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Staníková L, Kántor P, Fedorová K, Zeleník K, Komínek P. Clinical significance of type IV vascularization of laryngeal lesions according to the Ni classification. Front Oncol 2024; 14:1222827. [PMID: 38333687 PMCID: PMC10851150 DOI: 10.3389/fonc.2024.1222827] [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: 05/15/2023] [Accepted: 01/09/2024] [Indexed: 02/10/2024] Open
Abstract
Background Scattered, small, dot-like intraepithelial papillary capillary loops (IPCLs) represent type IV epithelial vascularization according to "Ni classification" and are considered to be nonmalignant. According to the European Laryngological Society classification, these loops are malignant vascular changes. This contradiction has high clinical importance; therefore, clarification of the clinical significance of type IV vascularization according to the Ni classification is needed. Methods The study was performed between June 2015 and December 2022. All recruited patients (n = 434) were symptomatic, with macroscopic laryngeal lesions (n = 674). Patients were investigated using the enhanced endoscopic methods of narrow band imaging (NBI) and the Storz Professional Image Enhancement System (IMAGE1 S). The microvascular patterns in the lesions were categorized according to Ni classification from 2011 and all lesions were examined histologically. Results A total of 674 lesions (434 patients) were investigated using flexible NBI endoscopy and IMAGE1 S endoscopy. Type IV vascularization was recognized in 293/674 (43.5%) lesions. Among these 293 lesions, 178 (60.7%) were benign (chronic laryngitis, hyperplasia, hyperkeratosis, polyps, cysts, granulomas, Reinkeho oedema and recurrent respiratory papillomatosis); 9 (3.1%) were squamous cell carcinoma; 61 (20.8%) were mildly dysplastic, 29 (9.9%) were moderately dysplastic, 14 (4.8%) were severe dysplastic and 2 (0.7%) were carcinoma in situ. The ability to recognize histologically benign lesions in group of nonmalignant vascular pattern according to Ni (vascularization type I-IV) and distinguish them from precancers and malignancies was with accuracy 75.5%, sensitivity 54.4%, specificity 94.4%, positive predictive value 89.6% and negative predictive value 69.9%. Conclusion Laryngeal lesions with type IV vascularization as defined by Ni present various histological findings, including precancerous and malignant lesions. Patients with type IV vascularization must be followed carefully and, in case of progression mucosal lesion microlaryngoscopy and excision are indicated.
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Affiliation(s)
- Lucia Staníková
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Ostrava, Ostrava, Czechia
- Department of Craniofacial Surgery, Faculty of Medicine, University of Ostrava, Ostrava, Czechia
| | - Peter Kántor
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Ostrava, Ostrava, Czechia
- Department of Craniofacial Surgery, Faculty of Medicine, University of Ostrava, Ostrava, Czechia
| | - Katarína Fedorová
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Ostrava, Ostrava, Czechia
| | - Karol Zeleník
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Ostrava, Ostrava, Czechia
- Department of Craniofacial Surgery, Faculty of Medicine, University of Ostrava, Ostrava, Czechia
| | - Pavel Komínek
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Ostrava, Ostrava, Czechia
- Department of Craniofacial Surgery, Faculty of Medicine, University of Ostrava, Ostrava, Czechia
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Esmaeili N, Davaris N, Boese A, Illanes A, Navab N, Friebe M, Arens C. Contact Endoscopy - Narrow Band Imaging (CE-NBI) data set for laryngeal lesion assessment. Sci Data 2023; 10:733. [PMID: 37865668 PMCID: PMC10590430 DOI: 10.1038/s41597-023-02629-7] [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: 10/17/2022] [Accepted: 10/11/2023] [Indexed: 10/23/2023] Open
Abstract
The endoscopic examination of subepithelial vascular patterns within the vocal fold is crucial for clinicians seeking to distinguish between benign lesions and laryngeal cancer. Among innovative techniques, Contact Endoscopy combined with Narrow Band Imaging (CE-NBI) offers real-time visualization of these vascular structures. Despite the advent of CE-NBI, concerns have arisen regarding the subjective interpretation of its images. As a result, several computer-based solutions have been developed to address this issue. This study introduces the CE-NBI data set, the first publicly accessible data set that features enhanced and magnified visualizations of subepithelial blood vessels within the vocal fold. This data set encompasses 11144 images from 210 adult patients with pathological vocal fold conditions, where CE-NBI images are annotated using three distinct label categories. The data set has proven invaluable for numerous clinical assessments geared toward diagnosing laryngeal cancer using Optical Biopsy. Furthermore, given its versatility for various image analysis tasks, we have devised and implemented diverse image classification scenarios using Machine Learning (ML) approaches to address critical clinical challenges in assessing laryngeal lesions.
