[Optical Biopsy in Head and Neck Surgery - State of the Art and Future Directions]

Optical biopsy denotes light-based in vivo techniques that infer tissue identity in real time from image or spectral data. In a review of the literature covering the past five years, we analyze the modalities used in head and neck surgery by principle, clinical application, evidence, and technology readiness. Optical biopsy technologies include confocal laser endomicroscopy, optical coherence tomography, hyperspectral imaging, near-infrared autofluorescence (NIRAF), Raman spectroscopy, photoacoustic imaging and fluorescence lifetime imaging; these support biopsy guidance, margin mapping, and preservation of critical structures. In addition, molecular NIR tracers provide high tumor-to-background contrast and laser-induced breakdown spectroscopy identifies osseous invasion. Morphological contrast techniques (contact endoscopy; narrow-band imaging/ SPIES) sharpen the detection of superficial lesions and microvascular patterns-thus enabling optical diagnosis-yet, in the strict sense, do not constitute optical biopsy. The evidence base is promising but heterogeneous; consistent patient-level benefits remain limited to date. At present, NIRAF for parathyroid identification and morphological contrast techniques as adjuncts to white-light endoscopy are suitable for routine use. All other modalities should be implemented within structured programs with standardized endpoint ascertainment (e.g., R0 resection rate, reoperations, quality of life). In the short to medium term, multimodal fusion, AI-assisted analysis with open datasets and external validation and integration into navigation and robotic workflows are likely to increase clinical impact and generalizability.