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Sampieri C, Azam MA, Ioppi A, Baldini C, Moccia S, Kim D, Tirrito A, Paderno A, Piazza C, Mattos LS, Peretti G. Real-Time Laryngeal Cancer Boundaries Delineation on White Light and Narrow-Band Imaging Laryngoscopy with Deep Learning. Laryngoscope 2024; 134:2826-2834. [PMID: 38174772 DOI: 10.1002/lary.31255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 12/05/2023] [Accepted: 12/11/2023] [Indexed: 01/05/2024]
Abstract
OBJECTIVE To investigate the potential of deep learning for automatically delineating (segmenting) laryngeal cancer superficial extent on endoscopic images and videos. METHODS A retrospective study was conducted extracting and annotating white light (WL) and Narrow-Band Imaging (NBI) frames to train a segmentation model (SegMENT-Plus). Two external datasets were used for validation. The model's performances were compared with those of two otolaryngology residents. In addition, the model was tested on real intraoperative laryngoscopy videos. RESULTS A total of 3933 images of laryngeal cancer from 557 patients were used. The model achieved the following median values (interquartile range): Dice Similarity Coefficient (DSC) = 0.83 (0.70-0.90), Intersection over Union (IoU) = 0.83 (0.73-0.90), Accuracy = 0.97 (0.95-0.99), Inference Speed = 25.6 (25.1-26.1) frames per second. The external testing cohorts comprised 156 and 200 images. SegMENT-Plus performed similarly on all three datasets for DSC (p = 0.05) and IoU (p = 0.07). No significant differences were noticed when separately analyzing WL and NBI test images on DSC (p = 0.06) and IoU (p = 0.78) and when analyzing the model versus the two residents on DSC (p = 0.06) and IoU (Senior vs. SegMENT-Plus, p = 0.13; Junior vs. SegMENT-Plus, p = 1.00). The model was then tested on real intraoperative laryngoscopy videos. CONCLUSION SegMENT-Plus can accurately delineate laryngeal cancer boundaries in endoscopic images, with performances equal to those of two otolaryngology residents. The results on the two external datasets demonstrate excellent generalization capabilities. The computation speed of the model allowed its application on videolaryngoscopies simulating real-time use. Clinical trials are needed to evaluate the role of this technology in surgical practice and resection margin improvement. LEVEL OF EVIDENCE III Laryngoscope, 134:2826-2834, 2024.
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Affiliation(s)
- Claudio Sampieri
- Department of Experimental Medicine (DIMES), University of Genova, Genoa, Italy
- Functional Unit of Head and Neck Tumors, Hospital Clínic, Barcelona, Spain
- Otorhinolaryngology Department, Hospital Clínic, Barcelona, Spain
| | - Muhammad Adeel Azam
- Department of Advanced Robotics, Istituto Italiano di Tecnologia, Genoa, Italy
- Dipartimento di Informatica, Bioingegneria, Robotica e Ingegneria dei Sistemi (DIBRIS), University of Genova, Genoa, Italy
| | - Alessandro Ioppi
- Unit of Otorhinolaryngology - Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
- Department of Otorhinolaryngology-Head and Neck Surgery, "S. Chiara" Hospital, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - Chiara Baldini
- Department of Advanced Robotics, Istituto Italiano di Tecnologia, Genoa, Italy
- Dipartimento di Informatica, Bioingegneria, Robotica e Ingegneria dei Sistemi (DIBRIS), University of Genova, Genoa, Italy
| | - Sara Moccia
- The BioRobotics Institute and Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Dahee Kim
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Alessandro Tirrito
- Unit of Otorhinolaryngology - Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
| | - Alberto Paderno
- Unit of Otorhinolaryngology - Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Cesare Piazza
- Unit of Otorhinolaryngology - Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Leonardo S Mattos
- Department of Advanced Robotics, Istituto Italiano di Tecnologia, Genoa, Italy
| | - Giorgio Peretti
- Unit of Otorhinolaryngology - Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