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Affiliation(s)
- Nazila Esmaeili
- Department of Otorhinolaryngology, Head and Neck Surgery, Justus Liebig University of Giessen, 35392, Giessen, Germany.
- Chair for Computer Aided Medical Procedures and Augmented Reality, Technical University of Munich, 85748, Munich, Germany.
- SURAG Medical GmbH, 04103, Leipzig, Germany.
| | - Nikolaos Davaris
- Department of Otorhinolaryngology, Head and Neck Surgery, Giessen University Hospital, 35392, Giessen, Germany
- Department of Otorhinolaryngology, Head and Neck Surgery, Magdeburg University Hospital, 39120, Magdeburg, Germany
| | - Axel Boese
- INKA-Innovation Laboratory for Image Guided Therapy, Medical Faculty, Otto-von-Guericke University Magdeburg, 39120, Magdeburg, Germany
| | | | - Nassir Navab
- Chair for Computer Aided Medical Procedures and Augmented Reality, Technical University of Munich, 85748, Munich, Germany
| | - Michael Friebe
- INKA-Innovation Laboratory for Image Guided Therapy, Medical Faculty, Otto-von-Guericke University Magdeburg, 39120, Magdeburg, Germany
- Department of Biocybernetics and Biomedical Engineering, AGH University Kraków, 30-059, Kraków, Poland
- CIBE - Center for Innovation, Business Development & Entrepreneurship, FOM University of Applied Sciences, 45141, Essen, Germany
| | - Christoph Arens
- Department of Otorhinolaryngology, Head and Neck Surgery, Giessen University Hospital, 35392, Giessen, Germany
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Pošta P, Kolk A, Pivovarčíková K, Liška J, Genčur J, Moztarzadeh O, Micopulos C, Pěnkava A, Frolo M, Bissinger O, Hauer L. Clinical Experience with Autofluorescence Guided Oral Squamous Cell Carcinoma Surgery. Diagnostics (Basel) 2023; 13:3161. [PMID: 37891982 PMCID: PMC10605623 DOI: 10.3390/diagnostics13203161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/02/2023] [Accepted: 10/05/2023] [Indexed: 10/29/2023] Open
Abstract
In our study, the effect of the use of autofluorescence (Visually Enhanced Lesion Scope-VELscope) on increasing the success rate of surgical treatment in oral squamous carcinoma (OSCC) was investigated. Our hypothesis was tested on a group of 122 patients suffering from OSCC, randomized into a study and a control group enrolled in our study after meeting the inclusion criteria. The preoperative checkup via VELscope, accompanied by the marking of the range of a loss of fluorescence in the study group, was performed before the surgery. We developed a unique mucosal tattoo marking technique for this purpose. The histopathological results after surgical treatment, i.e., the margin status, were then compared. In the study group, we achieved pathological free margin (pFM) in 55 patients, pathological close margin (pCM) in 6 cases, and we encountered no cases of pathological positive margin (pPM) in the mucosal layer. In comparison, the control group results revealed pPM in 7 cases, pCM in 14 cases, and pFM in 40 of all cases in the mucosal layer. This study demonstrated that preoperative autofluorescence assessment of the mucosal surroundings of OSCC increased the ability to achieve pFM resection 4.8 times in terms of lateral margins.
