Real-Time Laryngeal Cancer Boundaries Delineation on White Light and Narrow-Band Imaging Laryngoscopy with Deep Learning

Objective: To investigate the potential of deep learning for automatically delineating (segmenting) laryngeal cancer superficial extent on endoscopic images and videos. Methods: A retrospective study was conducted extracting and annotating white light (WL) and Narrow-Band Imaging (NBI) frames to train a segmentation model (SegMENT-Plus). Two external datasets were used for validation. The model's performances were compared with those of two otolaryngology residents. In addition, the model was tested on real intraoperative laryngoscopy videos. Results: A total of 3933 images of laryngeal cancer from 557 patients were used. The model achieved the following median values (interquartile range): Dice Similarity Coefficient (DSC) = 0.83 (0.70-0.90), Intersection over Union (IoU) = 0.83 (0.73-0.90), Accuracy = 0.97 (0.95-0.99), Inference Speed = 25.6 (25.1-26.1) frames per second. The external testing cohorts comprised 156 and 200 images. SegMENT-Plus performed similarly on all three datasets for DSC (p = 0.05) and IoU (p = 0.07). No significant differences were noticed when separately analyzing WL and NBI test images on DSC (p = 0.06) and IoU (p = 0.78) and when analyzing the model versus the two residents on DSC (p = 0.06) and IoU (Senior vs. SegMENT-Plus, p = 0.13; Junior vs. SegMENT-Plus, p = 1.00). The model was then tested on real intraoperative laryngoscopy videos. Conclusion: SegMENT-Plus can accurately delineate laryngeal cancer boundaries in endoscopic images, with performances equal to those of two otolaryngology residents. The results on the two external datasets demonstrate excellent generalization capabilities. The computation speed of the model allowed its application on videolaryngoscopies simulating real-time use. Clinical trials are needed to evaluate the role of this technology in surgical practice and resection margin improvement. Level of evidence: III Laryngoscope, 2024

Diagnostic therapeutic assistance pathway (PDTA) of type 2 chronic rhinosinusitis

Chronic rhinosinusitis (CRS) is a complex and heterogeneous disorder whose etiopathogenetic picture is not yet completely known and is classically divided into CRS with (CRSwNP) and without nasal polyps (CRSsNP). But today the distinction is made with type 2 and nontype 2 variants. A rational and defined pathway for the diagnosis of chronic rhinosinusitis is an indispensable means to be able to arrive at a correct identification of the patient. This typing is essential to be able to arrive at the correct course of treatment, which turns out to be different for different types of patients. For this reason, the realization of a diagnostic therapeutic pathway represents a fundamental way for the otolaryngologist specialist but not only, since today diagnostics has a multidisciplinary framework. In the present work, precise indications have been developed to arrive at a correct diagnosis. The various diagnostic pathways and processes to arrive at a correct therapeutic framing have been highlighted. Therapy ranging from medical therapy to surgical therapy without neglecting the new biological therapies. It does not represent a guideline but a diagnostic method that can be adapted to all the various territorial realities

Analysis of Complications in (Crico-) Tracheal Resection Anastomosis in Adults: A Multicenter Study

Objectives The gold standard treatments for advanced laryngotracheal stenosis (LTS) are represented by partial crico-tracheal (PCTRA) or tracheal resection and anastomosis (TRA). These procedures are potentially burdened by high postoperative complication rates. We investigated the impact of the most common stenosis and patient-related characteristics on the onset of complications in a multicentric cohort.Methods We retrospectively analyzed patients who underwent PCTRA or TRA for LTS of different etiologies in three referral centers. We tested the effectiveness of these procedures, the impact of complications on the outcomes, and identified factors causing postoperative complications.Results A total of 267 patients were included in the study (130 females; mean age, 51.46 +/- 17.64 years). The overall decannulation rate was 96.4%. Altogether, 102 (38.2%) patients presented at least one complication, whereas 12 (4.5%) had two or more. The only independent predictor of post-surgical complications was the presence of systemic comorbidities (p = 0.043). Patients experiencing complications needed additional surgery more frequently (70.1% vs. 29.9%, p < 0.001), and had a longer duration of hospitalization (20 +/- 10.9 vs. 11.3 +/- 4.1 days, p < 0.001). Six of 102 (5.9%) patients with complications had restenosis, although this event did not occur among patients without complications.Conclusion PCTRA and TRA have an excellent success rate even when performed for high-grade LTS. However, a significant percentage of patients may experience complications associated with a longer duration of hospitalization or the need for additional surgeries. The presence of medical comorbidities was independently related to an increased risk of complications

Post-COVID-19 airway stenosis treated by tracheal resection and anastomosis: a bicentric experience

The COVID-19 pandemic was an extraordinary challenge for the global healthcare system not only for the number of patients affected by pulmonary disease, but also for the incidence of long-term sequalae. In this regard, laryngo-tracheal stenosis (LTS) represents one of the most common complications of invasive ventilation

