Early Detection Of Laryngeal Cancer Research Articles

Vocal cord leukoplakia classification using deep learning models in white light and narrow band imaging endoscopy images.

Accurate vocal cord leukoplakia classification is critical for the individualized treatment and early detection of laryngeal cancer. Numerous deep learning techniques have been proposed, but it is unclear how to select one to apply in the laryngeal tasks. This article introduces and reliably evaluates existing deep learning models for vocal cord leukoplakia classification. We created white light and narrow band imaging (NBI) image datasets of vocal cord leukoplakia which were classified into six classes: normal tissues (NT), inflammatory keratosis (IK), mild dysplasia (MiD), moderate dysplasia (MoD), severe dysplasia (SD), and squamous cell carcinoma (SCC). Vocal cord leukoplakia classification was performed using six classical deep learning models, AlexNet, VGG, Google Inception, ResNet, DenseNet, and Vision Transformer. GoogLeNet (i.e., Google Inception V1), DenseNet-121, and ResNet-152 perform excellent classification. The highest overall accuracy of white light image classification is 0.9583, while the highest overall accuracy of NBI image classification is 0.9478. These three neural networks all provide very high sensitivity, specificity, and precision values. GoogLeNet, ResNet, and DenseNet can provide accurate pathological classification of vocal cord leukoplakia. It facilitates early diagnosis, providing judgment on conservative treatment or surgical treatment of different degrees, and reducing the burden on endoscopists.

A Novel Framework of Manifold Learning Cascade-Clustering for the Informative Frame Selection.

Narrow band imaging is an established non-invasive tool used for the early detection of laryngeal cancer in surveillance examinations. Most images produced from the examination are useless, such as blurred, specular reflection, and underexposed. Removing the uninformative frames is vital to improve detection accuracy and speed up computer-aided diagnosis. It often takes a lot of time for the physician to manually inspect the informative frames. This issue is commonly addressed by a classifier with task-specific categories of the uninformative frames. However, the definition of the uninformative categories is ambiguous, and tedious labeling still cannot be avoided. Here, we show that a novel unsupervised scheme is comparable to the current benchmarks on the dataset of NBI-InfFrames. We extract feature embedding using a vanilla neural network (VGG16) and introduce a new dimensionality reduction method called UMAP that distinguishes the feature embedding in the lower-dimensional space. Along with the proposed automatic cluster labeling algorithm and cost function in Bayesian optimization, the proposed method coupled with UMAP achieves state-of-the-art performance. It outperforms the baseline by 12% absolute. The overall median recall of the proposed method is currently the highest, 96%. Our results demonstrate the effectiveness of the proposed scheme and the robustness of detecting the informative frames. It also suggests the patterns embedded in the data help develop flexible algorithms that do not require manual labeling.

Machine-learning-assisted spontaneous Raman spectroscopy classification and feature extraction for the diagnosis of human laryngeal cancer

The early detection of laryngeal cancer significantly increases the survival rates, permits more conservative larynx sparing treatments, and reduces healthcare costs. A non-invasive optical form of biopsy for laryngeal carcinoma can increase the early detection rate, allow for more accurate monitoring of its recurrence, and improve intraoperative margin control.In this study, we evaluated a Raman spectroscopy system for the rapid intraoperative detection of human laryngeal carcinoma. The spectral analysis methods included principal component analysis (PCA), random forest (RF), and one-dimensional (1D) convolutional neural network (CNN) methods.We measured the Raman spectra from 207 normal and 500 tumor sites collected from 10 human laryngeal cancer surgical specimens. Random Forest analysis yielded an overall accuracy of 90.5%, sensitivity of 88.2%, and specificity of 92.8% on average over 10 trials. The 1D CNN demonstrated the highest performance with an accuracy of 96.1%, sensitivity of 95.2%, and specificity of 96.9% on average over 50 trials. In predicting the first three principal components (PCs) of normal and tumor data, both RF and CNN demonstrated high performances, except for the tumor PC2.This is the first study in which CNN-assisted Raman spectroscopy was used to identify human laryngeal cancer tissue with extracted feature weights. The proposed Raman spectroscopy feature extraction approach has not been previously applied to human cancer diagnosis. Raman spectroscopy, as assisted by machine learning (ML) methods, has the potential to serve as an intraoperative, non-invasive tool for the rapid diagnosis of laryngeal cancer and margin detection.