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Affiliation(s)
- Petr Pošta
- Department of Stomatology, University Hospital Pilsen, Faculty of Medicine, Charles University, 32300 Pilsen, Czech Republic; (J.L.); (L.H.)
| | - Andreas Kolk
- Department of Oral and Maxillofacial Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria; (A.K.); (O.B.)
| | - Kristýna Pivovarčíková
- Sikl’s Department of Pathology, Faculty of Medicine, Charles University, 32300 Pilsen, Czech Republic;
- Bioptic Laboratory Ltd., 32600 Pilsen, Czech Republic
| | - Jan Liška
- Department of Stomatology, University Hospital Pilsen, Faculty of Medicine, Charles University, 32300 Pilsen, Czech Republic; (J.L.); (L.H.)
| | - Jiří Genčur
- Department of Stomatology, University Hospital Pilsen, Faculty of Medicine, Charles University, 32300 Pilsen, Czech Republic; (J.L.); (L.H.)
| | - Omid Moztarzadeh
- Department of Stomatology, University Hospital Pilsen, Faculty of Medicine, Charles University, 32300 Pilsen, Czech Republic; (J.L.); (L.H.)
- Department of Anatomy, Faculty of Medicine, Charles University, 32300 Pilsen, Czech Republic
| | - Christos Micopulos
- Department of Stomatology, University Hospital Pilsen, Faculty of Medicine, Charles University, 32300 Pilsen, Czech Republic; (J.L.); (L.H.)
| | - Adam Pěnkava
- Department of Stomatology, University Hospital Pilsen, Faculty of Medicine, Charles University, 32300 Pilsen, Czech Republic; (J.L.); (L.H.)
| | - Maria Frolo
- Department of Stomatology, University Hospital Pilsen, Faculty of Medicine, Charles University, 32300 Pilsen, Czech Republic; (J.L.); (L.H.)
| | - Oliver Bissinger
- Department of Oral and Maxillofacial Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria; (A.K.); (O.B.)
| | - Lukáš Hauer
- Department of Stomatology, University Hospital Pilsen, Faculty of Medicine, Charles University, 32300 Pilsen, Czech Republic; (J.L.); (L.H.)
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Gomes Ataide EJ, Jabaraj MS, Schenke S, Petersen M, Haghghi S, Wuestemann J, Illanes A, Friebe M, Kreissl MC. Thyroid Nodule Detection and Region Estimation in Ultrasound Images: A Comparison between Physicians and an Automated Decision Support System Approach. Diagnostics (Basel) 2023; 13:2873. [PMID: 37761240 PMCID: PMC10529523 DOI: 10.3390/diagnostics13182873] [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: 07/31/2023] [Revised: 08/27/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Thyroid nodules are very common. In most cases, they are benign, but they can be malignant in a low percentage of cases. The accurate assessment of these nodules is critical to choosing the next diagnostic steps and potential treatment. Ultrasound (US) imaging, the primary modality for assessing these nodules, can lack objectivity due to varying expertise among physicians. This leads to observer variability, potentially affecting patient outcomes. PURPOSE This study aims to assess the potential of a Decision Support System (DSS) in reducing these variabilities for thyroid nodule detection and region estimation using US images, particularly in lesser experienced physicians. METHODS Three physicians with varying levels of experience evaluated thyroid nodules on US images, focusing on nodule detection and estimating cystic and solid regions. The outcomes were compared to those obtained from a DSS for comparison. Metrics such as classification match percentage and variance percentage were used to quantify differences. RESULTS Notable disparities exist between physician evaluations and the DSS assessments: the overall classification match percentage was just 19.2%. Individually, Physicians 1, 2, and 3 had match percentages of 57.6%, 42.3%, and 46.1% with the DSS, respectively. Variances in assessments highlight the subjectivity and observer variability based on physician experience levels. CONCLUSIONS The evident variability among physician evaluations underscores the need for supplementary decision-making tools. Given its consistency, the CAD offers potential as a reliable "second opinion" tool, minimizing human-induced variabilities in the critical diagnostic process of thyroid nodules using US images. Future integration of such systems could bolster diagnostic precision and improve patient outcomes.
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Affiliation(s)
- Elmer Jeto Gomes Ataide
- Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, 39120 Magdeburg, Germany; (S.S.); (M.C.K.)
| | | | - Simone Schenke
- Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, 39120 Magdeburg, Germany; (S.S.); (M.C.K.)
