Optical biopsy of penile cancer with in vivo confocal laser endomicroscopy

One-Stop Shop: Diagnosis and Treatment of Basal Cell Carcinoma in One Step

Monitoring the tumor margins of basal cell carcinomas is still a challenge in everyday clinical practice. Usually, the clinical margins of the tumor are marked by the naked eye or, even better, with dermoscopy before surgery and then examined in detail after the operation using histological examination. In order to achieve tumor freedom, several surgical steps are sometimes necessary, meaning that patients spend longer periods in hospital and the healthcare system is burdened more as a result. One way to improve this is the one-stop shop method, which requires precise diagnostics and margin marking before and during surgery so that tumor freedom can be achieved after just one surgery. For this reason, the current status of the diagnosis and treatment of basal cell carcinomas before and after surgery is to be examined following extensive literature research using devices and methods that have already been tested in order to determine how a simplified process of tumor margin control of basal cell carcinomas can be made possible both in vivo and ex vivo.

Validation of a classification and scoring system for the diagnosis of laryngeal and pharyngeal squamous cell carcinomas by confocal laser endomicroscopy

INTRODUCTION

Confocal laser endomicroscopy is an optical imaging technique that allows in vivo, real-time, microscope-like images of the upper aerodigestive tract's mucosa. The assessment of morphological tissue characteristics for the correct differentiation between healthy and malignant suspected mucosa requires strict evaluation criteria.

OBJECTIVE

This study aims to validate an eight-point score for the correct assessment of malignancy.

METHODS

We performed confocal laser endomicroscopy between March and October 2020 in 13 patients. 197 sequences (11.820 images) originated from the marginal area of pharyngeal and laryngeal carcinomas. Specimens were taken at corresponding locations and analyzed in H&E staining as a standard of reference. A total of six examiners evaluated the sequences based on a scoring system; they were blinded to the histopathological examination. The primary endpoints are sensitivity, specificity, and accuracy. Secondary endpoints are interrater reliability and receiver operator characteristics.

RESULTS

Healthy mucosa showed epithelium with uniform size and shape with distinct cytoplasmic membranes and regular vessel architecture. Confocal laser endomicroscopy of malignant cells demonstrated a disorganized arrangement of variable cellular morphology. We calculated an accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of 83.2%, 81.3%, 85.5%, 86.7%, and 79.7%, respectively, with a κ-value of 0.64, and an area under the curve of 0.86.

CONCLUSION

The results confirm that this scoring system is applicable in the laryngeal and pharyngeal mucosa to classify benign and malignant tissue. A scoring system based on defined and reproducible characteristics can help translate this experimental method to broad clinical practice in head and neck diagnosis.

Antiproliferative and Cytotoxic Activities of Fluorescein-A Diagnostic Angiography Dye

Fluorescein is a fluorescent dye used as a diagnostic tool in various fields of medicine. Although fluorescein itself possesses low toxicity, after photoactivation, it releases potentially toxic molecules, such as singlet oxygen (1O2) and, as we demonstrate in this work, also carbon monoxide (CO). As both of these molecules can affect physiological processes, the main aim of this study was to explore the potential biological impacts of fluorescein photochemistry. In our in vitro study in a human hepatoblastoma HepG2 cell line, we explored the possible effects on cell viability, cellular energy metabolism, and the cell cycle. We observed markedly lowered cell viability (≈30%, 75-2400 μM) upon irradiation of intracellular fluorescein and proved that this decrease in viability was dependent on the cellular oxygen concentration. We also detected a significantly decreased concentration of Krebs cycle metabolites (lactate and citrate < 30%; 2-hydroxyglutarate and 2-oxoglutarate < 10%) as well as cell cycle arrest (decrease in the G2 phase of 18%). These observations suggest that this photochemical reaction could have important biological consequences and may account for some adverse reactions observed in fluorescein-treated patients. Additionally, the biological activities of both 1O2 and CO might have considerable therapeutic potential, particularly in the treatment of cancer.