying power have been developed. These endoscopes can generate high-quality images of both living cancer cells and normal cells in the gastrointestinal tract, with a quality comparable to that possible with conventional cytology. These novel imaging technologies may make in vivo histological diagnosis by virtual histology possible.

Rigid and contact endoscopy in microlaryngoscopy

Objectives: The objective of this study was to demonstrate how important is the use of rigid and contact endoscopy and to compare the findings of contact endoscopy with the anatomopathological results of biopsies and surgical specimen of laryngeal pathologies. Methods: Thirty-five patients underwent rigid and contact microlaryngoscopy under general anesthesia. At first, the endolarynx was evaluated with a 400 mm lens microlaryngoscopy. Afterwards, a rigid endoscopy with 0, 30, 70, and 120 degree telescopes was done. Posteriorly, the vocal folds were stained with 1% metilen blue, and contact endoscopy was performed. In this phase of the procedure, the pathologist followed the contact endoscopic findings and compared them with the anatomopathological results. Results: The pathologies studied were: papilom, cyst, neoplasia, queratosis, Reinke’s edema, chronic laryngitis, and leucoplasia. The rigid endoscopy in laryngeal microsurgery and the position of the telescopic lens has allowed a better morphologic caracterization of the pathologies showing a positive correlation with the anatomopathological findings in all cases. Conclusion: The method allowed a more complete evaluation of endolarynx, mainly in endolaryngeal sites with difficult endoscopic access and has afforded a more adequated map of laryngeal lesions (limits and real extension of the lesion), beyond a histopathological study in vivo of benign lesions, premalignant and malignant pathologies of vocal folds, showing a positive correlation with the anatomopathological findings. Besides, through this method we obtain a better definition of site and real extension of the lesion. In our opinion, the contact endoscopy is a necessary method in laryngeal microsurgery after the new knowledgement of laryngeal morphophysiology and its microstructure.

Glomus tympanicum

Contact Endoscopy is a non invasive tool to visualise alterations in cell architecture in vivo. In this study we investigated the diagnostic accuracy of Contact Endoscopy in detecting malignancy in oral mucosal lesions.76 patients with oral mucosal lesions requiring biopsy were included. Contact Endoscopy was performed by Otolaryngologist before biopsy and findings recorded. The lesion was then biopsied and sent for histopathological examination by Pathologist who was blinded to Contact Endoscopy findings. Findings of Contact Endoscopy were compared with histopathological findings taking the latter as the gold standard. Two biopsies were reported as ‘inconclusive’ on histopathological examination and hence excluded from the final analysis. Data of the remaining 74 patients is presented here.Clinically lesions were diagnosed as ulcero-proliferative lesions in 34 patients, Leukoplakia in 19, Erythroplakia in 9, Lichen planus in 5 and Submucous fibrosis in 7 patients. Histopathological examination revealed presence of malignancy in 97.06% of ulcero-proliferative mucosal lesions, 10.53% of leukoplakia and 33.33% of erythroplakia while corresponding figures on Contact Endoscopy were 94.12%, 5.26% and 11.11% respectively. No malignancy was detected in lichen planus and submucous fibrosis by either technique. When compared with histopathological examination, CE showed sensitivity of 84.21%, specificity of 94.44% and accuracy of 89.19%. No adverse effects on the patients were seen due to the procedure or stain.Contact Endoscopy may be useful in determining cellular structure in vivo without biopsy to detect oral malignancy early. Further studies are suggested.

Observation of tongue papillae by video microscopy and contact endoscopy to investigate their correlation with taste function

Objectives: Contact endoscopy is a technique used to obtain detailed images of living epithelium in the fields of gynecology, rhinology and laryngology. Video microscopy is useful for observation of the surface of tongue papillae. In the present study, we attempted to apply the contact endoscopy technique together with video microscopy to observe tongue papillae, and to study the correlation between the condition of fungiform papillae and taste function. Methods: Ten subjects (3 men, 7 women) were divided into two groups based on the results of a taste examination by electrogustometry. We compared the shape and blood vessels of the papillae between normal taste and taste disorder groups. Results: In the normal taste group, round shaped papillae and clear blood vessels were observed with both microscopy and contact endoscopy. In the taste disorder group, flat and irregular papillae were observed with microscopy. Blood vessel flow of the papillae was observed to be poor with contact endoscopy. Conclusion: These findings suggested that the images of microscopy and contact endoscopy were related to taste function, and both techniques were useful for evaluating taste function.

In vitro evaluation of horizontal implant micromovement in bone specimen with contact endoscopy.

