1
|
Chen XY, Zhou G, Zhang J. Optical coherence tomography: Promising imaging technique for the diagnosis of oral mucosal diseases. Oral Dis 2024; 30:3638-3651. [PMID: 38191786 DOI: 10.1111/odi.14851] [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: 05/04/2023] [Revised: 11/02/2023] [Accepted: 12/15/2023] [Indexed: 01/10/2024]
Abstract
OBJECTIVE This review aims to summarize the latest application of optical coherence tomography (OCT) in oral mucosal diseases, promoting an accurate and earlier diagnosis of such disorders, which are difficult to be differentiated. SUBJECTIVE AND METHODS References on the application of OCT in oral mucosal diseases were mainly obtained from PubMed, Embase, Web of Science and Scopus databases, using the keywords: "optical coherence tomography and 'oral mucosa/oral cancers/oral potentially malignant diseases/oral lichen planus/oral leukoplakia/oral erythroplakia/discoid lupus erythematosus/oral autoimmune bullous diseases/oral ulcers/erythema multiforme/oral mucositis'". RESULTS It is found that OCT is showing a promising application potential in the early detection, diagnosis, differential diagnosis, monitoring of oral cancer and oral dysplastic lesions, as well as the delineation of tumor margins. OCT is also playing an increasingly important role in the diagnosis of oral potentially malignant disorders, oral mucosal bullous diseases, oral ulcerative diseases, erythema multiforme, and the early detection of oral mucositis. CONCLUSION Optical coherence tomography, as a novel optical technique featured by real-time, noninvasive, dynamic and high-resolution imaging, is of great use to serve as an adjunct tool for the diagnosis, differential diagnosis, monitoring and therapy evaluation of oral mucosal diseases.
Collapse
Affiliation(s)
- Xu-Ya Chen
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Gang Zhou
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
- Department of Oral Medicine, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Jing Zhang
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
- Department of Oral Medicine, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| |
Collapse
|
2
|
Zhou K, Zheng K, Huang L, Zheng X, Jiang C, Huang J, Wang R, Ruan X, Jiang W, Li W, Zhao Q, Lin L. Discrimination of healthy oral tissue from oral cancer based on the mean grey value determined by optical coherence tomography. BMC Oral Health 2024; 24:1004. [PMID: 39192293 DOI: 10.1186/s12903-024-04741-5] [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: 11/07/2023] [Accepted: 08/13/2024] [Indexed: 08/29/2024] Open
Abstract
OBJECTIVE This study aimed to identify a quantitative index for optical coherence tomography (OCT) images to discriminate tumours from surrounding tissues. SUBJECTS AND METHODS Based on OCT measurements, mean grey values were determined from 432 locations on fifty-four human tissue specimens (eighteen cancerous, para-cancerous, and normal tissues each). These results were histologically evaluated by hematoxylin and eosin staining (H&E). RESULTS The mean grey values of oral squamous cell carcinoma (OSCC) measurements were significantly different from those of the surrounding healthy tissue (p value < 0.0001), with the former being higher. The sensitivity and specificity of detecting tumourous tissue using this approach were 93 and 94%, respectively. CONCLUSIONS OCT as a non-invasive, real-time imaging method, correlates well with H&E pathological images. It can effectively distinguish squamous cell carcinoma from normal tissues with high sensitivity and specificity and is thus expected to assist and guide tumour margin evaluation. CLINICAL RELEVANCE This discovery highlights the potential of OCT in the objective evaluation of tumour margin during surgery.
Collapse
Affiliation(s)
- Kangwei Zhou
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- Department of Oral and Maxillofacial Surgery, Binhai Campus of the First Affiliated Hospital, National Regional Medical Center, Fujian Medical University, Fuzhou, China
| | - Kaili Zheng
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, Organ Transplantation Institute Center for Molecular Imaging and Translational Medicine, School of Public Health, Xiamen University, Xiamen, China
| | - Li Huang
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- Department of Oral and Maxillofacial Surgery, Binhai Campus of the First Affiliated Hospital, National Regional Medical Center, Fujian Medical University, Fuzhou, China
| | - Xianglong Zheng
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- Department of Oral and Maxillofacial Surgery, Binhai Campus of the First Affiliated Hospital, National Regional Medical Center, Fujian Medical University, Fuzhou, China
| | - Canyang Jiang
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- Department of Oral and Maxillofacial Surgery, Binhai Campus of the First Affiliated Hospital, National Regional Medical Center, Fujian Medical University, Fuzhou, China
| | - Jianping Huang
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- Department of Oral and Maxillofacial Surgery, Binhai Campus of the First Affiliated Hospital, National Regional Medical Center, Fujian Medical University, Fuzhou, China
| | - Rihui Wang
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- Department of Oral and Maxillofacial Surgery, Binhai Campus of the First Affiliated Hospital, National Regional Medical Center, Fujian Medical University, Fuzhou, China
| | - Xin Ruan
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- Department of Oral and Maxillofacial Surgery, Binhai Campus of the First Affiliated Hospital, National Regional Medical Center, Fujian Medical University, Fuzhou, China
| | - Weicai Jiang
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- Department of Oral and Maxillofacial Surgery, Binhai Campus of the First Affiliated Hospital, National Regional Medical Center, Fujian Medical University, Fuzhou, China
| | - Wen Li
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- Department of Oral and Maxillofacial Surgery, Binhai Campus of the First Affiliated Hospital, National Regional Medical Center, Fujian Medical University, Fuzhou, China
| | - Qingliang Zhao
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, Organ Transplantation Institute Center for Molecular Imaging and Translational Medicine, School of Public Health, Xiamen University, Xiamen, China.
| | - Lisong Lin
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
- Department of Oral and Maxillofacial Surgery, Binhai Campus of the First Affiliated Hospital, National Regional Medical Center, Fujian Medical University, Fuzhou, China.
| |
Collapse
|
3
|
Wang H, Li T, Chi Y, Yang M, Zhao L, Hou J. Near-infrared fluorescence imaging technology guided margin design in oral squamous cell carcinoma: a single-centre retrospective study. Front Oncol 2024; 14:1406595. [PMID: 38903725 PMCID: PMC11186989 DOI: 10.3389/fonc.2024.1406595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 05/23/2024] [Indexed: 06/22/2024] Open
Abstract
Objective The margin status of oral squamous cell carcinoma patients is considered to be predictive of recurrence and long-term survival. Therefore, precise intraoperative margin assessment is crucial. This study investigated the feasibility of using near-infrared fluorescence imaging technology to guide margin design in oral squamous cell carcinoma patients. Methods In this retrospective study, indocyanine green solution was intravenously injected preoperatively into patients. Intraoperatively, the surgical area was illuminated using a near-infrared fluorescence imaging system, which caused the lesion to fluoresce in the surgical area. Surgery was performed with the assistance of fluorescence imaging. The fluorescence intensity of the lesion area and surrounding normal tissue was recorded during surgery. Intraoperative margins were sent for rapid pathology, and postoperative margin pathology results were documented. Results Sixteen patients were included in this study (7 males, 9 females), with an average age of 65.65 ± 12.37 years. Preoperative biopsy and postoperative pathology confirmed oral squamous cell carcinoma in all patients. No cancer cells were found in the margin pathology results. The average fluorescence intensity of the lesion area was 214 ± 4.70, and that of the surrounding normal tissue was 104.63 ± 3.14. There was no significant difference in the fluorescence intensity values of the lesion areas among all patients (F=0.38, P>0.05). There was a significant difference in fluorescence intensity between the lesion area and surrounding normal tissue (t=33.76, P<0.05). Conclusion Near-infrared fluorescence imaging technology can aid in real-time imaging differentiation of lesion areas based on differences in fluorescence intensity during surgery. The use of this technology can assist surgeons in assessing the safety margin and reliably guide surgery.
Collapse
Affiliation(s)
- Honghao Wang
- School and Hospital of Stomatology, Fujian Medical University, Fuzhou, China
| | - Tingyu Li
- Department of Stomatology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yifan Chi
- Department of Stomatology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Mingen Yang
- Department of Stomatology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Li Zhao
- Department of Stomatology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jun Hou
- Department of Stomatology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| |
Collapse
|
4
|
Vlocskó M, Piffkó J, Janovszky Á. Intraoperative Assessment of Resection Margin in Oral Cancer: The Potential Role of Spectroscopy. Cancers (Basel) 2023; 16:121. [PMID: 38201548 PMCID: PMC10777979 DOI: 10.3390/cancers16010121] [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: 10/25/2023] [Revised: 12/21/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024] Open
Abstract
In parallel with the increasing number of oncological cases, the need for faster and more efficient diagnostic tools has also appeared. Different diagnostic approaches are available, such as radiological imaging or histological staining methods, but these do not provide adequate information regarding the resection margin, intraoperatively, or are time consuming. The purpose of this review is to summarize the current knowledge on spectrometric diagnostic modalities suitable for intraoperative use, with an emphasis on their relevance in the management of oral cancer. The literature agrees on the sensitivity, specificity, and accuracy of spectrometric diagnostic modalities, but further long-term prospective, multicentric clinical studies are needed, which may standardize the intraoperative assessment of the resection margin and the use of real-time spectroscopic approaches.
Collapse
Affiliation(s)
| | | | - Ágnes Janovszky
- Department of Oral and Maxillofacial Surgery, Albert Szent-Györgyi Medical School, University of Szeged, Kálvária 57, H-6725 Szeged, Hungary; (M.V.); (J.P.)
| |
Collapse
|
5
|
Rainu SK, Ramachandran RG, Parameswaran S, Krishnakumar S, Singh N. Advancements in Intraoperative Near-Infrared Fluorescence Imaging for Accurate Tumor Resection: A Promising Technique for Improved Surgical Outcomes and Patient Survival. ACS Biomater Sci Eng 2023; 9:5504-5526. [PMID: 37661342 DOI: 10.1021/acsbiomaterials.3c00828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
Clear surgical margins for solid tumor resection are essential for preventing cancer recurrence and improving overall patient survival. Complete resection of tumors is often limited by a surgeon's ability to accurately locate malignant tissues and differentiate them from healthy tissue. Therefore, techniques or imaging modalities are required that would ease the identification and resection of tumors by real-time intraoperative visualization of tumors. Although conventional imaging techniques such as positron emission tomography (PET), computed tomography (CT), magnetic resonance imaging (MRI), or radiography play an essential role in preoperative diagnostics, these cannot be utilized in intraoperative tumor detection due to their large size, high cost, long imaging time, and lack of cancer specificity. The inception of several imaging techniques has paved the way to intraoperative tumor margin detection with a high degree of sensitivity and specificity. Particularly, molecular imaging using near-infrared fluorescence (NIRF) based nanoprobes provides superior imaging quality due to high signal-to-noise ratio, deep penetration to tissues, and low autofluorescence, enabling accurate tumor resection and improved survival rates. In this review, we discuss the recent developments in imaging technologies, specifically focusing on NIRF nanoprobes that aid in highly specific intraoperative surgeries with real-time recognition of tumor margins.
Collapse
Affiliation(s)
- Simran Kaur Rainu
- Center for Biomedical Engineering, Indian Institute of Technology Delhi, Hauz Khas, New Delhi 110016, India
| | - Remya Girija Ramachandran
- L&T Ocular Pathology Department, Vision Research Foundation, Kamalnayan Bajaj Institute for Research in Vision and Ophthalmology, Chennai 600006, India
| | - Sowmya Parameswaran
- L&T Ocular Pathology Department, Vision Research Foundation, Kamalnayan Bajaj Institute for Research in Vision and Ophthalmology, Chennai 600006, India
| | - Subramanian Krishnakumar
- L&T Ocular Pathology Department, Vision Research Foundation, Kamalnayan Bajaj Institute for Research in Vision and Ophthalmology, Chennai 600006, India
| | - Neetu Singh
- Center for Biomedical Engineering, Indian Institute of Technology Delhi, Hauz Khas, New Delhi 110016, India
- Biomedical Engineering Unit, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| |
Collapse
|
6
|
Au VH, Miller LE, Deschler DG, Lin DT, Richmon JD, Varvares MA. Comparison of Preoperative DOI Estimation in Oral Tongue Cancer With cN0 Disease. Otolaryngol Head Neck Surg 2023; 169:948-953. [PMID: 36861847 DOI: 10.1002/ohn.314] [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: 10/30/2022] [Revised: 01/12/2023] [Accepted: 02/15/2023] [Indexed: 03/03/2023]
Abstract
OBJECTIVE To understand the accuracy of pre- and intraoperative estimation of tumor depth of invasion (DOI). STUDY DESIGN A retrospective case-control study. SETTING Patients who presented at 1 institution with oral tongue squamous cell carcinoma that underwent oncologic resection between 2017 and 2019 were identified. METHODS Patients that met the inclusion criteria were included. Patients with nodal, distant, or recurrent disease, prior history of head and neck cancer, or preoperative tumor assessment and/or final histopathology that did not include DOI were excluded. Preoperative DOI estimation and technique and pathology reports were obtained. Our primary outcome was the sensitivity and specificity of DOI estimation modalities including full-thickness biopsy (FTB), manual palpation (MP), punch biopsy (PB), and intraoperative ultrasound (IOUS). RESULTS Tumor DOI was assessed quantitatively preoperatively in 40 patients by FTB (n = 19, 48%), MP (n = 17, 42%), or PB (n = 4, 10%). Additionally, 19 patients underwent IOUS to assess DOI. The sensitivities of FTB, MP, and IOUS for DOI ≥ 4 mm were 83% (confidence interval [CI]: 44%-97%), 83% (CI: 55%-95%), and 90% (CI: 60%-98%), respectively, and the specificities were 85% (CI: 58%-96%), 60% (CI: 23%-88%), and 78% (CI: 45%-94%). CONCLUSION Our study demonstrated that DOI assessment tools measured had similar sensitivity and specificity in stratifying patients with DOI ≥4 mm, with no statistically superior diagnostic test. Our results support the need for additional research into nodal disease prediction and continued refinement of ND decisions with respect to DOI.