- Department of Nuclear Medicine, Klinikum Bayreuth, 95445 Bayreuth, Germany
| | - Manuela Petersen
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, 39120 Magdeburg, Germany
| | - Sarvar Haghghi
- Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, 39120 Magdeburg, Germany; (S.S.); (M.C.K.)
- Department of Nuclear Medicine, University Hospital Frankfurt, 60590 Frankfurt, Germany
| | - Jan Wuestemann
- Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, 39120 Magdeburg, Germany; (S.S.); (M.C.K.)
| | | | - Michael Friebe
- Surag Medical GmbH, 39118 Magdeburg, Germany
- Department of Biocybernetics and Biomedical Engineering, AGH University of Science and Technology, 30-059 Krakow, Poland
- Center for Innovation, Business Development and Entrepreneurship (CIBE), FOM University of Applied Science, 45127 Essen, Germany
| | - Michael C. Kreissl
- Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, 39120 Magdeburg, Germany; (S.S.); (M.C.K.)
- STIMULATE Research Campus, 39106 Magdeburg, Germany
- Center for Advanced Medical Engineering (CAME), Otto-von-Guericke University Magdeburg, 39106 Magdeburg, Germany
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Endoscopic Imaging Technology Today. Diagnostics (Basel) 2022; 12:diagnostics12051262. [PMID: 35626417 PMCID: PMC9140648 DOI: 10.3390/diagnostics12051262] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 05/02/2022] [Accepted: 05/16/2022] [Indexed: 02/04/2023] Open
Abstract
One of the most applied imaging methods in medicine is endoscopy. A highly specialized image modality has been developed since the first modern endoscope, the “Lichtleiter” of Bozzini was introduced in the early 19th century. Multiple medical disciplines use endoscopy for diagnostics or to visualize and support therapeutic procedures. Therefore, the shapes, functionalities, handling concepts, and the integrated and surrounding technology of endoscopic systems were adapted to meet these dedicated medical application requirements. This survey gives an overview of modern endoscopic technology’s state of the art. Therefore, the portfolio of several manufacturers with commercially available products on the market was screened and summarized. Additionally, some trends for upcoming developments were collected.
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Esmaeili N, Sharaf E, Gomes Ataide EJ, Illanes A, Boese A, Davaris N, Arens C, Navab N, Friebe M. Deep Convolution Neural Network for Laryngeal Cancer Classification on Contact Endoscopy-Narrow Band Imaging. SENSORS 2021; 21:s21238157. [PMID: 34884166 PMCID: PMC8662427 DOI: 10.3390/s21238157] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 12/02/2021] [Accepted: 12/03/2021] [Indexed: 12/14/2022]
Abstract
(1) Background: Contact Endoscopy (CE) and Narrow Band Imaging (NBI) are optical imaging modalities that can provide enhanced and magnified visualization of the superficial vascular networks in the laryngeal mucosa. The similarity of vascular structures between benign and malignant lesions causes a challenge in the visual assessment of CE-NBI images. The main objective of this study is to use Deep Convolutional Neural Networks (DCNN) for the automatic classification of CE-NBI images into benign and malignant groups with minimal human intervention. (2) Methods: A pretrained Res-Net50 model combined with the cut-off-layer technique was selected as the DCNN architecture. A dataset of 8181 CE-NBI images was used during the fine-tuning process in three experiments where several models were generated and validated. The accuracy, sensitivity, and specificity were calculated as the performance metrics in each validation and testing scenario. (3) Results: Out of a total of 72 trained and tested models in all experiments, Model 5 showed high performance. This model is considerably smaller than the full ResNet50 architecture and achieved the testing accuracy of 0.835 on the unseen data during the last experiment. (4) Conclusion: The proposed fine-tuned ResNet50 model showed a high performance to classify CE-NBI images into the benign and malignant groups and has the potential to be part of an assisted system for automatic laryngeal cancer detection.
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Affiliation(s)
- Nazila Esmaeili
- INKA—Innovation Laboratory for Image Guided Therapy, Otto-von-Guericke University Magdeburg, 39120 Magdeburg, Germany; (E.S.); (E.J.G.A.); (A.I.); (A.B.); (M.F.)