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Siddiq S, Stephen S, Lin D, Fox H, Robinson M, Paleri V. Robotic lateral oropharyngectomy following diagnostic tonsillectomy is oncologically safe in patients with human papillomavirus-related squamous cell cancer: Long-term results. Head Neck 2022; 44:2753-2759. [PMID: 36056651 DOI: 10.1002/hed.27186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/19/2022] [Accepted: 08/23/2022] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION To report the long-term oncological and functional outcomes of en bloc TORS lateral oropharyngectomy to address the close/involved margin following diagnostic tonsillectomy in HPV-related SCC of unknown primary. MATERIAL AND METHODS A single tertiary center observational cohort over a 4-year period. Primary outcome measures were disease-specific survival (DSS), overall survival (OS), and PSS NOD (Performance Status Scale-Normalcy of Diet) scores. RESULTS TORS specimens did not evidence residual carcinoma in 93% of patients. Of 14 patients, 50% received surgery alone (median follow-up 57 months; range 46-96), the remainder surgery and adjuvant therapy (median follow-up of 58 months; range 51-69) with 100% DSS, OS and no deterioration of PSS NOD scores. CONCLUSIONS Long-term oncological outcomes confirm TORS lateral oropharyngectomy alone is an oncologically safe treatment. Due consideration of this approach is warranted to mitigate against the morbidity of adjuvant radiotherapy treatment in this group of patients.
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Affiliation(s)
- Somiah Siddiq
- Head and Neck Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Sarah Stephen
- Otolaryngology - Head and Neck Surgery, Newcastle upon Tyne Hospitals, Newcastle upon Tyne, UK
| | - Daniel Lin
- Otolaryngology - Head and Neck Surgery, Newcastle upon Tyne Hospitals, Newcastle upon Tyne, UK
| | - Hannah Fox
- Otolaryngology - Head and Neck Surgery, Newcastle upon Tyne Hospitals, Newcastle upon Tyne, UK
| | - Max Robinson
- Centre for Oral Health Research, Newcastle University, Newcastle upon Tyne, UK
| | - Vinidh Paleri
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK
- The Institute of Cancer Research, London, UK
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NBI and Laryngeal Papillomatosis: A Diagnostic Challenge: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148716. [PMID: 35886569 PMCID: PMC9317038 DOI: 10.3390/ijerph19148716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/14/2022] [Accepted: 07/16/2022] [Indexed: 11/21/2022]
Abstract
Highlights Abstract Narrow-band imaging (NBI) represents a valid aid in laryngeal squamous cell carcinoma (LSCC) diagnosis for detecting vascular changes. However, LSCC and laryngeal papillomatosis (LP) show similar vascular patterns that may lead to misdiagnosis and improper treatment. This review aims to deepen this NBI limit in order to stress a careful preoperative evaluation of laryngeal lesions. The research was carried out on PubMed, Web of Science and Scopus databases using specific keywords. The topic of research was assessed by these parameters: accuracy, sensitivity, specificity, and positive and negative predictive values. This review included only five articles: they demonstrated that NBI is better than white-light endoscopy in detecting LSCC and LP. They also reported that LP is frequently mistaken for LSCC, resulting in high rates of false positives using NBI. This is the first review that emphasized this NBI limitation in distinguishing between LP and LSCC in cases of a type V pattern of intraepithelial papillary capillary loop. Although NBI application increased the rate of early cancer detection, LP reduces NBI accuracy. This drawback may lead to misdiagnosis and improper treatment. Our advice is to be careful in cases of type V pattern on NBI and to research LP epithelial and clinical features because it could be a pitfall.
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Chabrillac E, Dupret-Bories A, Vairel B, Woisard V, De Bonnecaze G, Vergez S. Narrow-Band Imaging in oncologic otorhinolaryngology: State of the art. Eur Ann Otorhinolaryngol Head Neck Dis 2021; 138:451-458. [PMID: 33722467 DOI: 10.1016/j.anorl.2021.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To describe the diagnostic performance of Narrow Band Imaging (NBI) combined with White Light Imaging (WLI) in the diagnosis of mucosal lesions at each location of the upper aerodigestive tract, for detection of primary tumor in case of carcinoma of unknown primary, for determination of intraoperative resection margins, and to describe its main diagnostic pitfalls. MATERIAL AND METHODS A PubMed search was carried out according to the PRISMA method. RESULTS Four hundred and seventy-seven articles published between 2007 and 2020 were identified, 133 of which met the study inclusion criteria and were assessed. CONCLUSION The current literature seems to support the use of NBI in diagnosis and/or follow-up of (pre-)malignant head & neck tumors, and in the determination of intraoperative resection margins.