Artificial Intelligence for Upper Aerodigestive Tract Endoscopy and Laryngoscopy: A Guide for Physicians and State-of-the-Art Review

Objective: The endoscopic and laryngoscopic examination is paramount for laryngeal, oropharyngeal, nasopharyngeal, nasal, and oral cavity benign lesions and cancer evaluation. Nevertheless, upper aerodigestive tract (UADT) endoscopy is intrinsically operator-dependent and lacks objective quality standards. At present, there has been an increased interest in artificial intelligence (AI) applications in this area to support physicians during the examination, thus enhancing diagnostic performances. The relative novelty of this research field poses a challenge both for the reviewers and readers as clinicians often lack a specific technical background. Data sources: Four bibliographic databases were searched: PubMed, EMBASE, Cochrane, and Google Scholar. Review methods: A structured review of the current literature (up to September 2022) was performed. Search terms related to topics of AI, machine learning (ML), and deep learning (DL) in UADT endoscopy and laryngoscopy were identified and queried by 3 independent reviewers. Citations of selected studies were also evaluated to ensure comprehensiveness. Conclusions: Forty-one studies were included in the review. AI and computer vision techniques were used to achieve 3 fundamental tasks in this field: classification, detection, and segmentation. All papers were summarized and reviewed. Implications for practice: This article comprehensively reviews the latest developments in the application of ML and DL in UADT endoscopy and laryngoscopy, as well as their future clinical implications. The technical basis of AI is also explained, providing guidance for nonexpert readers to allow critical appraisal of the evaluation metrics and the most relevant quality requirements

High-resolution US of the facial vessels with new facial vein landmarks for reconstructive surgery and dermal injection

Abstract Background Accurate knowledge of vessel anatomy is essential in facial reconstructive surgery. The technological advances of ultrasound (US) equipment with the introduction of new high-resolution probes improved the evaluation of facial anatomical structures. Our study had these objectives: the primary objective was to identify new surgical landmarks for the facial vein and to verify their precision with US, the secondary objective was to evaluate the potential of high-resolution US examination in the study of both the facial artery and vein. Methods Two radiologists examined a prospective series of adult volunteers with a 22–8 MHz hockey-stick probe. Two predictive lines of the facial artery and vein with respective measurement points were defined. The distance between the facial vein and its predictive line (named mandibular-orbital line) was determined at each measurement point. The distance from the skin and the area of the two vessels were assessed at every established measurement point. Results Forty-one volunteers were examined. The median distance of the facial vein from its predictive line did not exceed 2 mm. The facial vein was visible at every measurement point in all volunteers on the right side, and in 40 volunteers on the left. The facial artery was visible at every measurement point in all volunteers on the right and in 37 volunteers on the left. Conclusions The facial vein demonstrated a constant course concerning the mandibular-orbital line, which seems a promising clinical and imaging-based method for its identification. High-resolution US is valuable in studying the facial artery and vein. Relevance statement High-resolution US is valuable for examining facial vessels and can be a useful tool for pre-operative assessment, especially when combined with the mandibular-orbital line, a new promising imaging and clinical technique to identify the facial vein. Key points • High-resolution US is valuable in studying the facial artery and vein. • The facial vein demonstrated a constant course concerning its predictive mandibular-orbital line. • The clinical application of the mandibular-orbital line could help reduce facial surgical and cosmetic procedure complications. Graphical Abstrac

Cerebrospinal fluid leak repair: utility of intrathecal fluorescein for correct topographic identification of the skull base defects

Background: In the management of cerebrospinal fluid (CSF) leak the identification of the exact discharge spot is paramount. This can represent a challenge for the radiologist and the surgeon. In the present study, we analyzed a series of patients affected by endonasal CSF leak who underwent endoscopic surgical reconstruction aided by the use of intrathecal fluorescein (ITF). The purpose of this work is to assess the efficacy of intraoperative ITF in addition to computed tomography (CT) scan and magnetic resonance imaging (MRI) for correct topographic localization of the CSF leak. Methods: Eighty-three patients were enrolled in the study. The main outcome was the concordance between the supposed radiological defect site and the actual one seen intraoperatively. The recurrence free survival (RFS) was evaluated as secondary outcome. Results: ITF better defined the defect site allowing a change in the treatment in 21 cases (25.3%), in which a non-concordance was observed between the suspected radiological site and the actual surgical one. Good agreement was found between the specific topographic localization (k=0.737, p<0.0001), whereas fair agreement was observed considering the side of the defect (k=0.362, p=0.0009) and correct identification of multiple sites (k=0.044, p=0.666). The 10-year 96% estimate of RFS confirmed the correct repair of the fistula site in most of the cases. Conclusions: Our data demonstrate the utility and safety of intraoperative ITF for management of patients affected by endonasal CSF leak. ITF improved the topographical diagnosis of the leak site, ensuring the best target reconstruction and very low recurrence rate