Operative margin control with high-resolution optical microendoscopy for head and neck squamous cell carcinoma

Area of Science:

• Medical Imaging
• Gastroenterology
• Oncology

Background:

• High-resolution microendoscopy (HRME) offers real-time visualization of the upper aerodigestive tract's mucosal surface.
• This technology has the potential for noninvasive differentiation of benign and neoplastic epithelium.
• HRME may be valuable for intraoperative margin detection during cancer surgery.

Purpose of the Study:

• To evaluate the feasibility and accuracy of HRME in differentiating benign from neoplastic mucosa in patients with upper aerodigestive tract squamous cell carcinoma.
• To determine the sensitivity, specificity, and predictive values of HRME for intraoperative margin assessment.

Main Methods:

• A prospective, single-institution feasibility trial (Phase I) utilizing in vivo optical imaging.
• HRME images were correlated with histopathologic diagnoses in patients with squamous cell carcinoma of the upper aerodigestive tract.
• Blinded reviewers assessed HRME images, and statistical analysis calculated accuracy, sensitivity, specificity, PPV, NPV, and interrater agreement.

Main Results:

• The mean accuracy of HRME in differentiating mucosal status was 95.1%.
• High sensitivity (96%) and specificity (95%) were achieved, with a negative predictive value (NPV) of 98% and positive predictive value (PPV) of 91%.
• Excellent interrater reliability was demonstrated, with a Fleiss kappa statistic of 0.81.

Conclusions:

• HRME enables real-time discrimination between benign and neoplastic mucosa with high accuracy.
• The technology demonstrates significant potential for intraoperative margin control in upper aerodigestive tract cancers.
• HRME serves as a promising platform for future molecular imaging applications in this field.