Primary stability of dental implants is mandatory for their osseointegration. A method is described that allows objective measurements of implant displacement in bone sites during lateral loading. Ten samples of bovine bone (2 cm x 2 cm) with bone type II, III, and IV according to Lekholm and Zarb were used for the experiment. Ten Semados dental implants of 15-mm length and 3.75-mm diameter were placed. All implants were loaded with lateral forces of 5, 10, 20, and 30 N through 8-mm abutments for 2 seconds each. Lateral displacement was observed by means of contact endoscopy. Micromovement was detected with the help of a transmitter strip attached to the abutment. Endoscopic images were processed digitally and microdisplacement was calculated relative to the reference body (microscrew) placed adjacent to the implant. Micromovement observed varied with the force applied. Lateral force of 5 N resulted in a mean displacement of 39 microm; for 30 N, the mean displacement was 157 microm. Bone type also influenced the amount of movement. Contact endoscopy represents a new method for direct observation of implant movement relative to the bone surface in vitro. In combination with support immersion technique, contact endoscopy could be used as an office procedure to evaluate intraoperatively implant stability during functional loading.

Analysis of nasal and nasopharyngeal tumors by contact endoscopy

Analysis of nasal and nasopharyngeal tumors by contact endoscopy

Analysis of Nasal and Nasopharyngeal Tumors by Contact Endoscopy

Analysis of Nasal and Nasopharyngeal Tumors by Contact Endoscopy

P033: Diagnosis of Ciliary Dyskinesia with Nasal Contact Endoscopy

P033: Diagnosis of Ciliary Dyskinesia with Nasal Contact Endoscopy

Diagnosis of ciliary dyskinesia with nasal contact endoscopy

Diagnosis of ciliary dyskinesia with nasal contact endoscopy

Contact endoscopic quantification of fungiform papillae--correlation to taste ability?

Besides anamnestic data and taste test, the clarification of epithelial taste disorders makes macroscopic evaluation of the surface of the tongue necessary. In this article the contact endoscopy is evaluated for examination of the tongue epithelium and for quantification of the fungiforme papillae. These results are related to the results of the spatial taste test (1. chemical taste test with sodium chloride in 2 different suprathreshold concentrations and sucrose in also 2 different suprathreshold concentrations; 2. electrogustometry with a bipolar electrode). In a prospective study we performed contact endoscopy in 16 healthy volunteers from ages 7 to 68 years. The subjects were divided into 2 age groups (< or = 45 years and > 45 years) and 2 papillae density groups. In 34 patients with either taste disorders of unknown cause or in patients with macroscopic changes at the tongue surface, the spatial and whole mouth taste tests and contact endoscopy were used to clarify the cause of the complaints. Density and shape of the fungiform papillae as well as the shape of the subepithelial vessels of the papillae vary among the investigated human subjects in the different age groups. No correlation between intensity ratings, papillae density und age was found after stimulation with 40 % sucrose at the tongue tip in the younger age group. Stimulation of the tongue edge with 15 % sodium chloride, however, showed a relationship between the two different density groups and the different age groups. The contact endoscopy allows the evaluation of the epithelium in the oral cavity. It is a nondestructive method and is additionally easy to handle, but the evaluation of the observed epithelia needs interdisciplinary co-operation with pathologists. No relevant informations are supplied in diagnostics of taste disorders.

Contact Endoscopy for Intraoperative Parathyroid Identification

Experienced thyroid surgeons are often able to identify the parathyroid glands, but sometimes it is difficult to differentiate them from other contiguous tissues. Contact endoscopy was introduced in otolaryngology for the characterization of normal and pathological epithelia. Our objective was to analyze contact endoscopy as an auxiliary method for identification of the parathyroid glands during thyroid surgery. Five total thyroidectomies and 5 hemithyroidectomies were performed in September 2001. After surgical exposure, contact endoscopy was performed. A total of 15 peritracheal regions were studied. Superior and inferior parathyroid tissues were identified on the basis of color, size, and probable location. Contact endoscopy was performed before and after use of methylene blue stain. Contact endoscopy was also used in neighboring areas. We compared the visual impression to the contact endoscopy findings. Two structures were visually supposed to be the superior and inferior parathyroid glands in each case. From 30 visually supposed glands, 25 were confirmed by telescope. Of the other 5 structures initially supposed to be parathyroid tissue, 3 were adipose tissue and 2 were thyroid parenchyma. In the 5 cases in which the identification of one of the glands was not confirmed, an additional contact examination enabled us to further identify parathyroid glands in 3 cases in which structures were initially identified as adipose tissue. Contact endoscopy is an efficient auxiliary method for the identification of the parathyroid glands during thyroid surgery that poses little risk of morbidity to the patient.

Compact endoscopy of the larynx.

