Feasibility of intraoperative assessment of safe surgical margins during laryngectomy with confocal laser endomicroscopy: A pilot study.

Abstract

OBJECTIVE:

This pilot study aimed to assess the feasibility of intraoperative assessment of safe margins with Confocal Laser Endomicroscopy (CLE) during planned partial or total laryngectomy.

METHODS:

Eight patients with confirmed larynx squamous cell carcinoma (SCC) and planned partial or total laryngectomy were included in this study in March 2020. Two head and neck surgeons and one pathologist were asked to classify carcinoma or healthy epithelium in a sample of 94 representative sequences (5.640 images), blinded to the histological results (H&E staining).

RESULTS:

Healthy mucosa areas showed epithelium with cells of uniform size and shape with distinct cytoplasmic membranes and regular vessel architecture. CLE optical biopsy of SCC demonstrated a disorganized arrangement of variable cellular morphology. We calculated an accuracy, sensitivity, specificity, PPV, and NPV of 80.1%, 72.3%, 87.9%, 85.7%, and 76.1%, respectively. A distinct transition between healthy appearing tissue and suspicious lesions could also be detected.

CONCLUSION:

CLE can be easily integrated into the intraoperative setting, generate real-time, in-vivo microscopic images of the larynx for evaluation and demarcation of cancer. If validated in further studies, CLE could eventually contribute to a less radical approach by enabling a more precise evaluation of the cancer margin.

• Authors: Matti Sievert, Nicolai Oetter, Marc Aubreville, Florian Stelzle, Andreas Maier, Markus Eckstein, Konstantinos Mantsopoulos, Antoniu-Oreste Gostian, Sarina K Mueller, Michael Koch, Abbas Agaimy, Heinrich Iro, Miguel Goncalves
• Journal: Auris, nasus, larynx (Auris Nasus Larynx) Vol. 48 Issue 4 Pg. 764-769 (Aug 2021) ISSN: 1879-1476 [Electronic] Netherlands
• PMID: 33468350 (Publication Type: Journal Article)
• Copyright: Copyright © 2021. Published by Elsevier B.V.

Topics

• Aged
• Feasibility Studies
• Female
• Humans
• Intraoperative Care
• Laryngeal Neoplasms (diagnostic imaging, pathology, surgery)
• Laryngectomy (methods)
• Male
• Margins of Excision
• Microscopy, Confocal
• Middle Aged
• Pilot Projects
• Squamous Cell Carcinoma of Head and Neck (diagnostic imaging, pathology, surgery)