Collapse
Affiliation(s)
- Vivienne H Au
- SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Lauren E Miller
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel G Deschler
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Derrick T Lin
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Jeremy D Richmon
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Mark A Varvares
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
7
|
Kowalski LP. Eugene Nicholas Myers' Lecture on Head and Neck Cancer, 2020: The Surgeon as a Prognostic Factor in Head and Neck Cancer Patients Undergoing Surgery. Int Arch Otorhinolaryngol 2023; 27:e536-e546. [PMID: 37564472 PMCID: PMC10411134 DOI: 10.1055/s-0043-1761170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 09/26/2022] [Indexed: 08/12/2023] Open
Abstract
This paper is a transcript of the 29 th Eugene N. Myers, MD International Lecture on Head and Neck Cancer presented at the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) in 2020. By the end of the 19 th century, the survival rate in treated patients was 10%. With the improvements in surgical techniques, currently, about two thirds of patients survive for > 5 years. Teamwork and progress in surgical reconstruction have led to advancements in ablative surgery; the associated adjuvant treatments have further improved the prognosis in the last 30 years. However, prospective trials are lacking; most of the accumulated knowledge is based on retrospective series and some real-world data analyses. Current knowledge on prognostic factors plays a central role in an efficient treatment decision-making process. Although the influence of most tumor- and patient-related prognostic factors in head and neck cancer cannot be changed by medical interventions, some environmental factors-including treatment, decision-making, and quality-can be modified. Ideally, treatment strategy decisions should be taken in dedicated multidisciplinary team meetings. However, evidence suggests that surgeons and hospital volume and specialization play major roles in patient survival after initial or salvage head and neck cancer treatment. The metrics of surgical quality assurance (surgical margins and nodal yield) in neck dissection have a significant impact on survival in head and neck cancer patients and can be influenced by the surgeon's expertise. Strategies proposed to improve surgical quality include continuous performance measurement, feedback, and dissemination of best practice measures.
Collapse
Affiliation(s)
- Luiz P. Kowalski
- Head and Neck Surgery Department, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| |
Collapse
|
8
|
Puram SV, Mays AC, Bayon R, Bell D, Chung J, Fundakowski CE, Johnson BT, Massa ST, Sharma A, Varvares MA. Margins in Stage I and II Oral Cavity Squamous Cell Carcinoma: A Review From the American Head and Neck Society. JAMA Otolaryngol Head Neck Surg 2023; 149:636-642. [PMID: 37289469 DOI: 10.1001/jamaoto.2023.1201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Importance The assessment and management of surgical margins in stage I and II oral cavity squamous cell carcinoma is one of the most important perioperative aspects of oncologic care, with profound implications for patient outcomes and adjuvant therapy. Understanding and critically reviewing the existing data surrounding margins in this context is necessary to rigorously care for this challenging group of patients and minimize patient morbidity and mortality. Observations This review discusses the data related to the definitions related to surgical margins, methods for assessment, specimen vs tumor bed margin evaluation, and re-resection of positive margins. The observations presented emphasize notable controversy within the field about margin assessment, with early data coalescing around several key aspects of management, although studies are limited by their design. Conclusions and Relevance Stage I and II oral cavity cancer requires surgical resection with negative margins to obtain optimal oncologic outcomes, but controversy persists over margin assessment. Future studies with improved, well-controlled study designs are required to more definitively guide margin assessment and management.
Collapse
Affiliation(s)
- Sidharth V Puram
- Department of Otolaryngology-Head and Neck Surgery, Washington University in St Louis, St Louis, Missouri
- Department of Genetics, Washington University in St Louis, St Louis, Missouri
| | - Ashley C Mays
- Department of Otolaryngology, Cleveland Clinic Florida, Cleveland Clinic Indian River Hospital, Vero Beach
| | - Rodrigo Bayon
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City
| | - Diana Bell
- City of Hope Comprehensive Cancer Center, Duarte, California
| | - Jeffson Chung
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown
| | - Christopher E Fundakowski
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Bradley T Johnson
- Ear, Nose, Throat and Plastic Surgery Associates, AdventHealth, Winter Park, Florida
| | - Sean T Massa
- Department of Otolaryngology-Head and Neck Surgery, St Louis University, St Louis, Missouri
| | - Arun Sharma
- Department of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield
| | - Mark A Varvares
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston
| |
Collapse
|
9
|
Higginson JA, Breik O, Thompson AH, Ashrafian H, Hardman JC, Takats Z, Paleri V, Dhanda J. Diagnostic accuracy of intraoperative margin assessment techniques in surgery for head and neck squamous cell carcinoma: A meta-analysis. Oral Oncol 2023; 142:106419. [PMID: 37178655 DOI: 10.1016/j.oraloncology.2023.106419] [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: 01/17/2023] [Revised: 04/18/2023] [Accepted: 05/04/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Positive margins following head and neck squamous cell carcinoma (HNSCC) surgery lead to significant morbidity and mortality. Existing Intraoperative Margin Assessment (IMA) techniques are not widely used due to limitations in sampling technique, time constraints and resource requirements. We performed a meta-analysis of the diagnostic performance of existing IMA techniques in HNSCC, providing a benchmark against which emerging techniques may be judged. METHODS The study was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines. Studies were included if they reported diagnostic metrics of techniques used during HNSCC surgery, compared with permanent histopathology. Screening, manuscript review and data extraction was performed by multiple independent observers. Pooled sensitivity and specificity were estimated using the bivariate random effects model. RESULTS From an initial 2344 references, 35 studies were included for meta-analysis. Sensitivity (Sens), specificity (Spec), diagnostic odds ratio (DOR) and area under the receiver operating characteristic curve (AUROC) were calculated for each group (n, Sens, Spec, DOR, AUROC): frozen section = 13, 0.798, 0.991, 309.8, 0.976; tumour-targeted fluorescence (TTF) = 5, 0.957, 0.827, 66.4, 0.944; optical techniques = 10, 0.919, 0.855, 58.9, 0.925; touch imprint cytology = 3, 0.925, 0.988, 51.1, 0.919; topical staining = 4, 0.918, 0.759, 16.4, 0.833. CONCLUSIONS Frozen section and TTF had the best diagnostic performance. Frozen section is limited by sampling error. TTF shows promise but involves administration of a systemic agent. Neither is currently in widespread clinical use. Emerging techniques must demonstrate competitive diagnostic accuracy whilst allowing rapid, reliable, cost-effective results.
Collapse
Affiliation(s)
| | - Omar Breik
- School of Dentristy, University of Queensland, Australia
| | | | | | - John C Hardman
- International Centre for Recurrent Head and Neck Cancer, The Royal Marsden NHS Foundation Trust, UK
| | | | - Vinidh Paleri
- International Centre for Recurrent Head and Neck Cancer, The Royal Marsden NHS Foundation Trust, UK; Institute of Cancer Research, UK
| | - Jagtar Dhanda
- Department of Surgery, Brighton and Sussex Medical School, UK
| |
Collapse
|
10
|
Badhey AK, Schwarz JS, Laitman BM, Veremis BM, Westra WH, Yao M, Teng MS, Genden EM, Miles BA. Intraoperative Use of Wide-Field Optical Coherence Tomography to Evaluate Tissue Microstructure in the Oral Cavity and Oropharynx. JAMA Otolaryngol Head Neck Surg 2023; 149:71-78. [PMID: 36454583 PMCID: PMC9856682 DOI: 10.1001/jamaoto.2022.3763] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Importance Involvement of deep margins represents a significant challenge in the treatment of oropharyngeal cancer, and given practical limitations of frozen-section analysis, a need exists for real-time, nondestructive intraoperative margin analysis. Wide-field optical coherence tomography (WF-OCT) has been evaluated as a tool for high-resolution adjunct specimen imaging in breast surgery, but its clinical application in head and neck surgery has not been explored. Objective To evaluate the utility of WF-OCT for visualizing microstructures at margins of excised oral and oropharyngeal tissue. Design, Setting, and Participants This nonrandomized, investigator-initiated qualitative study evaluated the feasibility of the Perimeter Medical Imaging AI Otis WF-OCT device at a single academic center. Included participants were adults undergoing primary ablative surgery of the oral cavity or oropharynx for squamous cell carcinoma in 2018 and 2019. Data were analyzed in October 2019. Exposures Patients were treated according to standard surgical care. Freshly resected specimens were imaged with high-resolution WF-OCT prior to routine pathology. Interdisciplinary interpretation was performed to interpret WF-OCT images and compare them with corresponding digitized pathology slides. No clinical decisions were made based on WF-OCT image data. Main Outcomes and Measures Visual comparisons were performed between WF-OCT images and hematoxylin and eosin slides. Results A total of 69 specimens were collected and scanned from 53 patients (mean [SD] age, 59.4 [15.2] years; 35 [72.9%] men among 48 patients with demographic data) undergoing oral cavity or oropharynx surgery for squamous cell carcinoma, including 42 tonsillar tissue, 17 base of the tongue, 4 buccal tissue, 3 mandibular, and 3 other specimens. There were 41 malignant specimens (59.4%) and 28 benign specimens (40.6%). In visual comparisons of WF-OCT images and hematoxylin and eosin slides, visual differentiation among mucosa, submucosa, muscle, dysplastic, and benign tissue was possible in real time using WF-OCT images. Microarchitectural features observed in WF-OCT images could be matched with corresponding features within the permanent histology with fidelity. Conclusions and Relevance This qualitative study found that WF-OCT imaging was feasible for visualizing tissue microarchitecture at the surface of resected tissues and was not associated with changes in specimen integrity or surgical and pathology workflow. These findings suggest that formal clinical studies investigating use of WF-OCT for intraoperative analysis of deep margins in head and neck surgery may be warranted.
Collapse
Affiliation(s)
- Arvind K. Badhey
- Department of Otolaryngology Icahn School of Medicine at Mount Sinai, New York, New York,Now with Department of Otolaryngology, University of Massachusetts Chan Medical School, Worcester
| | - Julia S. Schwarz
- Department of Otolaryngology Icahn School of Medicine at Mount Sinai, New York, New York
| | - Benjamin M. Laitman
- Department of Otolaryngology Icahn School of Medicine at Mount Sinai, New York, New York
| | - Brandon M. Veremis
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - William H. Westra
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Mike Yao
- Department of Otolaryngology, Westchester Medical Center, Valhalla, New York
| | - Marita S. Teng
- Department of Otolaryngology Icahn School of Medicine at Mount Sinai, New York, New York
| | - Eric M. Genden
- Department of Otolaryngology Icahn School of Medicine at Mount Sinai, New York, New York
| | - Brett A. Miles
- Department of Otolaryngology Icahn School of Medicine at Mount Sinai, New York, New York,Now with Northwell Health, New Hyde Park, New York
| |
Collapse
|
11
|
Fernandes JR, Dos Santos LCF, Lamers ML. Applicability of autofluorescence and fluorescent probes in the trans-surgical of oral carcinomas: A systematic review. Photodiagnosis Photodyn Ther 2022; 41:103238. [PMID: 36509404 DOI: 10.1016/j.pdpdt.2022.103238] [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: 07/27/2022] [Revised: 11/07/2022] [Accepted: 12/08/2022] [Indexed: 12/13/2022]
Abstract
Oral cancer represents an important health problem, as it is the sixth most common type of cancer in the world and is associated with high rates of morbidity and mortality. The treatment considered the gold standard for this type of tumor is surgical resection with negative margins, with a distance of at least 5 mm from the tumor. This procedure is strongly associated with local control and disease-specific survival, however, in many cases, large amounts of healthy tissue are removed, resulting in surgical defects, compromising various functions and directly affecting the individual's quality of life. From this perspective, this systematic review aimed to evaluate the use of autofluorescence and fluorescent probes as potential adjuvant techniques to facilitate the delineation of surgical margins for oral cancers. A comprehensive search was performed in Pubmed, Scopus, Web of Science, LIVIVO, Embase, ProQuest Open Access Dissertations & Theses, Open Access Theses and Dissertations, and DART Europe databases, where 1948 articles were found. After the different stages of critical evaluation, 15 articles were selected, eligible for the inclusion criteria. Of these, 7 articles used autofluorescence, 7 used fluorescent probes and 1 article used both methods. As for autofluorescence, the most used device was the VELScope, and indocyanine green was the most used probe. Compared to histopathology, autofluorescence did not obtain significant and/or superiors results. In contrast to fluorescent probes that, most articles showed a good performance of margins during surgical resection, making them a promising alternative. However, it is still necessary to carry out the analysis of more articles, with more significant samples and sensitivity and specificity data to qualify the results.
Collapse
Affiliation(s)
- Julia Rodrigues Fernandes
- Department of Oral Pathology, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | - Marcelo Lazzaron Lamers
- Department of Morphological Sciences, Institute of Basic Health Sciences, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos 2600, Porto Alegre, RS CEP 90035-003, Brazil.
| |
Collapse
|
12
|
Cheng E, Jennings RN, Chen CL, Biggo MR, Erickson AK, Dornbusch JA, Linn SC, Lapsley J, Alva BM, Lorbach JN, Premanandan C, Selmic LE. Optical coherence tomography for surgical margin evaluation of excised canine cutaneous and subcutaneous tumours. Vet Comp Oncol 2022; 20:836-845. [PMID: 35662386 PMCID: PMC9796844 DOI: 10.1111/vco.12844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 05/15/2022] [Accepted: 06/01/2022] [Indexed: 01/07/2023]
Abstract
Currently, intraoperative tumour margin imaging is not routinely utilized in veterinary medicine. Optical coherence tomography (OCT) allows for real-time assessment of tissue morphology of 1-2 mm depth. The aims of this study were (1) to compare the histologic and OCT features of excised canine skin and subcutaneous specimens, and (2) to determine the diagnostic accuracy of OCT for surgical margin evaluation. The authors hypothesized that OCT imaging would correlate well with histopathology and that OCT would be sensitive for detection of incomplete margins. Eighty dogs were prospectively enrolled. Tumours were excised, and the surgical margins were imaged using a spectral domain OCT system. The tumour type and completeness of excision were determined by histopathology. Nine blinded observers received training in OCT image interpretation and were then given a set of OCT images and videos. The observers assigned each image/video a grade from 1 (no tumour) to 4 (tumour) and the results were compared to histopathology. The overall median sensitivity and specificity of OCT imaging for detection of incomplete margins were 86.7% and 84.6%, respectively. A potential limitation is that observers had varied experience with OCT image interpretation, ranging from no prior experience to participating in a previous OCT project. OCT is sensitive for detection of incomplete margins and could be a promising real-time surgical margin imaging modality. Further study is needed to evaluate intraoperative applications of OCT and its impact on tumour recurrence and long-term outcome.