Current Intraoperative Imaging Techniques to Improve Surgical Resection of Laryngeal Cancer: A Systematic Review.

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.

Early detection of laryngeal cancer: prominence of miRNA signature as a new tool for clinicians

Early detection of laryngeal cancer, essential in the initial stages of the disease to achieve a high survival rate, is unfortunately hampered by the lack of specific symptoms. In this regard, there is a pressing need to dispose of reliable and non-invasive diagnostic and prognostic markers for a real time monitoring availing of accurate and reproducible methods, in order ensure applicability for early diagnosis and primary and secondary prevention. This review focuses on the recent reports that emphasize the crucial role of miRNAs in regulating laryngeal cancer tumorigenesis. In detail, we have reported the most characterized miRNAs with an established oncogenic or oncosuppressive role in cell biology of laryngeal cancer, also describing, for each of them, the main molecular mechanisms responsible for their specific function. We have also defined the potential of miRNAs as novel diagnostic and prognostic markers in virtue of their differential expression between laryngeal carcinoma tissues and the adjacent normal counterpart. Moreover, their proven stability in systemic circulation and other body fluids, as well as their easy detection and quantization, makes the analysis of miRNA signatures an excellent tool for clinicians as hallmark for cancer classification and diagnosis. Moreover, an eventual similarity between deregulated miRNAs in tumor tissues and in body fluids would allow to provide a considerable advantage for patients’ compliance, replacing invasive tissue biopsies with simple assays on easily obtained blood products.

Narrow band imaging as screening test for early detection of laryngeal cancer: a prospective study.

To analyse the specificity and sensibility of narrow band imaging illumination technology in the early detection of laryngeal cancer in the patients' population without previous diagnosis of laryngeal cancer in a screening setting. Unicentre, prospective study. One tertiary medical centre. A total of 158 patients completed all protocol steps. Sensitivity, specificity, positive and negative predictive values of narrow band imaging (NBI) in detecting precancerous lesions and early laryngeal cancer. The blind assessment of NBI patterns concurred in 90% of patients. In identifying laryngeal cancer and its precursor lesions, in-office NBI showed a high sensitivity of 97% (CI, 84.2%-99.9%), specificity of 92.5% (CI, 79.6%-98.4%), PPV of 91.4% (CI, 76.9%-98.2%), NPV of 97.4% (CI, 86.2%-99.9%) and accuracy of 94.5% but intra-operative NBI demonstrated a sensitivity of 97% (CI, 84.2%-99.9%), a slightly higher specificity of 95% (CI, 83.1%-99.4%), PPV of 94.1% (CI, 80.3%-993%), NPV of 97.4% (CI, 86.5%-99.9%) and accuracy of 95.9%. The comparative receiver operating characteristic curves confirmed a slightly higher performance for the intra-operative NBI evaluation without any statistical significance (P = 0.41). Our results confirm the high values of sensitivity and specificity of NBI system in detecting pre-neoplastic laryngeal lesions or early laryngeal cancer in a patients' population selected only by means of risk factors exposure and confirmed the potential role of NBI evaluation as in-office screening tool.

Value of narrow band imaging endoscopy in detection of early laryngeal squamous cell carcinoma

Narrow band imaging (NBI) is an endoscopic method using filtered wavelengths in detection of microvascular abnormalities associated with preneoplastic and neoplastic changes of the mucosa. The aim of the study is to evaluate the value of NBI endoscopy in the dia-gnosis of laryngeal precancerous and early stages of cancerous lesions and to investigate impact of NBI method in prehistological diagnostics in vivo. One hundred patients were enrolled in the study and their larynx was investigated using white light HD endoscopy and narrow band imaging between 6/ 2013- 10/ 2014. Indication criteria included chronic laryngitis, hoarseness for more than three weeks or macroscopic laryngeal lesion. Features of mucosal lesions were evaluated by white light endoscopy and afterwards were compared with intra-epithelial papillary capillary loop changes, viewed using NBI endoscopy. Suspicious lesions (leukoplakia, exophytic tumors, recurrent respiratory papillomatosis and/ or malignant type of vascular network by NBI endoscopy) were evaluated by histological analysis, results were compared with prehistological NBI dia-gnosis. Using NBI endoscopy, larger demarcation of pathological mucosal features than in white light visualization were recorded in 32/ 100 (32.0%) lesions, in 4/ 100 (4.0%) cases even new lesions were detected only by NBI endoscopy. 63/ 100 (63.0%) suspected lesions were evaluated histologically - malign changes (carcinoma in situ or invasive carcinoma) were observed in 25/ 63 (39.7%). Prehistological diagnostics of malignant lesions using NBI endoscopy were in agreement with results of histological examination in 23/ 25 (92.0%) cases. The sensitivity of NBI in detecting malignant lesions was 89.3%, specificity of this method was 94.9%. NBI endoscopy is a promising optical technique enabling in vivo differentiation of superficial neoplastic lesions. These results suggest endoscopic NBI may be useful in the early detection of laryngeal cancer and precancerous lesions.

