Imaging guidance for cholesteatoma surgery using tissue autofluorescence

Area of Science:

• Otolaryngology
• Biomedical Imaging
• Optical Spectroscopy

Background:

• Cholesteatoma is a destructive middle ear lesion with high recurrence rates due to difficulties in distinguishing it from surrounding mucosa.
• Accurate differentiation of cholesteatoma margins is crucial for complete surgical excision and preventing recidivism.

Purpose of the Study:

• To develop an imaging system capable of enhancing the visibility of cholesteatoma tissue and its margins during surgical procedures.
• To enable more precise surgical removal of cholesteatoma by improving intraoperative tissue differentiation.

Main Methods:

• Excised cholesteatoma and middle ear mucosa tissues were illuminated with narrowband lights (405, 450, 520 nm).
• Spectroradiometric measurements and digital imaging using a red-green-blue (RGB) camera with longpass filters were employed.
• A prototype fluorescence imaging system was constructed using a 495 nm longpass filter and an RGB camera.

Main Results:

• Cholesteatoma tissue exhibited fluorescence under 405 nm and 450 nm illumination, while middle ear mucosa did not.
• Spectroradiometric data indicated that cholesteatoma fluorescence is predictable by emissions from keratin and flavin adenine dinucleotide.
• The prototype system successfully captured calibrated images distinguishing cholesteatoma from mucosa based on autofluorescence.

Conclusions:

• A prototype fluorescence imaging system was successfully developed for measuring cholesteatoma tissue autofluorescence.
• This technology holds promise for improving surgical outcomes in cholesteatoma management by enhancing tissue visualization.