Collapse
Affiliation(s)
- Edward Cheng
- Department of Veterinary Clinical Sciences, College of Veterinary MedicineThe Ohio State UniversityColumbusOhioUSA
| | - Ryan N. Jennings
- Department of Veterinary Biosciences, College of Veterinary MedicineThe Ohio State UniversityColumbusOhioUSA
| | - Carolyn L. Chen
- Department of Veterinary Clinical Sciences, College of Veterinary MedicineThe Ohio State UniversityColumbusOhioUSA
| | - Morgan R. Biggo
- Department of Veterinary Clinical Sciences, College of Veterinary MedicineThe Ohio State UniversityColumbusOhioUSA
| | - Andrea K. Erickson
- Department of Veterinary Clinical Sciences, College of Veterinary MedicineThe Ohio State UniversityColumbusOhioUSA
| | - Josephine A. Dornbusch
- Department of Veterinary Clinical Sciences, College of Veterinary MedicineThe Ohio State UniversityColumbusOhioUSA
| | - Sarah C. Linn
- Department of Veterinary Biosciences, College of Veterinary MedicineThe Ohio State UniversityColumbusOhioUSA
| | - Janis Lapsley
- Department of Veterinary Clinical Sciences, College of Veterinary MedicineThe Ohio State UniversityColumbusOhioUSA
| | - Bianca M. Alva
- Department of Veterinary Clinical Sciences, College of Veterinary MedicineThe Ohio State UniversityColumbusOhioUSA
| | - Joshua N. Lorbach
- Department of Veterinary Biosciences, College of Veterinary MedicineThe Ohio State UniversityColumbusOhioUSA
| | - Christopher Premanandan
- Department of Veterinary Biosciences, College of Veterinary MedicineThe Ohio State UniversityColumbusOhioUSA
| | - Laura E. Selmic
- Department of Veterinary Clinical Sciences, College of Veterinary MedicineThe Ohio State UniversityColumbusOhioUSA
| |
Collapse
|
13
|
Dey R, Alexandrov S, Owens P, Kelly J, Phelan S, Leahy M. Skin cancer margin detection using nanosensitive optical coherence tomography and a comparative study with confocal microscopy. BIOMEDICAL OPTICS EXPRESS 2022; 13:5654-5666. [PMID: 36733740 PMCID: PMC9872867 DOI: 10.1364/boe.474334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/23/2022] [Accepted: 09/26/2022] [Indexed: 05/08/2023]
Abstract
Excision biopsy and histology represent the gold standard for morphological investigation of the skin, in particular for cancer diagnostics. Nevertheless, a biopsy may alter the original morphology, usually requires several weeks for results, is non-repeatable on the same site and always requires an iatrogenic trauma. Hence, diagnosis and clinical management of diseases may be substantially improved by new non-invasive imaging techniques. Optical Coherence Tomography (OCT) is a non-invasive depth-resolved optical imaging modality based on low coherence interferometry that enables high-resolution, cross-sectional imaging in biological tissues and it can be used to obtain both structural and functional information. Beyond the resolution limit, it is not possible to detect structural and functional information using conventional OCT. In this paper, we present a recently developed technique, nanosensitive OCT (nsOCT), improved using broadband supercontinuum laser, and demonstrate nanoscale sensitivity to structural changes within ex vivo human skin tissue. The extended spectral bandwidth permitted access to a wider distribution of spatial frequencies and improved the dynamic range of the nsOCT. Firstly, we demonstrate numerical and experimental detection of a few nanometers structural difference using the nsOCT method from single B-scan images of phantoms with sub-micron periodic structures, acting like Bragg gratings, along the depth. Secondly, our study shows that nsOCT can distinguish nanoscale structural changes at the skin cancer margin from the healthy region in en face images at clinically relevant depths. Finally, we compare the nsOCT en face image with a high-resolution confocal microscopy image to confirm the structural differences between the healthy and lesional/cancerous regions, allowing the detection of the skin cancer margin.
Collapse
Affiliation(s)
- Rajib Dey
- Tissue Optics and Microcirculation Imaging (TOMI) Facility, National Biophotonics and Imaging Platform School of Physics, National University of Ireland, Galway, Galway, Ireland
| | - Sergey Alexandrov
- Tissue Optics and Microcirculation Imaging (TOMI) Facility, National Biophotonics and Imaging Platform School of Physics, National University of Ireland, Galway, Galway, Ireland
| | - Peter Owens
- Center for Microscopy and Imaging, National University of Ireland, Galway, Galway, Ireland
| | - Jack Kelly
- Plastic and Reconstructive Surgery, Galway University Hospital, Galway, Ireland
| | - Sine Phelan
- Department of Anatomic Pathology, Galway University Hospital and Department of Pathology, National University of Ireland, Galway, Galway, Ireland
| | - Martin Leahy
- Tissue Optics and Microcirculation Imaging (TOMI) Facility, National Biophotonics and Imaging Platform School of Physics, National University of Ireland, Galway, Galway, Ireland
- Institute of Photonic Sciences (ICFO), Barcelona, Spain
| |
Collapse
|
14
|
Young K, Ma E, Kejriwal S, Nielsen T, Aulakh SS, Birkeland AC. Intraoperative In Vivo Imaging Modalities in Head and Neck Cancer Surgical Margin Delineation: A Systematic Review. Cancers (Basel) 2022; 14:cancers14143416. [PMID: 35884477 PMCID: PMC9323577 DOI: 10.3390/cancers14143416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/06/2022] [Accepted: 07/12/2022] [Indexed: 11/16/2022] Open
Abstract
Surgical margin status is one of the strongest prognosticators in predicting patient outcomes in head and neck cancer, yet head and neck surgeons continue to face challenges in the accurate detection of these margins with the current standard of care. Novel intraoperative imaging modalities have demonstrated great promise for potentially increasing the accuracy and efficiency in surgical margin delineation. In this current study, we collated and analyzed various intraoperative imaging modalities utilized in head and neck cancer to evaluate their use in discriminating malignant from healthy tissues. The authors conducted a systematic database search through PubMed/Medline, Web of Science, and EBSCOhost (CINAHL). Study screening and data extraction were performed and verified by the authors, and more studies were added through handsearching. Here, intraoperative imaging modalities are described, including optical coherence tomography, narrow band imaging, autofluorescence, and fluorescent-tagged probe techniques. Available sensitivities and specificities in delineating cancerous from healthy tissues ranged from 83.0% to 100.0% and 79.2% to 100.0%, respectively, across the different imaging modalities. Many of these initial studies are in small sample sizes, with methodological differences that preclude more extensive quantitative comparison. Thus, there is impetus for future larger studies examining and comparing the efficacy of these intraoperative imaging technologies.
Collapse
Affiliation(s)
- Kurtis Young
- John A. Burns School of Medicine, Honolulu, HI 96813, USA; (K.Y.); (E.M.); (S.K.); (T.N.)
| | - Enze Ma
- John A. Burns School of Medicine, Honolulu, HI 96813, USA; (K.Y.); (E.M.); (S.K.); (T.N.)
| | - Sameer Kejriwal
- John A. Burns School of Medicine, Honolulu, HI 96813, USA; (K.Y.); (E.M.); (S.K.); (T.N.)
| | - Torbjoern Nielsen
- John A. Burns School of Medicine, Honolulu, HI 96813, USA; (K.Y.); (E.M.); (S.K.); (T.N.)
| | | | - Andrew C. Birkeland
- Department of Otolaryngology—Head and Neck Surgery, University of California, Davis, CA 95817, USA
- Correspondence:
| |
Collapse
|
15
|
Voskuil FJ, Vonk J, van der Vegt B, Kruijff S, Ntziachristos V, van der Zaag PJ, Witjes MJH, van Dam GM. Intraoperative imaging in pathology-assisted surgery. Nat Biomed Eng 2022; 6:503-514. [PMID: 34750537 DOI: 10.1038/s41551-021-00808-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 06/17/2021] [Indexed: 12/12/2022]
Abstract
The pathological assessment of surgical specimens during surgery can reduce the incidence of positive resection margins, which otherwise can result in additional surgeries or aggressive therapeutic regimens. To improve patient outcomes, intraoperative spectroscopic, fluorescence-based, structural, optoacoustic and radiological imaging techniques are being tested on freshly excised tissue. The specific clinical setting and tumour type largely determine whether endogenous or exogenous contrast is to be detected and whether the tumour specificity of the detected biomarker, image resolution, image-acquisition times or penetration depth are to be prioritized. In this Perspective, we describe current clinical standards for intraoperative tissue analysis and discuss how intraoperative imaging is being implemented. We also discuss potential implementations of intraoperative pathology-assisted surgery for clinical decision-making.
Collapse
Affiliation(s)
- Floris J Voskuil
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jasper Vonk
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Bert van der Vegt
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Schelto Kruijff
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Vasilis Ntziachristos
- Chair for Biological Imaging, Center for Translational Cancer Research, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany.,Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
| | - Pieter J van der Zaag
- Phillips Research Laboratories, Eindhoven, The Netherlands.,Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Molecular Biophysics, Zernike Institute, University of Groningen, Groningen, The Netherlands
| | - Max J H Witjes
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gooitzen M van Dam
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. .,AxelaRx/TRACER BV, Groningen, The Netherlands.
| |
Collapse
|
16
|
Wang J, Wohlberg B, Adamson RBA. Convolutional dictionary learning for blind deconvolution of optical coherence tomography images. BIOMEDICAL OPTICS EXPRESS 2022; 13:1834-1854. [PMID: 35519239 PMCID: PMC9045938 DOI: 10.1364/boe.447394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/23/2022] [Accepted: 02/02/2022] [Indexed: 06/14/2023]
Abstract
In this study, we demonstrate a sparsity-regularized, complex, blind deconvolution method for removing sidelobe artefacts and stochastic noise from optical coherence tomography (OCT) images. Our method estimates the complex scattering amplitude of tissue on a line-by-line basis by estimating and deconvolving the complex, one-dimensional axial point spread function (PSF) from measured OCT A-line data. We also present a strategy for employing a sparsity weighting mask to mitigate the loss of speckle brightness within tissue-containing regions caused by the sparse deconvolution. Qualitative and quantitative analyses show that this approach suppresses sidelobe artefacts and background noise better than traditional spectral reshaping techniques, with negligible loss of tissue structure. The technique is particularly useful for emerging OCT applications where OCT images contain strong specular reflections at air-tissue boundaries that create large sidelobe artefacts.
Collapse
Affiliation(s)
- Junzhe Wang
- School of Biomedical Engineering, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Brendt Wohlberg
- Theoretical Division, Los Alamos National Laboratory, Los Alamos, NM 87545, USA
| | - R. B. A. Adamson
- School of Biomedical Engineering, Dalhousie University, Halifax, NS B3H 4R2, Canada
- Electrical & Computer Engineering Department, Dalhousie University, Halifax, NS B3H 4R2, Canada
| |
Collapse
|
17
|
Giannitto C, Mercante G, Disconzi L, Boroni R, Casiraghi E, Canzano F, Cerasuolo M, Gaino F, De Virgilio A, Fiamengo B, Ferreli F, Esposito AA, Oliva P, Ronzoni F, Terracciano L, Spriano G, Balzarini L. Frozen Section Analysis and Real-Time Magnetic Resonance Imaging of Surgical Specimen Oriented on 3D Printed Tongue Model to Assess Surgical Margins in Oral Tongue Carcinoma: Preliminary Results. Front Oncol 2021; 11:735002. [PMID: 34956865 PMCID: PMC8698483 DOI: 10.3389/fonc.2021.735002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 11/10/2021] [Indexed: 11/13/2022] Open
Abstract
Background A surgical margin is the apparently healthy tissue around a tumor which has been removed. In oral cavity carcinoma, a negative margin is considered ≥ 5 mm, a close margin between 1 and 5 mm, and a positive margin ≤ 1 mm. Currently, the intraoperative surgical margin status is based on the visual inspection and tissue palpation by the surgeon and intraoperative histopathological assessment of the resection margins by frozen section analysis (FSA). FSA technique is limited and susceptible to sampling errors. Definitive information on the deep resection margins requires postoperative histopathological analysis. Methods We described a novel approach for the assessment of intraoperative surgical margins by examining a surgical specimen oriented through a 3D-printed specific patient tongue with real-time Magnetic Resonance Imaging (MRI). We reported the preliminary results of a case series of 10 patients, prospectively enrolled, with oral tongue carcinoma who underwent surgery between February 2020 and April 2021. Two radiologists with 5 and 10 years of experience, respectively, in Head and Neck radiology in consensus evaluated specimen MRI and measured the distance between the tumor and the specimen surface. We performed intraoperative bedside FSA. To compare the performance of bedside FSA and MRI in predicting definitive margin status we computed the weighted sensitivity (SE), specificity (SP), accuracy (ACC), area under the ROC curve (AUC), F1-score, Positive Predictive Value (PPV), and Negative Predictive Value (NPV). To express the concordance between FSA and ex-vivo MRI we reported the jaccard index. Results Intraoperative bedside FSA showed SE of 90%, SP of 100%, F1 of 95%, ACC of 0.9%, PPV of 100%, NPV (not a number), and jaccard of 90%, and ex-vivo MRI showed SE of 100%, SP of 100%, F1 of 100%, ACC of 100%, PPV of 100%, NPV of 100%, and jaccard of 100%. These results needed to be validated in a larger sample size of 21- 44 patients. Conclusion The presented method allows a more accurate evaluation of surgical margin status, and the first clinical experiences underline the high potential of integrating FSA with ex-vivo MRI of the fresh surgical specimen.