FRI0462 Nasal Mucosa Narrow Band Imaging (NBI) in Granulomatosis with Poliangiitis (Wegener Granulomatosis): A Preliminary Study

BackgroundGranulomatosis with polyangiitis, former Wegener's (GPA) is a systemic vasculitis characterized by necrotizing granulomatous inflammation and necrotizing vasculitis classically affecting the ear, nose and throat (ENT) district, the lower respiratory...

Endoscopic diagnosis of laryngeal cancer and precancerous lesions by narrow band imaging

To investigate the characteristics of the laryngeal mucosal microvascular network in suspected laryngeal cancer patients, using narrow band imaging, and to evaluate the value of narrow band imaging endoscopy in the early diagnosis of laryngeal precancerous and cancerous lesions. Eighty-five consecutive patients with suspected precancerous or cancerous laryngeal lesions were enrolled in the study. Endoscopic narrow band imaging findings were classified into five types (I to V) according to the features of the mucosal intraepithelial papillary capillary loops assessed. A total of 104 lesions (45 malignancies and 59 nonmalignancies) was detected under white light and narrow band imaging modes. The sensitivity and specificity of narrow band imaging in detecting malignant lesions were 88.9 and 93.2 per cent, respectively. The intraepithelial papillary capillary loop classification, as determined by narrow band imaging, was closely associated with the laryngeal lesions' histological findings. Type I to IV lesions were considered nonmalignant and type V lesions malignant. For type Va lesions, the sensitivity and specificity of narrow band imaging in detecting severe dysplasia or carcinoma in situ were 100 and 79.5 per cent, respectively. In patients with type Vb and Vc lesions, the sensitivity and specificity of narrow band imaging in detecting invasive carcinoma were 83.8 and 100 per cent, respectively. Narrow band imaging is a promising approach enabling in vivo differentiation of nonmalignant from malignant laryngeal lesions by evaluating the morphology of mucosal capillaries. These results suggest endoscopic narrow band imaging may be useful in the early detection of laryngeal cancer and precancerous lesions.

The value of narrow band imaging for early detection of laryngeal cancer

We evaluate the value of laryngoscopy using narrow band imaging (NBI) system in the diagnosis of precancerous and cancerous laryngeal lesions. Thirty-four patients were suspected of having a total of 35 precancerous or cancerous laryngeal lesions among patients receiving conventional white-light laryngoscopy. All 34 patients underwent laryngoscopy with NBI system to determine whether those lesions were malignant before biopsy procedure. The diagnostic criteria of malignancy by NBI view was the presence of demarcated brownish area with scattered brown spots in the lesion. Histopathologic results were retrospectively compared with results of determination of malignancy made by NBI view. Of the 23 lesions histopathologically proved to be malignancies, 21 lesions were classified as malignant by NBI view. Sensitivity and specificity for the diagnosis of malignancy by means of NBI view compared with histopathologic results were 91.3% for sensitivity and 91.6% for specificity. NBI endoscopy seems to be a very promising diagnostic tool in the diagnosis of laryngeal malignant disease.