In order to improve preoperative assessment of suspected precancerous and cancerous lesions of the larynx, we examined 83 patients by compact endoscopy (combination of autofluorescence and contact endoscopy) during microlaryngoscopy in a pilot study. The intraoperative findings were related to histopathologic examination. Cancerous laryngeal mucosa was illuminated during autofluorescence endoscopy by use of blue filtered light (D-light AF system) for optical demarcation of the lesion. After staining the mucosa with methylene blue (1%), we performed contact endoscopy. During autofluorescence examination of the endolaryngeal mucosa, the appearance of precancerous and cancerous lesions varied between opaque light areas and darker reddish areas. By contact endoscopy, it was possible to observe the cells, nuclei, and cytoplasm, as well as different degrees of abnormality. Histopathologic findings of 83 patients revealed laryngeal dysplasia (grade I in 29 patients, grade II in 15, and grade III or carcinoma in situ in 8) and laryngeal cancer (31 patients). In 73 cases (88%), the findings of compact endoscopy corresponded to those of histopathology. In 5 cases, epithelial lesions were overestimated because of inflammation and scarring, and 5 cases were underestimated because of hyperkeratotic thickening of the mucosa covering basal epithelial layers with focal dysplasia of grades II and III, carcinoma in situ, and microinvasive cancer. We conclude that compact endoscopy enables the laryngologist to assess laryngeal cancer and its preceding lesions more accurately during microlaryngoscopy.

In vivo diagnosis of persistent and recurrent nasopharyngeal carcinoma by contact endoscopy.

To evaluate the potential use of contact endoscopy for the diagnosis of persistent and recurrent nasopharyngeal carcinoma in postirradiated patients. Prospective study to examine 64 consecutive patients who have been irradiated for nasopharyngeal carcinoma in a clinic setting using contact rhinoscopes (Karl Storz, Tuttlingen, Germany [7215 AA, 0 degrees, and 7215 BA, 30 degrees; 23 cm long. 4 mm in diameter]). The superficial cells of the posterior walls of the nasopharynx were stained with 1% methylene blue and examined with contact rhinoscopes with the patient under local anesthesia at high magnifications (x60 and x150). Biopsy of the areas under examination was performed. The contact endoscopic images were analyzed and correlated with the corresponding histological sections of the biopsy tissues. Contact endoscopy was performed in 64 patients (54 men; mean age, 42 y) with the use of local anesthesia. Four patterns of contact endoscopic findings were identified: squamous metaplasia (43 cases), postirradiation atypia (10), granulation tissue (6), and malignancy (5). In the last group, the nasopharynx appeared normal in two patients (40%). The findings of contact endoscopy correlated well with the histological findings (kappa reliability coefficient = 0.847; P <.001; diagnostic accuracy, 92.1%). For prediction of persistent and recurrent disease, the sensitivity and specificity of endoscopic findings were both 100%. Contact endoscopy is an accurate, reliable office-based procedure that allows for in vivo and in situ diagnosis of persistent and recurrent nasopharyngeal carcinoma in postirradiated patients.

Cholesteatoma recurrences caused by intraoperative cell seeding? Contact endoscopic and cytologic studies

The high rate of recurrences of cholesteatomas after surgery is mostly caused by insufficient removal of matrix. Another factor may be intraoperative scattering of matrix cells e. g. with the running burr, which later may become the origin of new cholesteatoma growth. In this paper we tried to visualize these cells for gaining further informations. In 10 patients intraoperative contact endoscopy of the cholesteatoma was carried out during mastoidectomy. After intravital staining with methylene blue the very superficial tissue layers can directly be considered via a contacting endoscope. In addition, sucked-off rinsing fluid was cytologically examined for epithelial cells. Both investigations show only very rare vital squamous cells - besides other cells like or ciliated cells and foreign body giant cells. Inspite of their small number, these squamous cells in principle could cause dispersed growth of cholesteatoma. However, this seems to be much less significant than the assumption of matrix left behind intraoperatively. The danger of dispersed cell growth can further be diminished by adequate operating techniques with sufficient rinsing, smoothing the bony cavity walls and avoiding blind corners.

In vivo diagnosis of nasopharyngeal carcinoma using contact rhinoscopy.

To evaluate the potential use of contact endoscopy for the diagnosis of nasopharyngeal carcinoma (NPC). Prospective study to examine the nasopharynx of 30 patients with nasopharyngeal carcinoma and 18 subjects with normal nasopharynx in a clinic setting using contact rhinoscopes (Karl Storz, Tuttlingen, Germany, 7215 AA, 00 and 7215 BA, 300; 23 cm long; 4 mm in diameter). The superficial cells of the normal nasopharynx and the nasopharyngeal tumors were stained with 1% methylene blue and examined with contact rhinoscopes at high magnifications (x 60 and x 150). The areas under examination were then biopsied. The contact endoscopic images were compared with the corresponding hematoxylin and eosin-stained histologic sections of the biopsied tissues. Sixty-six procedures were performed in 48 patients. The images of normal pseudostratified ciliated epithelium and squamous epithelium were readily recognized by contact endoscopy in all subjects with normal nasopharynx (10 men and 8 women; mean age, 51.9 y). Twenty-six of 30 patients with NPC (86.6%; 18 men and 8 women; mean age, 50.6 y) were successfully examined by contact endoscopy under local anesthesia. In these 26 patients, two patterns of malignant cells were identified with contact endoscopy. The patterns of contact endoscopic images corresponded well with the histologic findings. Contact endoscopy is an accurate and reliable office-based procedure, which allows for in-vivo diagnosis of nasopharyngeal carcinoma.