Collapse
Affiliation(s)
- Caterina Giannitto
- Department of Diagnostic Radiology, Humanitas Clinical and Research Center Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Giuseppe Mercante
- Otorhinolaryngology Unit, Humanitas Clinical and Research Centre Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Luca Disconzi
- Department of Diagnostic Radiology, Humanitas Clinical and Research Center Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Riccardo Boroni
- Department of Supply Chain, Humanitas Clinical and Research Center Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), Rozzano, Milan, Italy
| | - Elena Casiraghi
- Department of Computer Science (DI), Università degli Studi di Milano, Milan, Italy
| | - Federica Canzano
- Otorhinolaryngology Unit, Humanitas Clinical and Research Centre Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Michele Cerasuolo
- Otorhinolaryngology Unit, Humanitas Clinical and Research Centre Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Francesca Gaino
- Otorhinolaryngology Unit, Humanitas Clinical and Research Centre Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Armando De Virgilio
- Otorhinolaryngology Unit, Humanitas Clinical and Research Centre Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Barbara Fiamengo
- Department of Pathology, Humanitas Clinical and Research Center Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Fabio Ferreli
- Otorhinolaryngology Unit, Humanitas Clinical and Research Centre Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | | | - Paolo Oliva
- Department of Supply Chain, Humanitas Clinical and Research Center Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), Rozzano, Milan, Italy
| | - Flavio Ronzoni
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Luigi Terracciano
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Pathology, Humanitas Clinical and Research Center Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Giuseppe Spriano
- Otorhinolaryngology Unit, Humanitas Clinical and Research Centre Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Luca Balzarini
- Department of Diagnostic Radiology, Humanitas Clinical and Research Center Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| |
Collapse
|
18
|
Single-Fiber Diffuse Reflectance Spectroscopy and Spatial Frequency Domain Imaging in Surgery Guidance: A Study on Optical Phantoms. MATERIALS 2021; 14:ma14247502. [PMID: 34947102 PMCID: PMC8708622 DOI: 10.3390/ma14247502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/06/2021] [Accepted: 12/03/2021] [Indexed: 11/25/2022]
Abstract
Diffuse reflectance spectroscopy (DRS) and imaging are increasingly being used in surgical guidance for tumor margin detection during endoscopic operations. However, the accuracy of the boundary detection with optical techniques may depend on the acquisition parameters, and its evaluation is in high demand. In this work, using optical phantoms with homogeneous and heterogeneous distribution of chromophores mimicking normal and pathological bladder tissues, the accuracy of tumor margin detection using single-fiber diffuse reflectance spectroscopy and spatial frequency domain imaging was evaluated. We also showed how the diffuse reflectance response obtained at different spatial frequencies with the spatial frequency domain imaging technique could be used not only to quantitatively map absorption and scattering coefficients of normal tissues and tumor-like heterogeneities but also to estimate the tumor depth localization. The demonstrated results could be helpful for proper analysis of the DRS data measured in vivo and for translation of optical techniques for tumor margin detection to clinics.
Collapse
|
19
|
Kumar G, Jena S, Jnaneswar A, Jha K, Suresan V, Singh A. Advancements in diagnostic techniques for oral cancer detection. Minerva Dent Oral Sci 2021; 71:192-198. [PMID: 34851069 DOI: 10.23736/s2724-6329.21.04637-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Oral malignancy is among the highest prevalent malignancies all over the world. In comparison to systemic malignancies such as lung cancer and colon cancer, they are frequently overlooked by the general public. Nevertheless, they can be exceedingly lethal if left ignored, regardless at the early stage of the condition. Dentists are the finest qualified healthcare specialists in this sector and are responsible for detecting benign and potentially malignant oral conditions such as oral cancers. Oral carcinoma's high prevalence and delayed appearance are serious international medical concerns. Early detection and management of oral carcinoma are the key goals of the World Health Organization (WHO). The identification of key clinical manifestations during the preliminary oral examination can enhance the patient's likelihood of living. Unfortunately, the conventional technology's practical value is limited by a number of drawbacks. Current advancements in optical scanning techniques, such as tissue-fluorescence imaging and optical coherence tomography, have proven to be quite effective. In particular, nanoparticle-based immunosensors, genomics, and salivary biomarkers, epigenetics and microarray have all received a lot of attention. Raising awareness about frequent dental examinations and using noninvasive, effective, and cost-effective screening tools would improve initial stage detection of oral carcinoma and improve patients' longevity.
Collapse
Affiliation(s)
- Gunjan Kumar
- Department of Public Health Dentistry, Kalinga Institute of Dental Science, KIIT Deemed to be University, Bhubaneswar, India
| | - Samikshya Jena
- Department of Public Health Dentistry, Kalinga Institute of Dental Science, KIIT Deemed to be University, Bhubaneswar, India -
| | - Avinash Jnaneswar
- Department of Public Health Dentistry, Kalinga Institute of Dental Science, KIIT Deemed to be University, Bhubaneswar, India
| | - Kunal Jha
- Department of Public Health Dentistry, Kalinga Institute of Dental Science, KIIT Deemed to be University, Bhubaneswar, India
| | - Vinay Suresan
- Department of Public Health Dentistry, Kalinga Institute of Dental Science, KIIT Deemed to be University, Bhubaneswar, India
| | - Arpita Singh
- KIIT Deemed to be University, Bhubaneswar, Odisha, India
| |
Collapse
|
20
|
Intra-operative resection margin model of tongue carcinoma using 3D reconstructed ultrasound. ADVANCES IN ORAL AND MAXILLOFACIAL SURGERY 2021. [DOI: 10.1016/j.adoms.2021.100154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
21
|
Machine-Learning Assisted Discrimination of Precancerous and Cancerous from Healthy Oral Tissue Based on Multispectral Autofluorescence Lifetime Imaging Endoscopy. Cancers (Basel) 2021; 13:cancers13194751. [PMID: 34638237 PMCID: PMC8507537 DOI: 10.3390/cancers13194751] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 09/13/2021] [Accepted: 09/15/2021] [Indexed: 12/20/2022] Open
Abstract
Multispectral autofluorescence lifetime imaging (maFLIM) can be used to clinically image a plurality of metabolic and biochemical autofluorescence biomarkers of oral epithelial dysplasia and cancer. This study tested the hypothesis that maFLIM-derived autofluorescence biomarkers can be used in machine-learning (ML) models to discriminate dysplastic and cancerous from healthy oral tissue. Clinical widefield maFLIM endoscopy imaging of cancerous and dysplastic oral lesions was performed at two clinical centers. Endoscopic maFLIM images from 34 patients acquired at one of the clinical centers were used to optimize ML models for automated discrimination of dysplastic and cancerous from healthy oral tissue. A computer-aided detection system was developed and applied to a set of endoscopic maFLIM images from 23 patients acquired at the other clinical center, and its performance was quantified in terms of the area under the receiver operating characteristic curve (ROC-AUC). Discrimination of dysplastic and cancerous from healthy oral tissue was achieved with an ROC-AUC of 0.81. This study demonstrates the capabilities of widefield maFLIM endoscopy to clinically image autofluorescence biomarkers that can be used in ML models to discriminate dysplastic and cancerous from healthy oral tissue. Widefield maFLIM endoscopy thus holds potential for automated in situ detection of oral dysplasia and cancer.
Collapse
|
22
|
Moiseev AA, Sirotkina MA, Potapov AL, Matveev LA, Vagapova NN, Kuznetsova IA, Gladkova ND. Lymph vessels visualization from optical coherence tomography data using depth-resolved attenuation coefficient calculation. JOURNAL OF BIOPHOTONICS 2021; 14:e202100055. [PMID: 34057296 DOI: 10.1002/jbio.202100055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/26/2021] [Accepted: 05/11/2021] [Indexed: 06/12/2023]
Abstract
Multimodal optical coherent tomography grows popularity with researchers and clinicians over the past decade. One of the modalities is lymphangiography, which allows visualization of the lymphatic vessel networks within optical coherence tomography (OCT) imaging volume. In the present study, it is shown that lymphatic vessel visualization obtained from the depth-resolved attenuation coefficient distributions, corrected for the noise, shows improved contrast and detail in comparison with previously proposed approaches. We also argue that the two most popular approaches for lymphatic vessel visualization, namely simple intensity thresholding and vesselness calculation based on local Hessian matrix eigenvalues, imply different definitions of the lymphatic vessel's appearance in the OCT volume and lead to the different networks.
Collapse
Affiliation(s)
| | | | - Arseny L Potapov
- Privolzhsky Research Medical University, Nizhny Novgorod, Russia
| | - Lev A Matveev
- Institute of Applied Physics RAS, Nizhny Novgorod, Russia
| | - Nailya N Vagapova
- N.A. Semashko Nizhny Novgorod Regional Clinical Hospital, Nizhny Novgorod, Russia
| | | | | |
Collapse
|
23
|
van Schaik JE, Halmos GB, Witjes MJH, Plaat BEC. An overview of the current clinical status of optical imaging in head and neck cancer with a focus on Narrow Band imaging and fluorescence optical imaging. Oral Oncol 2021; 121:105504. [PMID: 34454339 DOI: 10.1016/j.oraloncology.2021.105504] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/25/2021] [Accepted: 08/18/2021] [Indexed: 11/28/2022]
Abstract
Early and accurate identification of head and neck squamous cell carcinoma (HNSCC) is important to improve treatment outcomes and prognosis. New optical imaging techniques may assist in both the diagnostic process as well as in the operative setting by real-time visualization and delineation of tumor. Narrow Band Imaging (NBI) is an endoscopic technique that uses blue and green light to enhance mucosal and submucosal blood vessels, leading to better detection of (pre)malignant lesions showing aberrant blood vessel patterns. Fluorescence optical imaging makes use of near-infrared fluorescent agents to visualize and delineate HNSCC, resulting in fewer positive surgical margins. Targeted fluorescent agents, such as fluorophores conjugated to antibodies, show the most promising results. The aim of this review is: (1) to provide the clinical head and neck surgeon an overview of the current clinical status of various optical imaging techniques in head and neck cancer; (2) to provide an in-depth review of NBI and fluorescence optical imaging, as these techniques have the highest potential for clinical implementation; and (3) to describe future improvements and developments within the field of these two techniques.
Collapse
Affiliation(s)
- Jeroen E van Schaik
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
| | - Gyorgy B Halmos
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Max J H Witjes
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, the Netherlands
| | - Boudewijn E C Plaat
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| |
Collapse
|
24
|
Coleman MJ, Selmic LE, Samuelson JP, Jennings R, Huang PC, McLaughlin EM, Wavreille VA, Dornbusch JA, Lapsley J, Howard J, Cheng E, Kalamaras A, Hearon K, Cray M, Grimes J, Wustefeld-Janssens B, Kennedy K, Skinner O, Amsellem P, Boppart SA. Diagnostic accuracy of optical coherence tomography for surgical margin assessment of feline injection-site sarcoma. Vet Comp Oncol 2021; 19:632-640. [PMID: 34427379 DOI: 10.1111/vco.12766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 03/31/2021] [Accepted: 08/18/2021] [Indexed: 02/05/2023]
Abstract
The invasive, locally aggressive nature of feline injection-site sarcomas (FISSs) poses a unique challenge for surgeons to obtain complete margins with surgical excision. Optical coherence tomography (OCT), an imaging technology that uses light waves to generate real-time views of tissue architecture, provides an emerging solution to this dilemma by allowing fast, high-resolution scanning of surgical margins. The purpose of this study was to use OCT to assess surgical margins of FISS and to evaluate the diagnostic accuracy of OCT for detecting residual cancer using six evaluators of varying experience. Five FISSs were imaged with OCT to create a training set of OCT images that were compared with histopathology. Next, 25 FISSs were imaged with OCT prior to histopathology. Six evaluators of varying experience participated in a training session on OCT imaging after which each of the evaluators was given a dataset that included OCT images and videos to score on a scale from cancerous to non-cancerous. Diagnostic accuracy statistics were calculated. The overall sensitivity and specificity for classification of OCT images by evaluators were 78.9% and 77.6%, respectively. Correct classification rate of OCT images was associated with experience, while individual sensitivities and specificities had more variation between experience groups. This study demonstrates the ability of evaluators to correctly classify OCT images with overall low levels of experience and training and also illustrates areas where increased training can improve accuracy of evaluators in interpretation of OCT surgical margin images.
Collapse
Affiliation(s)
- Mary J Coleman
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Laura E Selmic
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Jonathan P Samuelson
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Ryan Jennings
- Department of Veterinary Biosciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Pin-Chieh Huang
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA.,Department of Bioengineering, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Eric M McLaughlin
- Center for Biostatistics, The Ohio State University, Columbus, Ohio, USA
| | - Vincent A Wavreille
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Josephine A Dornbusch
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Janis Lapsley
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, USA
| | - James Howard
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Edward Cheng
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Alex Kalamaras
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Kendra Hearon
- Department of Surgery, Metropolitan Veterinary Specialists, Philadelphia, Pennsylvannia, USA
| | - Megan Cray
- Department of Surgery, Angell Animal Medical Center, Boston, Massachusetts, USA
| | - Janet Grimes
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, Georgia, USA
| | - Brandan Wustefeld-Janssens
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Texas A & M University, College Station, Texas, USA
| | - Katie Kennedy
- Department of Surgery, Animal Medical Center, New York City, New York, USA
| | - Owen Skinner
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Missouri, Columbia, Missouri, USA
| | - Pierre Amsellem
- Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Minnesota, Twin Cities, Minnesota, USA
| | - Stephen A Boppart
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA.,Department of Bioengineering, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA.,Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA.,Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| |
Collapse
|
25
|
Ogrinc N, Saudemont P, Takats Z, Salzet M, Fournier I. Cancer Surgery 2.0: Guidance by Real-Time Molecular Technologies. Trends Mol Med 2021; 27:602-615. [PMID: 33965341 DOI: 10.1016/j.molmed.2021.04.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 03/30/2021] [Accepted: 04/02/2021] [Indexed: 12/14/2022]
Abstract
In vivo cancer margin delineation during surgery remains a major challenge. Despite the availability of several image guidance techniques and intraoperative assessment, clear surgical margins and debulking efficiency remain scarce. For this reason, there is particular interest in developing rapid intraoperative tools with high sensitivity and specificity to help guide cancer surgery in vivo. Recently, several emerging technologies including intraoperative mass spectrometry have paved the way for molecular guidance in a clinical setting. We evaluate these techniques and assess their relevance for intraoperative surgical guidance and how they can transform the future of molecular cancer surgery, diagnostics, patient management and care.