Spectrometric measurements in laryngeal cancer

Objectives: Direct and indirect autofluorescence endoscopy of the larynx have proven to facilitate the detection and delineation of precancerous lesions, carcinoma in situ and cancer. The aim of the study is to evaluate spectrometric changes during autofluorescence examination in laryngeal dysplasia and cancer. Methods: In a prospective study, 42 patients with suspected precancerous or cancerous lesions were investigated during microlaryngoscopy. Autofluorescence was induced by filtered blue light (375–440 nm) of a xenon short arc lamp and processed by a CCD camera system (D-light-AF-system). Autofluorescecne images were gathered in a contact mode. For spectrometric measurements, an optical multi channel analyzer (AVS-USB200) was applied. Results were compared to pathohistological findings. Results: Autofluorescence spectra of normal laryngeal mucosa demonstrated peaks at 475, 510, 550, 600, and 630 nm. Highest intensity was observed in the green spectrum resulting in green autofluorescence images. In precancerous and cancerous alterations of the mucosa the autofluorescence signal changed from green fluorescence to a reddish-violet color. Highest loss of intensity was observed at 510 nm. Conclusions: According to our results, the autofluorescence spectroscopy of the larynx seems to be a promising diagnostic tool for the early detection of laryngeal cancer and its precursor lesions. A difference between precancerous and cancerous laryngeal mucosa could not be detected. Scarring, marked hyperkeratosis and inflammation can limit the predictive value of the method.

喉頭癌検診の成果と問題点

Mass screening examinations for the detection of early laryngeal cancer were carried out five times in the past 20 years in Fukui prefecture. A total of 1452 people, 1003 male and 449 female, ranging from 30 to over 90 years of age, underwent the examination. 14 glottic laryngeal cancers were detected.Of those 14 cases, 13 were Tis or Tla cases and one was a T3. Thus, approximately 1% of the population studied was identified as having laryngeal cancer.As mentioned in previous reports, this rate was considerably higher than that reported for cancer screening for other organs. Thirteen patients, those diagnosed with Tis or Tla, were cured of cancer by radiation therapy only. Their larynxes were preserved. Therefore, this mass screening contributed to curing patients with laryngeal cancer while preserving their larynxes. On the other hand, this screening process had several weak points, such as the small absolute number of examinees, the high relative number of examinees who were not in a high-risk group and few subsequent checkups for patients with benign laryngeal disease. Taken together, mass screening examinations have proved useful for early detection of laryngeal cancer, and should be continually refined to overcome faults.

The Usefulness of Screening in the Early Detection of Laryngeal Cancer

Fischinger J, MlaČak B. The usefulness of screening in the early detection of laryngeal cancer. Acta Otolaryngol (Stockh) 1997; Suppl 527: 150-151.Opinions are divided about screening for cancer in the early stage and for hyperplastic alterations of the laryngeal mucosa which may lead to cancer. In order to form our own opinion we conducted a laryngological survey of 100 male and 50 female patients aged 30-70, employed in the textile and metallurgical industry, most of whom were smokers. In no case did we detect cancer or any abnormalities that would require immediate additional diagnostic procedures. We are well aware that caution is required in the analysis of data obtained in a sample as small as ours. Nevertheless we were to find even in this small group at risk, at least a few patients with laryngeal mucosa which could progress into cancer, yet we did not detect such changes. For this reason we concluded that screening does not always result in the hoped for outcome. It also requires much time and effort. We even question the justification of yearly examinations of the populations at risk, even though some authors consider this to be feasible. More important than screening is public health education which is primarily the responsibility of general practitioners as well as laryngologists. The population has to be educated and made to understand that surgery or radiation therapy at early stage of cancer is almost totally curable and does not result in any mutilation or invalidity.

過去2回の喉頭癌に対する「声がれ検診」の成績

From May to July in 1985, and again in June of 1988 a mass screening for early detection of laryngeal cancer was conducted in Fukui prefecture. All persons who responded to a newspaper add for free voice assessment were examined. A total of 918 people, 542 males and 376 females from 30 to over 90 years of age were studied. The age distribution included 95 people in their thirties, 288 in forties, 288 in their fifties, 152 in their sixties, 84 in their seventies, 8 in their eighties and 1 who was 90 years of age. The screening included a routine indirect mirror laryngoscopic examination. Ten glottic laryngeal cancers were detected, nine of them were Tla cases and one was a T3. Thus, approximately 1.1% of the population studied were identified as having laryngeal cancer. This cancer rate is considerably higher than that reported for cancer screening for other organs. Of the 918 persons screened there were no false positives. These results demonstrate the usefulness of this screening technique for early detection of glottic laryngeal cancer.

XXV Direct Laryngoscopy—A Simplified Technique. An Aid to the Early Detection of Laryngeal Cancer

XXV Direct Laryngoscopy—A Simplified Technique. An Aid to the Early Detection of Laryngeal Cancer