- Chair for Computer Aided Medical Procedures and Augmented Reality, Technical University of Munich, 85748 Munich, Germany;
- Correspondence:
| | - Esam Sharaf
- INKA—Innovation Laboratory for Image Guided Therapy, Otto-von-Guericke University Magdeburg, 39120 Magdeburg, Germany; (E.S.); (E.J.G.A.); (A.I.); (A.B.); (M.F.)
| | - Elmer Jeto Gomes Ataide
- INKA—Innovation Laboratory for Image Guided Therapy, Otto-von-Guericke University Magdeburg, 39120 Magdeburg, Germany; (E.S.); (E.J.G.A.); (A.I.); (A.B.); (M.F.)
- Department of Nuclear Medicine, Medical Faculty, Otto-von-Guericke University Magdeburg, 39120 Magdeburg, Germany
| | - Alfredo Illanes
- INKA—Innovation Laboratory for Image Guided Therapy, Otto-von-Guericke University Magdeburg, 39120 Magdeburg, Germany; (E.S.); (E.J.G.A.); (A.I.); (A.B.); (M.F.)
| | - Axel Boese
- INKA—Innovation Laboratory for Image Guided Therapy, Otto-von-Guericke University Magdeburg, 39120 Magdeburg, Germany; (E.S.); (E.J.G.A.); (A.I.); (A.B.); (M.F.)
| | - Nikolaos Davaris
- Department of Otorhinolaryngology, Head and Neck Surgery, Magdeburg University Hospital, 39120 Magdeburg, Germany;
| | - Christoph Arens
- Department of Otorhinolaryngology, Head and Neck Surgery, Giessen University Hospital, 35392 Giessen, Germany;
| | - Nassir Navab
- Chair for Computer Aided Medical Procedures and Augmented Reality, Technical University of Munich, 85748 Munich, Germany;
| | - Michael Friebe
- INKA—Innovation Laboratory for Image Guided Therapy, Otto-von-Guericke University Magdeburg, 39120 Magdeburg, Germany; (E.S.); (E.J.G.A.); (A.I.); (A.B.); (M.F.)
- IDTM GmbH, 45657 Recklinghausen, Germany
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Klimza H, Jackowska J, Pietruszewska W, Rzepakowska A, Wierzbicka M. The Narrow Band Imaging as an essential complement to White Light Endoscopy in Recurrent Respiratory Papillomatosis diagnostics and follow-up process. Otolaryngol Pol 2021; 76:1-5. [DOI: 10.5604/01.3001.0015.4540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The aim of the study is to discuss the role of NBI imaging in upper respiratory papillomatosis (RRP). In the available literature on the subject, as of 2009, there have been 117 publications on NBI imaging focusing on the diagnosis of the upper respiratory and digestive tract, especially the larynx. They discuss the following diagnostic and therapeutic problems: identifying an abnormal vascular pattern within the mucosa, differentiating benign and malignant lesions, assessing the nature of lesions under the leukoplakia plaque, pre-operative definition of laryngeal cancer margins, supporting laser procedures to obtain safe margins, postoperative monitoring after cancer treatment, detecting second simultaneous and metachronic neoplasms and primary tumors in the case of metastases from an unknown primary site. Few reports have been devoted to the assessment of the extent and recurrence of RRP. Due to its recurrent nature, this pathology deserves special attention as it requires multiple inspections and manipulation within the larynx. It also applies to the pediatric population, where there should be no margin for underestimating or overestimating changes, because any suspicion of recurrence results in subsequent general anesthesia. Hence the attempt to define an unambiguous picture of RRP recurrence and the criteria for referring for subsequent surgical treatment.
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Affiliation(s)
- Hanna Klimza
- Department of Otolaryngology, Head and Neck Surgery, Poznan University of Medical Sciences, Poland
| | - Joanna Jackowska
- Department of Otolaryngology, Head and Neck Surgery, Poznan University of Medical Sciences, Poland
| | - Wioletta Pietruszewska
- Department of Otolaryngology, Head and Neck Oncology, Medical University of Lodz, Poland
| | | | - Małgorzata Wierzbicka
- Department of Otolaryngology, Head and Neck Surgery, Poznan University of Medical Sciences, Poland
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