Collapse
Affiliation(s)
- Nina Ogrinc
- University of Lille, Inserm, CHU Lille, U1192 - Protéomique Réponse Inflammatoire Spectrométrie de Masse - PRISM, F-59000 Lille, France
| | - Philippe Saudemont
- University of Lille, Inserm, CHU Lille, U1192 - Protéomique Réponse Inflammatoire Spectrométrie de Masse - PRISM, F-59000 Lille, France
| | - Zoltan Takats
- University of Lille, Inserm, CHU Lille, U1192 - Protéomique Réponse Inflammatoire Spectrométrie de Masse - PRISM, F-59000 Lille, France
| | - Michel Salzet
- University of Lille, Inserm, CHU Lille, U1192 - Protéomique Réponse Inflammatoire Spectrométrie de Masse - PRISM, F-59000 Lille, France; Institut Universitaire de France (IUF), Paris, France.
| | - Isabelle Fournier
- University of Lille, Inserm, CHU Lille, U1192 - Protéomique Réponse Inflammatoire Spectrométrie de Masse - PRISM, F-59000 Lille, France; Institut Universitaire de France (IUF), Paris, France.
| |
Collapse
|
26
|
Brouwer de Koning SG, Schaeffers AWMA, Schats W, van den Brekel MWM, Ruers TJM, Karakullukcu MB. Assessment of the deep resection margin during oral cancer surgery: A systematic review. Eur J Surg Oncol 2021; 47:2220-2232. [PMID: 33895027 DOI: 10.1016/j.ejso.2021.04.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 04/13/2021] [Indexed: 12/14/2022] Open
Abstract
The main challenge for radical resection in oral cancer surgery is to obtain adequate resection margins. Especially the deep margin, which can only be estimated based on palpation during surgery, is often reported inadequate. To increase the percentage of radical resections, there is a need for a quick, easy, minimal invasive method, which assesses the deep resection margin without interrupting or prolonging surgery. This systematic review provides an overview of technologies that are currently being studied with the aim of fulfilling this demand. A literature search was conducted through the databases Medline, Embase and the Cochrane Library. A total of 62 studies were included. The results were categorized according to the type of technique: 'Frozen Section Analysis', 'Fluorescence', 'Optical Imaging', 'Conventional imaging techniques', and 'Cytological assessment'. This systematic review gives for each technique an overview of the reported performance (accuracy, sensitivity, specificity, positive predictive value, negative predictive value, or a different outcome measure), acquisition time, and sampling depth. At the moment, the most prevailing technique remains frozen section analysis. In the search for other assessment methods to evaluate the deep resection margin, some technologies are very promising for future use when effectiveness has been shown in larger trials, e.g., fluorescence (real-time, sampling depth up to 6 mm) or optical techniques such as hyperspectral imaging (real-time, sampling depth few mm) for microscopic margin assessment and ultrasound (less than 10 min, sampling depth several cm) for assessment on a macroscopic scale.
Collapse
Affiliation(s)
- S G Brouwer de Koning
- Department of Head and Neck Surgery and Oncology, Antoni van Leeuwenhoek, Netherlands Cancer Institute, Amsterdam, the Netherlands.
| | - A W M A Schaeffers
- Department of Head and Neck Surgery and Oncology, Antoni van Leeuwenhoek, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - W Schats
- Scientific Information Service, Antoni van Leeuwenhoek, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - M W M van den Brekel
- Department of Head and Neck Surgery and Oncology, Antoni van Leeuwenhoek, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - T J M Ruers
- Department of Surgical Oncology, Antoni van Leeuwenhoek, Netherlands Cancer Institute, Amsterdam, the Netherlands; Faculty of Science and Technology, University of Twente, Enschede, the Netherlands
| | - M B Karakullukcu
- Department of Head and Neck Surgery and Oncology, Antoni van Leeuwenhoek, Netherlands Cancer Institute, Amsterdam, the Netherlands
| |
Collapse
|
27
|
Trebing CT, Sen S, Rues S, Herpel C, Schöllhorn M, Lux CJ, Rammelsberg P, Schwindling FS. Non-invasive three-dimensional thickness analysis of oral epithelium based on optical coherence tomography-development and diagnostic performance. Heliyon 2021; 7:e06645. [PMID: 33898808 PMCID: PMC8055558 DOI: 10.1016/j.heliyon.2021.e06645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 02/12/2021] [Accepted: 03/26/2021] [Indexed: 12/12/2022] Open
Abstract
Objectives Evaluating structural changes in oral epithelium can assist with the diagnosis of cancerous lesions. Two-dimensional (2D) non-invasive optical coherence tomography (OCT) is an established technique for this purpose. The objective of this study was to develop and test the diagnostic accuracy of a three-dimensional (3D) evaluation method. Methods The oral lip mucosa of 10 healthy volunteers was scanned using an 870-nm spectral-domain OCT device (SD-OCT) with enhanced depth imaging (EDI). Four raters semi-automatically segmented the epithelial layer twice. Thus, eighty 3D datasets were created and analyzed for epithelial thickness. To provide a reference standard for comparison, the raters took cross-sectional 2D measurements at representative sites. The correlation between the 2D and 3D measurements, as well as intra- and inter-rater reliability, were analyzed using intraclass correlation coefficients (ICC). Results Mean epithelial thickness was 280 ± 64μm (range 178–500 μm) and 268 ± 49μm (range 163–425 μm) for the 2D and 3D analysis, respectively. The inter-modality correlation of the thickness values was good (ICC: 0.76 [0.626–0.846]), indicating that 3D analysis of epithelial thickness provides valid results. Intra-rater and inter-rater reliability were good (3D analysis) and excellent (2D analysis), suggesting high reproducibility. Conclusions Diagnostic accuracy was high for the developed 3D analysis of oral epithelia using non-invasive, radiation-free OCT imaging. Clinical significance This new 3D technique could potentially be used to improve time-efficiency and quality in the diagnosis of epithelial lesions compared with the 2D reference standard.
Collapse
Affiliation(s)
| | - Sinan Sen
- Department of Orthodontics, Heidelberg University Hospital, Heidelberg, Germany
| | - Stefan Rues
- Department of Prosthodontics, Heidelberg University Hospital, Heidelberg, Germany
| | - Christopher Herpel
- Department of Prosthodontics, Heidelberg University Hospital, Heidelberg, Germany
| | - Maria Schöllhorn
- Department of Prosthodontics, Heidelberg University Hospital, Heidelberg, Germany
| | - Christopher J Lux
- Department of Orthodontics, Heidelberg University Hospital, Heidelberg, Germany
| | - Peter Rammelsberg
- Department of Prosthodontics, Heidelberg University Hospital, Heidelberg, Germany
| | | |
Collapse
|
28
|
Karnowski K, Li Q, Poudyal A, Villiger M, Farah CS, Sampson DD. Influence of tissue fixation on depth-resolved birefringence of oral cavity tissue samples. JOURNAL OF BIOMEDICAL OPTICS 2020; 25:JBO-200071R. [PMID: 32914607 PMCID: PMC7481436 DOI: 10.1117/1.jbo.25.9.096003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 07/29/2020] [Indexed: 06/11/2023]
Abstract
SIGNIFICANCE To advance our understanding of the contrast observed when imaging with polarization-sensitive optical coherence tomography (PS-OCT) and its correlation with oral cancerous pathologies, a detailed comparison with histology provided via ex vivo fixed tissue is required. The effects of tissue fixation, however, on such polarization-based contrast have not yet been investigated. AIM A study was performed to assess the impact of tissue fixation on depth-resolved (i.e., local) birefringence measured with PS-OCT. APPROACH A PS-OCT system based on depth-encoded polarization multiplexing and polarization-diverse detection was used to measure the Jones matrix of a sample. A wide variety of ex vivo samples were measured freshly after excision and 24 h after fixation, consistent with standard pathology. Some samples were also measured 48 h after fixation. RESULTS The tissue fixation does not diminish the birefringence contrast. Statistically significant changes were observed in 11 out of 12 samples; these changes represented an increase in contrast, overall, by 11% on average. CONCLUSIONS We conclude that the fixed samples are suitable for studies seeking a deeper understanding of birefringence contrast in oral tissue pathology. The enhancement of contrast removes the need to image immediately postexcision and will facilitate future investigations with PS-OCT and other advanced polarization-sensitive microscopy methods, such as mapping of the local optic axis with PS-OCT and PS-optical coherence microscopy.
Collapse
Affiliation(s)
- Karol Karnowski
- The University of Western Australia, Optical+Biomedical Engineering Laboratory, Department of Electrical, Electronic, and Computer Engineering, Perth, Western Australia, Australia
- Polish Academy of Sciences, Institute of Physical Chemistry, Warsaw, Poland
| | - Qingyun Li
- The University of Western Australia, Optical+Biomedical Engineering Laboratory, Department of Electrical, Electronic, and Computer Engineering, Perth, Western Australia, Australia
| | - Anima Poudyal
- The University of Western Australia, UWA Dental School, Perth, Western Australia, Australia
| | - Martin Villiger
- Harvard Medical School, Massachusetts General Hospital, Wellman Center for Photomedicine, Boston, Massachusetts, United Sates
| | - Camile S. Farah
- The University of Western Australia, UWA Dental School, Perth, Western Australia, Australia
- Australian Centre for Oral Oncology Research and Education, Perth, Western Australia, Australia
- Fiona Stanley Hospital, Oral, Maxillofacial, and Dental Surgery, Murdoch, Western Australia, Australia
| | - David D. Sampson
- University of Surrey, Surrey Biophotonics, School of Physics, Guilford, United Kingdom
- University of Surrey, Surrey Biophotonics, School of Biosciences and Medicine, Guilford, United Kingdom
| |
Collapse
|
29
|
An Update on Surgical Margins in the Head Neck Squamous Cell Carcinoma: Assessment, Clinical Outcome, and Future Directions. Curr Oncol Rep 2020; 22:82. [PMID: 32601821 DOI: 10.1007/s11912-020-00942-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE OF REVIEW Failure to achieve tumor-free margins is the single largest cause of death for head neck cancer patients. At the same time, it is the only factor that is in complete control of the surgeon. This review summarizes evidence for the definition, clinical implications, and methods to achieve optimal margins. RECENT FINDINGS The previous universally followed definition of adequate margin (5 mm in final histopathology) has been disputed. Various biological, optical, and imaging adjuncts can aid in achieving optimal margins. Extent of resection and margins in human papilloma virus (HPV)-positive oropharyngeal cancers and following induction chemotherapy remain controversial. Though practiced widely, frozen section-guided margin revision has not conclusively shown improved local control rates. The role of molecular assessment of margins is promising but not established. The definition of adequate margin differs according to the site in the head neck region. Currently, the 5-mm margin at final histopathology is the most commonly accepted definition of an "adequate" margin.
Collapse
|
30
|
Nie Z, Yeh SCA, LePalud M, Badr F, Tse F, Armstrong D, Liu LWC, Deen MJ, Fang Q. Optical Biopsy of the Upper GI Tract Using Fluorescence Lifetime and Spectra. Front Physiol 2020; 11:339. [PMID: 32477151 PMCID: PMC7237753 DOI: 10.3389/fphys.2020.00339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 03/24/2020] [Indexed: 12/11/2022] Open
Abstract
Screening and surveillance for gastrointestinal (GI) cancers by endoscope guided biopsy is invasive, time consuming, and has the potential for sampling error. Tissue endogenous fluorescence spectra contain biochemical and physiological information, which may enable real-time, objective diagnosis. We first briefly reviewed optical biopsy modalities for GI cancer diagnosis with a focus on fluorescence-based techniques. In an ex vivo pilot clinical study, we measured fluorescence spectra and lifetime on fresh biopsy specimens obtained during routine upper GI screening procedures. Our results demonstrated the feasibility of rapid acquisition of time-resolved fluorescence (TRF) spectra from fresh GI mucosal specimens. We also identified spectroscopic signatures that can differentiate between normal mucosal samples obtained from the esophagus, stomach, and duodenum.
Collapse
Affiliation(s)
- Zhaojun Nie
- School of Biomedical Engineering, Faculty of Engineering, McMaster University, Hamilton, ON, Canada
| | - Shu-Chi Allison Yeh
- Advanced Microscopy Program, Center for Systems Biology and Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Michelle LePalud
- School of Biomedical Engineering, Faculty of Engineering, McMaster University, Hamilton, ON, Canada
| | - Fares Badr
- School of Biomedical Engineering, Faculty of Engineering, McMaster University, Hamilton, ON, Canada
| | - Frances Tse
- Division of Gastroenterology and Farncombe Family Digestive Health Research Institute, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - David Armstrong
- Division of Gastroenterology and Farncombe Family Digestive Health Research Institute, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Louis W. C. Liu
- Division of Gastrointestinal Diseases, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - M. Jamal Deen
- School of Biomedical Engineering, Faculty of Engineering, McMaster University, Hamilton, ON, Canada
- Department of Electrical and Computer Engineering, Faculty of Engineering, McMaster University, Hamilton, ON, Canada
| | - Qiyin Fang
- School of Biomedical Engineering, Faculty of Engineering, McMaster University, Hamilton, ON, Canada
- Department of Engineering Physics, Faculty of Engineering, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
31
|
Heidkamp J, Weijs WLJ, van Engen-van Grunsven ACH, de Laak-de Vries I, Maas MC, Rovers MM, Fütterer JJ, Steens SCA, Takes RP. Assessment of surgical tumor-free resection margins in fresh squamous-cell carcinoma resection specimens of the tongue using a clinical MRI system. Head Neck 2020; 42:2039-2049. [PMID: 32119170 PMCID: PMC7496932 DOI: 10.1002/hed.26125] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 01/29/2020] [Accepted: 02/20/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Current intraoperative methods of visual inspection and tissue palpation by the surgeon, and frozen section analysis cannot reliably prevent inadequate surgical margins in patients treated for oral squamous-cell carcinoma (OSCC). This study assessed feasibility of MRI for the assessment of surgical resection margins in fresh OSCC specimens. METHODS Ten consecutive tongue specimens containing OSCC were scanned using 3 T clinical whole-body MRI. Two radiologists independently annotated OSCC location and minimal tumor-free margins. Whole-mount histology was the reference standard. RESULTS The positive predictive values (PPV) and negative predictive values (NPV) for OSCC localization were 96% and 75%, and 87% and 79% for reader 1 and 2, respectively. The PPV and NPV for identification of margins <5 mm were 38% and 91%, and 5% and 87% for reader 1 and 2, respectively. CONCLUSIONS MRI accurately localized OSCC with high inter-reader agreement in fresh OSCC specimens, but it seemed not yet feasible to accurately assess the surgical margin status.
Collapse
Affiliation(s)
- Jan Heidkamp
- Department of Radiology and Nuclear Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Willem L J Weijs
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | | | - Ilse de Laak-de Vries
- Department of Pathology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marnix C Maas
- Department of Radiology and Nuclear Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Maroeska M Rovers
- Department of Operating Rooms, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jurgen J Fütterer
- Department of Radiology and Nuclear Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Stefan C A Steens
- Department of Radiology and Nuclear Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Robert P Takes
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| |
Collapse
|
32
|
Heidari AE, Pham TT, Ifegwu I, Burwell R, Armstrong WB, Tjoson T, Whyte S, Giorgioni C, Wang B, Wong BJ, Chen Z. The use of optical coherence tomography and convolutional neural networks to distinguish normal and abnormal oral mucosa. JOURNAL OF BIOPHOTONICS 2020; 13:e201900221. [PMID: 31710775 PMCID: PMC7250484 DOI: 10.1002/jbio.201900221] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 11/08/2019] [Accepted: 11/10/2019] [Indexed: 06/10/2023]
Abstract
Incomplete surgical resection of head and neck squamous cell carcinoma (HNSCC) is the most common cause of local HNSCC recurrence. Currently, surgeons rely on preoperative imaging, direct visualization, palpation and frozen section to determine the extent of tissue resection. It has been demonstrated that optical coherence tomography (OCT), a minimally invasive, nonionizing near infrared mesoscopic imaging modality can resolve subsurface differences between normal and abnormal head and neck mucosa. Previous work has utilized two-dimensional OCT imaging which is limited to the evaluation of small regions of interest generated frame by frame. OCT technology is capable of performing rapid volumetric imaging, but the capacity and expertise to analyze this massive amount of image data is lacking. In this study, we evaluate the ability of a retrained convolutional neural network to classify three-dimensional OCT images of head and neck mucosa to differentiate normal and abnormal tissues with sensitivity and specificity of 100% and 70%, respectively. This method has the potential to serve as a real-time analytic tool in the assessment of surgical margins.
