Abstract
Introduction:
Confocal laser endomicroscopy is an optical imaging technique that allows in vivo, real-time, microscope-like images of the upper aerodigestive tract’s mucosa. The assessment of morphological tissue characteristics for the correct differentiation between healthy and malignant suspected mucosa requires strict evaluation criteria.
Objective:
This study aims to validate an eight-point score for the correct assessment of malignancy.
Methods:
We performed confocal laser endomicroscopy between March and October 2020 in 13 patients. 197 sequences (11.820 images) originated from the marginal area of pharyngeal and laryngeal carcinomas. Specimens were taken at corresponding locations and analyzed in H&E staining as a standard of reference. A total of six examiners evaluated the sequences based on a scoring system; they were blinded to the histopathological examination. The primary endpoints are sensitivity, specificity, and accuracy. Secondary endpoints are interrater reliability and receiver operator characteristics.
Results:
Healthy mucosa showed epithelium with uniform size and shape with distinct cytoplasmic membranes and regular vessel architecture. Confocal laser endomicroscopy of malignant cells demonstrated a disorganized arrangement of variable cellular morphology. We calculated an accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of 83.2%, 81.3%, 85.5%, 86.7%, and 79.7%, respectively, with a κ-value of 0.64, and an area under the curve of 0.86.
Conclusion:
The results confirm that this scoring system is applicable in the laryngeal and pharyngeal mucosa to classify benign and malignant tissue. A scoring system based on defined and reproducible characteristics can help translate this experimental method to broad clinical practice in head and neck diagnosis.
KEYWORDS
Confocal laser endomicroscopy; Squamous cell carcinoma; Head and neck cancer; Diagnosis
HIGHLIGHTS
Confocal laser endomicroscopy enables real-time, non-invasive identification of malignancy in pharynx and larynx.
Confocal laser endomicroscopy classification scores for the oral mucosa are also valid in pharynx and larynx.
Sensitivity and specificity for carcinoma was 81.3% and 85.5%, respectively.
Confocal laser endomicroscopy can be performed with substantial interrater agreement (k = 0.64).
Presently confocal laser endomicroscopy can aid intraoperative assessment but does not replace histology.
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