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Affiliation(s)
- E Chabrillac
- Department of ENT-Head and Neck Surgery, University Cancer Institute Toulouse and Toulouse University Hospital, Hôpital Larrey, 24 Chemin de Pouvourville, 31059 Toulouse, France; Department of Surgery, University Cancer Institute Toulouse-Oncopole, 1 Avenue Irène Joliot-Curie, 31059 Toulouse, France
| | - A Dupret-Bories
- Department of Surgery, University Cancer Institute Toulouse-Oncopole, 1 Avenue Irène Joliot-Curie, 31059 Toulouse, France
| | - B Vairel
- Department of ENT-Head and Neck Surgery, University Cancer Institute Toulouse and Toulouse University Hospital, Hôpital Larrey, 24 Chemin de Pouvourville, 31059 Toulouse, France; Department of Surgery, University Cancer Institute Toulouse-Oncopole, 1 Avenue Irène Joliot-Curie, 31059 Toulouse, France
| | - V Woisard
- Department of ENT-Head and Neck Surgery, University Cancer Institute Toulouse and Toulouse University Hospital, Hôpital Larrey, 24 Chemin de Pouvourville, 31059 Toulouse, France; Department of Surgery, University Cancer Institute Toulouse-Oncopole, 1 Avenue Irène Joliot-Curie, 31059 Toulouse, France
| | - G De Bonnecaze
- Department of ENT-Head and Neck Surgery, University Cancer Institute Toulouse and Toulouse University Hospital, Hôpital Larrey, 24 Chemin de Pouvourville, 31059 Toulouse, France
| | - S Vergez
- Department of ENT-Head and Neck Surgery, University Cancer Institute Toulouse and Toulouse University Hospital, Hôpital Larrey, 24 Chemin de Pouvourville, 31059 Toulouse, France; Department of Surgery, University Cancer Institute Toulouse-Oncopole, 1 Avenue Irène Joliot-Curie, 31059 Toulouse, France.
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Contribution of narrow band imaging in delineation of laryngopharyngeal superficial cancer spread: a prospective study. Eur Arch Otorhinolaryngol 2021; 278:1491-1497. [PMID: 33398548 DOI: 10.1007/s00405-020-06499-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 11/11/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE The aim of this study was to assess the performance of Narrow Band Imaging (NBI) added to White Light (WL) in the delineation of laryngopharyngeal superficial cancer spread during office-based transnasal flexible endoscopy. METHODS This bi-centric prospective study was conducted between October 2014 and December 2017. We included consecutive patients with laryngopharyngeal malignant tumors. Transnasal flexible endoscopy was performed by two endoscopists who were blinded to each other's assessments and who examined each patient independently. The first endoscopist only performed a WL examination, while the second endoscopist carried out both WL and NBI. The extent of tumor involvement was reported based on predefined anatomical sub-units. Biopsies in NBI + /WL- sub-units were subsequently performed during panendoscopy. RESULTS Eighty-four patients were included in the study. A total of 72 NBI + /WL- sub-units were sampled in 38 patients, and 37 of the biopsies were positive (51.4%): 16 for invasive carcinoma, 17 for high-grade dysplasia/carcinoma in situ and 4 for low-grade dysplasia. Ultimately, 26.2% of patients had at least one positive biopsy in an NBI + /WL- sub-unit and, therefore, a better tumor delineation. The clinical T stage was upgraded in 4.8% of cases examined. CONCLUSION Adding NBI to WL imaging during transnasal flexible endoscopy in patients presenting with laryngopharyngeal pre-malignant or malignant lesions improves the delineation of superficial cancer spread, thereby leading to better adapted treatments. Clinicaltrials.gov registration number: NCT02035735.
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