Collapse
Affiliation(s)
- Andrew E. Heidari
- Beckman Laser Institute & Medical Clinic, Irvine, CA 92612, USA
- Department of Biomedical Engineering, University of California - Irvine, Irvine, CA 92697, USA
| | - Tiffany T. Pham
- Beckman Laser Institute & Medical Clinic, Irvine, CA 92612, USA
- University of California - Irvine, School of Medicine, Irvine, CA 92617, USA
| | - Ibe Ifegwu
- Department of Pathology, University of California – Irvine, Irvine, CA 92697, USA
| | - Ross Burwell
- Department of Pathology, University of California – Irvine, Irvine, CA 92697, USA
| | - William B. Armstrong
- Department of Otolaryngology - Head and Neck Surgery, University of California - Irvine, School of Medicine, Orange, CA 92868, USA
| | - Tjoa Tjoson
- Department of Otolaryngology - Head and Neck Surgery, University of California - Irvine, School of Medicine, Orange, CA 92868, USA
| | - Stephanie Whyte
- Department of Pathology, University of California – Irvine, Irvine, CA 92697, USA
| | - Carmen Giorgioni
- Department of Pathology, University of California – Irvine, Irvine, CA 92697, USA
| | - Beverly Wang
- Department of Pathology, University of California – Irvine, Irvine, CA 92697, USA
| | - Brian J.F. Wong
- Beckman Laser Institute & Medical Clinic, Irvine, CA 92612, USA
- Department of Biomedical Engineering, University of California - Irvine, Irvine, CA 92697, USA
- Department of Otolaryngology - Head and Neck Surgery, University of California - Irvine, School of Medicine, Orange, CA 92868, USA
| | - Zhongping Chen
- Beckman Laser Institute & Medical Clinic, Irvine, CA 92612, USA
- Department of Biomedical Engineering, University of California - Irvine, Irvine, CA 92697, USA
| |
Collapse
|
33
|
Marin R, Lifante J, Besteiro LV, Wang Z, Govorov AO, Rivero F, Alfonso F, Sanz‐Rodríguez F, Jaque D. Plasmonic Copper Sulfide Nanoparticles Enable Dark Contrast in Optical Coherence Tomography. Adv Healthc Mater 2020; 9:e1901627. [PMID: 31977166 DOI: 10.1002/adhm.201901627] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 12/20/2019] [Indexed: 12/29/2022]
Abstract
Optical coherence tomography (OCT) is an imaging technique affording noninvasive optical biopsies. Like for other imaging techniques, the use of dedicated contrast agents helps better discerning biological features of interest during the clinical practice. Although bright OCT contrast agents have been developed, no dark counterpart has been proposed yet. Herein, plasmonic copper sulfide nanoparticles as the first OCT dark contrast agents working in the second optical transparency window are reported. These nanoparticles virtually possess no light scattering capabilities at the OCT working wavelength (≈1300 nm); thus, they exclusively absorb the probing light, which in turn results in dark contrast. The small size of the nanoparticles and the absence of apparent cytotoxicity support the amenability of this system to biomedical applications. Importantly, in the pursuit of systems apt to yield OCT dark contrast, a library of copper sulfide nanoparticles featuring plasmonic resonances spanning the three optical transparency windows is prepared, thus highlighting the versatility and potential of these systems in light-controlled biomedical applications.
Collapse
Affiliation(s)
- Riccardo Marin
- Fluorescence Imaging Group (FIG)Departamento de Física de MaterialesFacultad de CienciasUniversidad Autónoma de Madrid C/ Francisco Tomás y Valiente 7 Madrid 28049 Spain
| | - José Lifante
- Nanobiology GroupInstituto Ramón y Cajal de InvestigaciónSanitaria Hospital Ramón y Cajal Ctra. De Colmenar Viejo, Km. 9100 Madrid 28034 Spain
| | - Lucas V. Besteiro
- Institut National de la Recherche Scientifique (INRS)Centre ÉnergieMatériaux et TélécommunicationsUniversité du Québec 1650 Boul. Lionel‐Boulet Varennes Québec J3 X 1S2 Canada
- Institute of Fundamental and Frontier SciencesUniversity of Electronic Science and Technology of China Chengdu 610054 Sichuan China
| | - Zhiming Wang
- Institute of Fundamental and Frontier SciencesUniversity of Electronic Science and Technology of China Chengdu 610054 Sichuan China
| | - Alexander O. Govorov
- Institute of Fundamental and Frontier SciencesUniversity of Electronic Science and Technology of China Chengdu 610054 Sichuan China
- Department of Physics and AstronomyOhio University Athens OH 45701 USA
| | - Fernando Rivero
- Unit of CardiologyHospital la Princesa Calle de Diego de León, 62 Madrid 28006 Spain
| | - Fernando Alfonso
- Unit of CardiologyHospital la Princesa Calle de Diego de León, 62 Madrid 28006 Spain
| | - Francisco Sanz‐Rodríguez
- Nanobiology GroupInstituto Ramón y Cajal de InvestigaciónSanitaria Hospital Ramón y Cajal Ctra. De Colmenar Viejo, Km. 9100 Madrid 28034 Spain
- Fluorescence Imaging Group (FIG)Departamento de BiologíaFacultad de CienciasUniversidad Autónoma de Madrid C/ Francisco Tomás y Valiente 7 Madrid 28049 Spain
| | - Daniel Jaque
- Fluorescence Imaging Group (FIG)Departamento de Física de MaterialesFacultad de CienciasUniversidad Autónoma de Madrid C/ Francisco Tomás y Valiente 7 Madrid 28049 Spain
- Nanobiology GroupInstituto Ramón y Cajal de InvestigaciónSanitaria Hospital Ramón y Cajal Ctra. De Colmenar Viejo, Km. 9100 Madrid 28034 Spain
| |
Collapse
|
34
|
De Leeuw F, Abbaci M, Casiraghi O, Ben Lakhdar A, Alfaro A, Breuskin I, Laplace-Builhé C. Value of Full-Field Optical Coherence Tomography Imaging for the Histological Assessment of Head and Neck Cancer. Lasers Surg Med 2020; 52:768-778. [PMID: 32072655 DOI: 10.1002/lsm.23223] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND OBJECTIVES In head and neck surgery, intraoperative and postoperative evaluation of tumor margins is achieved by histopathological assessment, which is a multistep process. Intraoperative analysis of tumor margins to obtain a preliminary diagnosis is usually carried out on frozen sections. Analysis of frozen sections is challenging due to technical difficulties in processing. Full-field optical coherence tomography (FFOCT) provides ex vivo images of fresh tissue samples at a microscopic scale without tissue processing. The objectives of our study were to define the diagnostic criteria required to interpret head and neck FFOCT images and to evaluate the reliability of a histological diagnosis made on an "optical biopsy" produced by head and neck FFOCT imaging compared with conventional histology. STUDY DESIGN/MATERIALS AND METHODS First, we established an atlas of comparative images (FFOCT/standard histology) and defined the diagnostic criteria based on FFOCT images. Two pathologists subsequently performed a blinded review on 57 FFOCT images (32 patients). Specificity and sensitivity were measured by comparison with the standard histological diagnosis. The primary endpoint was major concordance, defined as two classifications leading to the same therapeutic decision (treatment/no treatment). RESULTS Pathologists identified four main criteria for tissue diagnosis on FFOCT images: heterogeneous cell distribution, stromal reaction, coiling, and keratinization abnormalities. The correlation study showed good results, with sensitivity from 88% to 90% and specificity from 81% to 87%, regardless of whether the FFOCT image review was performed by a pathologist with or without previous experience in optical imaging. CONCLUSIONS Our results demonstrate that FFOCT images can be used by pathologists for differential diagnosis, and that high-resolution FFOCT imaging can provide an assessment of microscopic architecture in head and neck tissues without tissue processing requirements. Lasers Surg. Med. © 2020 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Frederic De Leeuw
- Gustave Roussy, Plate-forme Imagerie et Cytométrie, Université Paris-Saclay, UMS 23/3655, Villejuif, F-94805, France
| | - Muriel Abbaci
- Gustave Roussy, Plate-forme Imagerie et Cytométrie, Université Paris-Saclay, UMS 23/3655, Villejuif, F-94805, France.,UMR CNRS 8081-IR4M, Univ Paris-Sud, Université Paris-Saclay, Orsay, F-91401, France
| | - Odile Casiraghi
- Département de pathologie, Gustave Roussy, Université Paris-Saclay, Villejuif, F-94805, France
| | - Aïcha Ben Lakhdar
- Département de pathologie, Gustave Roussy, Université Paris-Saclay, Villejuif, F-94805, France
| | - Alexia Alfaro
- Gustave Roussy, Plate-forme Imagerie et Cytométrie, Université Paris-Saclay, UMS 23/3655, Villejuif, F-94805, France
| | - Ingrid Breuskin
- Département de chirurgie, Gustave Roussy, Université Paris-Saclay, Villejuif, F-94805, France
| | - Corinne Laplace-Builhé
- Gustave Roussy, Plate-forme Imagerie et Cytométrie, Université Paris-Saclay, UMS 23/3655, Villejuif, F-94805, France.,UMR CNRS 8081-IR4M, Univ Paris-Sud, Université Paris-Saclay, Orsay, F-91401, France
| |
Collapse
|
35
|
Jerjes W, Hamdoon Z, Hopper C. Structural validation of facial skin using optical coherence tomography: A descriptive study. Skin Res Technol 2019; 26:153-162. [PMID: 31544983 DOI: 10.1111/srt.12791] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 09/05/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND In this immediate ex vivo study, we aimed to identify the structures of normal and pathological facial skin using optical coherence tomography (OCT) and compared them to the gold standard histopathology. MATERIAL AND METHODS A total of 53 patients, with 57 suspicious facial lesions, participated in this study. A set of variables have been highlighted by the pathologist to represent the minimum unique features that could be used to diagnose a skin pathology have been included in a checklist. One pathologist used this checklist while examining the histopathology slides and one clinician while examining the OCT images. The data from both checklists have been reviewed and compared. RESULTS Optical coherence tomography's overall accuracy in diagnosing AK was 83%. Best accuracy was achieved in diagnosing BCC and was 97%, while it was 85% for cutaneous SCC. OCT failed to diagnose LM with an accuracy of 33.3% based on the two parameters of the pathology checklist, while it was 81% for malignant melanoma. CONCLUSION This study proved the success of OCT in identifying structural changes in normal and pathological facial skin. Further studies to prove its usefulness in vivo are recommended.
Collapse
Affiliation(s)
- Waseem Jerjes
- University College London Medical School, London, UK.,North End Medical Centre, London, UK
| | - Zaid Hamdoon
- College of Dental Medicine, University of Sharjah, Sharjah, UAE.,Unit of OMFS, UCL Eastman Dental Institute, London, UK
| | - Colin Hopper
- University College London Medical School, London, UK.,Unit of OMFS, UCL Eastman Dental Institute, London, UK
| |
Collapse
|
36
|
Jerjes W, Hamdoon Z, Yousif AA, Al-Rawi NH, Hopper C. Epithelial tissue thickness improves optical coherence tomography's ability in detecting oral cancer. Photodiagnosis Photodyn Ther 2019; 28:69-74. [PMID: 31454715 DOI: 10.1016/j.pdpdt.2019.08.029] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 08/17/2019] [Accepted: 08/23/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND OCT is a non-invasive imaging technique that enables the measurement of epithelial thickness and architectural changes, which can help in the diagnosis of pre-cancerous and cancerous lesions. The purpose of the study was to assess whether epithelial tissue thickness improves optical coherence tomography's ability in detecting oral cancer. PATIENTS AND METHODS Surgically resected oral margins from 60 patients diagnosed with oral squamous cell carcinoma were subjected to OCT. Three OCT measurements (immediate, 1 h and 24 h post-resection) were conducted per resected tissue specimen to look at the effect of saline and formalin on the specimen and its effect on the reproducibility of the OCT. OCT was, then, used to measure the epithelial tissue thickness in cancer-free and cancer-involved margins in eight oral anatomical locations. This data was, then, combined with architectural changes data to calculate the sensitivity and specificity. RESULTS An overall of 189 cancer-free margins and 51 cancer-involved margins had their epithelial thickness measured using OCT and compared to histopathology. With regards to the validity of the OCT and histopathological measurements, epithelial thickness showed good correlation between different readings at all oral sites. With regards to the reproducibility of the OCT measurements, the mean epithelial thickness for all measurements at first (immediate) and second (1 h post-resection - saline preserved) measurements was not significantly different. Underestimation of the epithelial depth in cancer-free margins was 20 μm, while in the cancer-involved margins was 10 μm. Combining data from architectural changes and epithelial thickness, a sensitivity of 92% and a specificity of 94% was achieved. CONCLUSION Oral epithelium measurements using OCT were valid compared to those made with gold standard pathology. Measurements made using OCT was also reproducible with minor underestimation. Epithelial thickness, combined with architectural changes, led to high accuracy in differentiating between cancer-free and cancer-involved margins.
Collapse
Affiliation(s)
- Waseem Jerjes
- University College London Medical School, London, UK; North End Medical Centre, London, UK.
| | - Zaid Hamdoon
- College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates; Unit of OMFS, UCL Eastman Dental Institute, London, UK
| | - Aamr A Yousif
- College of Pharmacy, University of Duhok, Duhok, Iraq
| | - Natheer H Al-Rawi
- College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Colin Hopper
- University College London Medical School, London, UK; Unit of OMFS, UCL Eastman Dental Institute, London, UK
| |
Collapse
|
37
|
Surgical margins in oral squamous cell cancer: intraoperative evaluation and prognostic impact. Curr Opin Otolaryngol Head Neck Surg 2019; 27:98-103. [PMID: 30844923 DOI: 10.1097/moo.0000000000000516] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW To summarize recent findings regarding surgical management of oral squamous cell cancer (OSCC) through analysis of different intraoperative techniques for assessment of margins, evaluate the pros and cons of each, and ensuing prognostic impact. RECENT FINDINGS 'En bloc' OSCC resection and histopathologic evaluation of margins on the formalin-fixed specimen remain the 'gold standard' for oral oncologic surgery, whereas assessment of intraoperative surgical margins and its overall clinical value are still questioned and debated in the literature. The commonly applied evaluation of frozen sections still raises concerns regarding its efficacy and reproducibility; therefore, several ancillary diagnostic methods have entered the field of head and neck oncology in the last decades, aiming to support the surgeon in achieving tumor-free margins during ablative procedures. SUMMARY Poor prognosis of OSCC is strongly associated with residual tumor after surgery. Negative surgical margins are one of the strongest prognosticators for disease-free survival and locoregional control, but their intraoperative determination seems still to be suboptimal and needs better refinement. The most studied techniques to assess intraoperative margins include fluorescence, Raman spectroscopy, narrow band imaging, optical coherence tomography, and cytological bone margins analysis; each has its unique characteristics that are described in detail herein.
Collapse
|
38
|
Jiang Y, Girard EJ, Pakiam F, Seibel EJ. Calibration of fluorescence imaging for tumor surgical margin delineation: multistep registration of fluorescence and histological images. J Med Imaging (Bellingham) 2019; 6:025005. [PMID: 31093519 DOI: 10.1117/1.jmi.6.2.025005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 04/15/2019] [Indexed: 02/02/2023] Open
Abstract
Although a greater extent of tumor resection is important for patients' survival, complete tumor removal, especially tumor margins, remains challenging due to the lack of sensitivity and specificity of current surgical guidance techniques at the margins. Intraoperative fluorescence imaging with targeted fluorophores is promising for tumor margin delineation. To verify the tumor margins detected by the fluorescence images, it is necessary to register fluorescence with histological images, which provide the ground truth for tumor regions. However, current registration methods compare fluorescence images to a single-layer histological slide, which is selected subjectively and represents a single plane of the three-dimensional tumor. A multistep pipeline is established to correlate fluorescence images to stacked histological images, including fluorescence calibration and multistep registration. Multiple histological slices are integrated as a two-dimensional (2-D) tumor map using optical attenuation model and average intensity projection. A BLZ-100-labeled medulloblastoma mouse model is used to test the whole framework. On average, the synthesized 2-D tumor map outperforms the selected best slide as ground truth [Dice similarity coefficient (DSC): 0.582 versus 0.398, with significant differences; mean area under the curve (AUC) of the receiver operating characteristic curve: 88% versus 85.5%] and the randomly selected slide as ground truth (DSC: 0.582 versus 0.396 with significant differences; mean AUC: 88% versus 84.1% with significant differences), which indicates our pipeline is reliable and can be applied to investigate targeted fluorescence probes in tumor margin detection. Following this proposed pipeline, BLZ-100 shows enhancement in both tumor cores and tumor margins (mean target-to-background ratio: 8.64 ± 5.76 and 4.82 ± 2.79 , respectively).
Collapse
Affiliation(s)
- Yang Jiang
- University of Washington, Human Photonics Lab, Seattle, Washington, United States
| | - Emily J Girard
- Fred Hutchinson Cancer Research Center, Olson Lab, Seattle, Washington, United States
| | - Fiona Pakiam
- Fred Hutchinson Cancer Research Center, Olson Lab, Seattle, Washington, United States
| | - Eric J Seibel
- University of Washington, Human Photonics Lab, Seattle, Washington, United States
| |
Collapse
|
39
|
Kain JJ, Birkeland AC, Udayakumar N, Morlandt AB, Stevens TM, Carroll WR, Rosenthal EL, Warram JM. Surgical margins in oral cavity squamous cell carcinoma: Current practices and future directions. Laryngoscope 2019; 130:128-138. [PMID: 31025711 DOI: 10.1002/lary.27943] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 02/09/2019] [Accepted: 03/01/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To discuss the current available techniques for intraoperative margin assessment in the surgical treatment of oral squamous cell carcinoma (OSCC) through a review of the available literature. METHODS A systematic review was undertaken of the available English literature between 2008 through 2018 regarding surgical margins in OCSS. A total of 893 relevant articles were returned; 144 met criteria for review; and 64 articles were included. RESULTS In this review, we discuss the data surrounding the use of frozen section in OCSS. Additionally, alternative techniques for margin assessment are discussed, including Mohs, molecular analysis, nonfluorescent dyes, fluorescent dyes, autofluorescent imaging, narrow-band imaging, optical coherence tomography, confocal microscopy, high-resolution microendoscopy, and spectroscopy. For each technique, particular emphasis is placed on the local recurrence, disease-free survival, and overall survival rates when available. CONCLUSION This review provides support for the practice of specimen-driven margin assessment when using frozen section analysis to improve the utility of the results. Finally, several alternatives for intraoperative margin assessment currently under investigation, including pathologic, wide-field imaging and narrow-field imaging techniques, are presented. We aim to fuel further investigation into methods for margin assessment that will improve survival for patients with OSCC through a critical analysis of the available techniques. LEVEL OF EVIDENCE NA Laryngoscope, 130:128-138, 2020.
Collapse
Affiliation(s)
- Joshua J Kain
- Department of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
| | - Andrew C Birkeland
- Department of Otolaryngology, Stanford University, Stanford, California, U.S.A
| | - Neha Udayakumar
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
| | - Anthony B Morlandt
- Department of Oral & Maxillofacial Surgery, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
| | - Todd M Stevens
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
| | - William R Carroll
- Department of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
| | - Eben L Rosenthal
- Department of Otolaryngology, Stanford University, Stanford, California, U.S.A
| | - Jason M Warram
- Department of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
| |
Collapse
|
40
|
Sunny SP, Agarwal S, James BL, Heidari E, Muralidharan A, Yadav V, Pillai V, Shetty V, Chen Z, Hedne N, Wilder-Smith P, Suresh A, Kuriakose MA. Intra-operative point-of-procedure delineation of oral cancer margins using optical coherence tomography. Oral Oncol 2019; 92:12-19. [PMID: 31010617 DOI: 10.1016/j.oraloncology.2019.03.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 02/18/2019] [Accepted: 03/09/2019] [Indexed: 01/22/2023]
Abstract
OBJECTIVES Surgical margin status is a significant determinant of treatment outcome in oral cancer. Negative surgical margins can decrease the loco-regional recurrence by five-fold. The current standard of care of intraoperative clinical examination supplemented by histological frozen section, can result in a risk of positive margins from 5 to 17 percent. In this study, we attempted to assess the utility of intraoperative optical coherence tomography (OCT) imaging with automated diagnostic algorithm to improve on the current method of clinical evaluation of surgical margin in oral cancer. MATERIALS AND METHODS We have used a modified handheld OCT device with automated algorithm based diagnostic platform for imaging. Intraoperatively, images of 125 sites were captured from multiple zones around the tumor of oral cancer patients (n = 14) and compared with the clinical and pathologic diagnosis. RESULTS OCT showed sensitivity and specificity of 100%, equivalent to histological diagnosis (kappa, ĸ = 0.922), in detection of malignancy within tumor and tumor margin areas. In comparison, for dysplastic lesions, OCT-based detection showed a sensitivity of 92.5% and specificity of 68.8% and a moderate concordance with histopathology diagnosis (ĸ = 0.59). Additionally, the OCT scores could significantly differentiate squamous cell carcinoma (SCC) from dysplastic lesions (mild/moderate/severe; p ≤ 0.005) as well as the latter from the non-dysplastic lesions (p ≤ 0.05). CONCLUSION The current challenges associated with clinical examination-based margin assessment could be improved with intra-operative OCT imaging. OCT is capable of identifying microscopic tumor at the surgical margins and demonstrated the feasibility of mapping of field cancerization around the tumor.
Collapse
Affiliation(s)
- Sumsum P Sunny
- Head and Neck Oncology, Mazumdar Shaw Medical Centre, NH Health City, Bangalore, India; Integrated Head and Neck Oncology Program (DSRG-5), Mazumdar Shaw Medical Foundation, NH Health City, Bangalore, India
| | - Sagar Agarwal
- Head and Neck Oncology, Mazumdar Shaw Medical Centre, NH Health City, Bangalore, India
| | - Bonney Lee James
- Integrated Head and Neck Oncology Program (DSRG-5), Mazumdar Shaw Medical Foundation, NH Health City, Bangalore, India
| | | | - Anjana Muralidharan
- Integrated Head and Neck Oncology Program (DSRG-5), Mazumdar Shaw Medical Foundation, NH Health City, Bangalore, India
| | - Vishal Yadav
- Head and Neck Oncology, Mazumdar Shaw Medical Centre, NH Health City, Bangalore, India
| | - Vijay Pillai
- Head and Neck Oncology, Mazumdar Shaw Medical Centre, NH Health City, Bangalore, India
| | - Vivek Shetty
- Head and Neck Oncology, Mazumdar Shaw Medical Centre, NH Health City, Bangalore, India
| | | | - Naveen Hedne
- Head and Neck Oncology, Mazumdar Shaw Medical Centre, NH Health City, Bangalore, India
| | | | - Amritha Suresh
- Head and Neck Oncology, Mazumdar Shaw Medical Centre, NH Health City, Bangalore, India; Integrated Head and Neck Oncology Program (DSRG-5), Mazumdar Shaw Medical Foundation, NH Health City, Bangalore, India
| | - Moni Abraham Kuriakose
- Head and Neck Oncology, Mazumdar Shaw Medical Centre, NH Health City, Bangalore, India; Integrated Head and Neck Oncology Program (DSRG-5), Mazumdar Shaw Medical Foundation, NH Health City, Bangalore, India.
| |
Collapse
|
41
|
Butola A, Ahmad A, Dubey V, Srivastava V, Qaiser D, Srivastava A, Senthilkumaran P, Mehta DS. Volumetric analysis of breast cancer tissues using machine learning and swept-source optical coherence tomography. APPLIED OPTICS 2019; 58:A135-A141. [PMID: 30873970 DOI: 10.1364/ao.58.00a135] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 11/22/2018] [Indexed: 05/22/2023]
Abstract
In breast cancer, 20%-30% of cases require a second surgery because of incomplete excision of malignant tissues. Therefore, to avoid the risk of recurrence, accurate detection of the cancer margin by the clinician or surgeons needs some assistance. In this paper, an automated volumetric analysis of normal and breast cancer tissue is done by a machine learning algorithm to separate them into two classes. The proposed method is based on a support-vector-machine-based classifier by dissociating 10 features extracted from the A-line, texture, and phase map by the swept-source optical coherence tomographic intensity and phase images. A set of 88 freshly excised breast tissue [44 normal and 44 cancers (invasive ductal carcinoma tissues)] samples from 22 patients was used in our study. The algorithm successfully classifies the cancerous tissue with sensitivity, specificity, and accuracy of 91.56%, 93.86%, and 92.71% respectively. The present computational technique is fast, simple, and sensitive, and extracts features from the whole volume of the tissue, which does not require any special tissue preparation nor an expert to analyze the breast cancer as required in histopathology. Diagnosis of breast cancer by extracting quantitative features from optical coherence tomographic images could be a potentially powerful method for cancer detection and would be a valuable tool for a fine-needle-guided biopsy.
Collapse
|
42
|
van Manen L, Dijkstra J, Boccara C, Benoit E, Vahrmeijer AL, Gora MJ, Mieog JSD. The clinical usefulness of optical coherence tomography during cancer interventions. J Cancer Res Clin Oncol 2018; 144:1967-1990. [PMID: 29926160 PMCID: PMC6153603 DOI: 10.1007/s00432-018-2690-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 06/16/2018] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Tumor detection and visualization plays a key role in the clinical workflow of a patient with suspected cancer, both in the diagnosis and treatment. Several optical imaging techniques have been evaluated for guidance during oncological interventions. Optical coherence tomography (OCT) is a technique which has been widely evaluated during the past decades. This review aims to determine the clinical usefulness of OCT during cancer interventions focussing on qualitative features, quantitative features and the diagnostic value of OCT. METHODS A systematic literature search was performed for articles published before May 2018 using OCT in the field of surgical oncology. Based on these articles, an overview of the clinical usefulness of OCT was provided per tumor type. RESULTS A total of 785 articles were revealed by our search, of which a total of 136 original articles were available for analysis, which formed the basis of this review. OCT is currently utilised for both preoperative diagnosis and intraoperative detection of skin, oral, lung, breast, hepatobiliary, gastrointestinal, urological, and gynaecological malignancies. It showed promising results in tumor detection on a microscopic level, especially using higher resolution imaging techniques, such as high-definition OCT and full-field OCT. CONCLUSION In the near future, OCT could be used as an additional tool during bronchoscopic or endoscopic interventions and could also be implemented in margin assessment during (laparoscopic) cancer surgery if a laparoscopic or handheld OCT device will be further developed to make routine clinical use possible.
Collapse
Affiliation(s)
- Labrinus van Manen
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Jouke Dijkstra
- Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | - Alexander L Vahrmeijer
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Michalina J Gora
- ICube Laboratory, CNRS, Strasbourg University, Strasbourg, France
| | - J Sven D Mieog
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands.
| |
Collapse
|
43
|
Farah CS. Narrow Band Imaging-guided resection of oral cavity cancer decreases local recurrence and increases survival. Oral Dis 2018; 24:89-97. [PMID: 29480612 DOI: 10.1111/odi.12745] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 08/18/2017] [Indexed: 12/14/2022]
Abstract
PURPOSE Overall local recurrence of oral squamous cell carcinoma (OSCC) is estimated at 20%. Incomplete primary tumour excision contributes to localised postsurgical recurrence of OSCC. The purpose of this study was to report on patient outcomes following resection of OSCC using Narrow Band Imaging (NBI). MATERIALS AND METHODS Patients with OSCC requiring resection were visualised under conventional white light (WL) then NBI using an Olympus NBI ENF-VQ nasendoscope with CLV-180 light source and processor (Olympus Medical Systems, Tokyo, Japan). OSCC tissue was resected to the NBI-defined surgical margins, and patients followed for a minimum of 5 years postsurgery to assess local recurrence rate (LRR) and disease-free survival (DFS). RESULTS Of the 20 patients recruited for this study, one patient (5%) declined follow-up. At the latest follow-up period (up to 7 years postsurgery), 14 of 19 patients (73.68%) were alive with no recurrence. Two patients (10.53%) had died from metastatic disease with no local recurrence, one patient (5.26%) had died from disease with local recurrence, and two patients (10.53%) had died disease-free from other causes. In total, 16 of 19 patients (84.21%) who were followed for a minimum of 5 years were still alive and had not developed local recurrence. Only one patient developed local recurrence. Five-year DFS was 84.21% and LRR was 5.26%. CONCLUSION Resection to NBI-defined margins improves survival rates and decreases recurrence rates of OSCC compared to traditional methods and should be adopted as the new gold standard for determining mucosal surgical margins for treatment of oral cavity cancer. These promising results have set the scene for a multicentred randomised controlled trial comparing NBI to WL currently underway.
Collapse
Affiliation(s)
- C S Farah
- Australian Centre for Oral Oncology Research & Education, UWA Dental School, University of Western Australia, Nedlands, WA, Australia
| |
Collapse
|
44
|
Thomas Robbins K, Triantafyllou A, Suárez C, López F, Hunt JL, Strojan P, Williams MD, Braakhuis BJM, de Bree R, Hinni ML, Kowalski LP, Rinaldo A, Rodrigo JP, Vander Poorten V, Nixon IJ, Takes RP, Silver CE, Ferlito A. Surgical margins in head and neck cancer: Intra- and postoperative considerations. Auris Nasus Larynx 2018; 46:10-17. [PMID: 30172560 DOI: 10.1016/j.anl.2018.08.011] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 08/13/2018] [Accepted: 08/15/2018] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To provide a perspective on the significance of recent reports for optimizing cancer free surgical margins that have challenged standard practices. METHODS We conducted a review of the recent literature (2012-2018) using the keywords surgical margin analysis, frozen and paraffin section techniques, head and neck cancer, spectroscopy and molecular markers. RESULTS Of significance are the reports indicating superiority of tumor specimen directed sampling of margins compared to patient directed (tumor bed) sampling for frozen section control of oral cancers. With reference to optimal distance between tumor and the surgical margin, recent reports recommended cutoffs less than 5mm. Employment of new technologies such as light spectroscopy and molecular analysis of tissues, provide opportunities for a "real time" assessment of surgical margins. CONCLUSIONS The commonly practiced method of patient directed margin sampling involving previous studies raises concern over conclusions made regarding the efficacy of frozen section margin control. The recent studies that challenge the optimal distance for clear surgical margins are retrospective and address patient cohorts with inherently confounding factors. The use of novel ancillary techniques require further refinements, clinical trial validation, and justification based on the additional resources.
Collapse
Affiliation(s)
- K Thomas Robbins
- Division of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA.
| | - Asterios Triantafyllou
- Liverpool Clinical Laboratories and School of Dentistry, University of Liverpool, Liverpool, UK
| | - Carlos Suárez
- Instituto de Investigación Sanitaria del Principado de Asturias and CIBERONC, ISCIII, Oviedo, Spain; Instituto Universitario de Oncología del Principado de Asturias, University of Oviedo, Oviedo, Spain
| | - Fernando López
- Department of Otolaryngology, Hospital Universitario Central de Asturias, IUOPA, University of Oviedo, CIBERONC, Oviedo, Spain
| | - Jennifer L Hunt
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
| | - Michelle D Williams
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Remco de Bree
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Michael L Hinni
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Luiz P Kowalski
- Otorhinolaryngology-Head and Neck Surgery,Centro de Tratamento e Pesquisa Hospital do Cancer A.C. Camargo, São Paulo, Brazil
| | | | - Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, IUOPA, University of Oviedo, CIBERONC, Oviedo, Spain
| | - Vincent Vander Poorten
- Otorhinolaryngology-Head and Neck Surgery and Department of Oncology, Section Head and Neck Oncology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Iain J Nixon
- Departments of Surgery and Otolaryngology, Head and Neck Surgery, Edinburgh University, Edinburgh, UK
| | - Robert P Takes
- Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Carl E Silver
- Department of Surgery, University of Arizona College of Medicine, Phoenix, AZ, USA
| | | |
Collapse
|
45
|
Carrasco-Zevallos OM, Viehland C, Keller B, Draelos M, Kuo AN, Toth CA, Izatt JA. Review of intraoperative optical coherence tomography: technology and applications [Invited]. BIOMEDICAL OPTICS EXPRESS 2017; 8:1607-1637. [PMID: 28663853 PMCID: PMC5480568 DOI: 10.1364/boe.8.001607] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 02/09/2017] [Accepted: 02/09/2017] [Indexed: 05/19/2023]
Abstract
During microsurgery, en face imaging of the surgical field through the operating microscope limits the surgeon's depth perception and visualization of instruments and sub-surface anatomy. Surgical procedures outside microsurgery, such as breast tumor resections, may also benefit from visualization of the sub-surface tissue structures. The widespread clinical adoption of optical coherence tomography (OCT) in ophthalmology and its growing prominence in other fields, such as cancer imaging, has motivated the development of intraoperative OCT for real-time tomographic visualization of surgical interventions. This article reviews key technological developments in intraoperative OCT and their applications in human surgery. We focus on handheld OCT probes, microscope-integrated OCT systems, and OCT-guided laser treatment platforms designed for intraoperative use. Moreover, we discuss intraoperative OCT adjuncts and processing techniques currently under development to optimize the surgical feedback derivable from OCT data. Lastly, we survey salient clinical studies of intraoperative OCT for human surgery.
Collapse
Affiliation(s)
| | - Christian Viehland
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
| | - Brenton Keller
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
| | - Mark Draelos
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
| | - Anthony N. Kuo
- Department of Ophthalmology, Duke University Medical Center, NC 27710, USA
| | - Cynthia A. Toth
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
- Department of Ophthalmology, Duke University Medical Center, NC 27710, USA
| | - Joseph A. Izatt
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
- Department of Ophthalmology, Duke University Medical Center, NC 27710, USA
| |
Collapse
|
46
|
Shadfan A, Darwiche H, Blanco J, Gillenwater A, Richards-Kortum R, Tkaczyk TS. Development of a multimodal foveated endomicroscope for the detection of oral cancer. BIOMEDICAL OPTICS EXPRESS 2017; 8:1525-1535. [PMID: 28663847 PMCID: PMC5480562 DOI: 10.1364/boe.8.001525] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 02/06/2017] [Accepted: 02/06/2017] [Indexed: 05/11/2023]
Abstract
A multimodal endomicroscope was developed for cancer detection that combines hyperspectral and confocal imaging through a single foveated objective and a vibrating optical fiber bundle. Standard clinical examination has a limited ability to identify early stage oral cancer. Optical detection methods are typically restricted by either achievable resolution or a small field-of-view. By combining high resolution and widefield spectral imaging into a single probe, a device was developed that provides spectral and spatial information over a 5 mm field to locate suspicious lesions that can then be inspected in high resolution mode. The device was evaluated on ex vivo biopsies of human oral tumors.
Collapse
Affiliation(s)
- Adam Shadfan
- Rice University, Bioengineering Department, 6100 Main Street, Houston, TX 77005, USA
| | - Hawraa Darwiche
- Department of Head and Neck Surgery, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Jesus Blanco
- Department of Head and Neck Surgery, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Ann Gillenwater
- Department of Head and Neck Surgery, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | | | - Tomasz S. Tkaczyk
- Rice University, Bioengineering Department, 6100 Main Street, Houston, TX 77005, USA
- Rice University, Electrical and Computer Engineering, 6100 Main Street, Houston, TX 77005, USA
| |
Collapse
|
47
|
Barroso EM, Smits RWH, van Lanschot CGF, Caspers PJ, Ten Hove I, Mast H, Sewnaik A, Hardillo JA, Meeuwis CA, Verdijk R, Noordhoek Hegt V, Baatenburg de Jong RJ, Wolvius EB, Bakker Schut TC, Koljenović S, Puppels GJ. Water Concentration Analysis by Raman Spectroscopy to Determine the Location of the Tumor Border in Oral Cancer Surgery. Cancer Res 2016; 76:5945-5953. [PMID: 27530325 DOI: 10.1158/0008-5472.can-16-1227] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 07/06/2016] [Indexed: 11/16/2022]
Abstract
Adequate resection of oral cavity squamous cell carcinoma (OCSCC) means complete tumor removal with a clear margin of more than 5 mm. For OCSCC, 85% of the surgical resections appear inadequate. Raman spectroscopy is an objective and fast tool that can provide real-time information about the molecular composition of tissue and has the potential to provide an objective and fast intraoperative assessment of the entire resection surface. A previous study demonstrated that OCSCC can be discriminated from healthy surrounding tissue based on the higher water concentration in tumor. In this study, we investigated how the water concentration changes across the tumor border toward the healthy surrounding tissue on freshly excised specimens from the oral cavity. Experiments were performed on tissue sections from 20 patients undergoing surgery for OCSCC. A transition from a high to a lower water concentration, from tumor (76% ± 8% of water) toward healthy surrounding tissue (54% ± 24% of water), takes place over a distance of about 4 to 6 mm across the tumor border. This was accompanied by an increase of the heterogeneity of the water concentration in the surrounding healthy tissue. The water concentration distributions between the regions were significantly different (P < 0.0001). This new finding highlights the potential of Raman spectroscopy for objective intraoperative assessment of the resection margins. Cancer Res; 76(20); 5945-53. ©2016 AACR.
Collapse
Affiliation(s)
- Elisa M Barroso
- Department of Oral & Maxillofacial Surgery, Special Dental Care, and Orthodontics, Cancer Institute, Erasmus MC, Rotterdam, The Netherlands
| | - Roeland W H Smits
- Department of Otorhinolaryngology & Head and Neck Surgery, Cancer Institute, Erasmus MC, Rotterdam, The Netherlands
| | - Cornelia G F van Lanschot
- Department of Otorhinolaryngology & Head and Neck Surgery, Cancer Institute, Erasmus MC, Rotterdam, The Netherlands
| | - Peter J Caspers
- Center for Optical Diagnostics & Therapy, Department of Dermatology, Cancer Institute, Erasmus MC, Rotterdam, The Netherlands. RiverD International BV, Rotterdam, The Netherlands
| | - Ivo Ten Hove
- Department of Oral & Maxillofacial Surgery, Special Dental Care, and Orthodontics, Cancer Institute, Erasmus MC, Rotterdam, The Netherlands
| | - Hetty Mast
- Department of Oral & Maxillofacial Surgery, Special Dental Care, and Orthodontics, Cancer Institute, Erasmus MC, Rotterdam, The Netherlands
| | - Aniel Sewnaik
- Department of Otorhinolaryngology & Head and Neck Surgery, Cancer Institute, Erasmus MC, Rotterdam, The Netherlands
| | - José A Hardillo
- Department of Otorhinolaryngology & Head and Neck Surgery, Cancer Institute, Erasmus MC, Rotterdam, The Netherlands
| | - Cees A Meeuwis
- Department of Otorhinolaryngology & Head and Neck Surgery, Cancer Institute, Erasmus MC, Rotterdam, The Netherlands
| | - Rob Verdijk
- Department of Pathology, Cancer Institute, Erasmus MC, Rotterdam, The Netherlands
| | | | - Robert J Baatenburg de Jong
- Department of Otorhinolaryngology & Head and Neck Surgery, Cancer Institute, Erasmus MC, Rotterdam, The Netherlands
| | - Eppo B Wolvius
- Department of Oral & Maxillofacial Surgery, Special Dental Care, and Orthodontics, Cancer Institute, Erasmus MC, Rotterdam, The Netherlands
| | - Tom C Bakker Schut
- Center for Optical Diagnostics & Therapy, Department of Dermatology, Cancer Institute, Erasmus MC, Rotterdam, The Netherlands. RiverD International BV, Rotterdam, The Netherlands.
| | - Senada Koljenović
- Department of Pathology, Cancer Institute, Erasmus MC, Rotterdam, The Netherlands
| | - Gerwin J Puppels
- Center for Optical Diagnostics & Therapy, Department of Dermatology, Cancer Institute, Erasmus MC, Rotterdam, The Netherlands. RiverD International BV, Rotterdam, The Netherlands
| |
Collapse
|
48
|
Will the mininvasive approach challenge the old paradigms in oral cancer surgery? Eur Arch Otorhinolaryngol 2016; 274:1279-1289. [DOI: 10.1007/s00405-016-4221-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 07/18/2016] [Indexed: 02/06/2023]
|
49
|
Green B, Tsiroyannis C, Brennan PA. Optical diagnostic systems for assessing head and neck lesions. Oral Dis 2016; 22:180-4. [DOI: 10.1111/odi.12398] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 10/28/2015] [Indexed: 11/26/2022]
Affiliation(s)
- B Green
- Department of General Medicine; Torbay Hospital; Torquay UK
| | - C Tsiroyannis
- Department of Oral & Maxillofacial Surgery; Queen Alexandra Hospital; Portsmouth UK
| | - PA Brennan
- Department of Oral & Maxillofacial Surgery; Queen Alexandra Hospital; Portsmouth UK
| |
Collapse
|
50
|
Banerjee S, Chatterjee S, Anura A, Chakrabarty J, Pal M, Ghosh B, Paul RR, Sheet D, Chatterjee J. Global spectral and local molecular connects for optical coherence tomography features to classify oral lesions towards unravelling quantitative imaging biomarkers. RSC Adv 2016. [DOI: 10.1039/c5ra24117k] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
The biopsy based diagnosis of oral precancers like leukoplakia (OLK) and submucous fibrosis (OSF) as well as squamous cell carcinoma (OSCC) suffers from observer specific variability.
Collapse
Affiliation(s)
- Satarupa Banerjee
- School of Medical Science and Technology
- Indian Institute of Technology
- Kharagpur
- India
| | - Swarnadip Chatterjee
- Advanced Technology Development Centre
- Indian Institute of Technology
- Kharagpur
- India
| | - Anji Anura
- School of Medical Science and Technology
- Indian Institute of Technology
- Kharagpur
- India
| | | | - Mousumi Pal
- Department of Oral and Maxillofacial Pathology
- Guru Nanak Institute of Dental Science and Research
- Kolkata
- India
| | - Bhaskar Ghosh
- Department of ENT & Head Neck Surgery
- Medical College
- Kolkata
- India
| | - Ranjan Rashmi Paul
- Department of Oral and Maxillofacial Pathology
- Guru Nanak Institute of Dental Science and Research
- Kolkata
- India
| | - Debdoot Sheet
- Department of Electrical Engineering
- Indian Institute of Technology
- Kharagpur
- India
| | - Jyotirmoy Chatterjee
- School of Medical Science and Technology
- Indian Institute of Technology
- Kharagpur
- India
| |
Collapse
|