Evaluation der optischen Kohärenztomographie in der Tumorfrühdiagnostik im oberen Luft-Speiseweg

Einleitung: Tumore des oberen Luft-Speiseweges sind die 7. häufigste Krebserkrankung in Europa. Diese Studie überprüfte inwieweit die Optische Kohärenztomographie (OCT) zur Detektion und Differenzierung prä- und frühmaligner Läsionen in diesem Bereich beitragen kann. Methode: Ein intraorales OCT Screening wurde an 52 gesunden Probanden durchgeführt. Bei 38 Läsionen wurden die Epitheldicken auf den OCT Bildern mit denen in den histologischen Schnittbildern verglichen. 100 primäre Läsionen wurden bezüglich der Integrität der Basalmembran von einem unverblindeten Bewerter beurteilt, dann biopsiert und verglichen. Alle OCT Bilder wurden von 3 verblindeten Untersuchern bewertet. 48 OCT Bilder wurden einer zusätzlichen Intensitätsanalyse unterzogen. Ergebnisse: Das Screening zeigte große Unterschiede in der Epitheldicke. Die mittels OCT und Histologie ermittelten Epitheldicken zeigten eine gute Korrelation (κ=0.63). In der unverblindeten Bewertung konnten invasive und nichtinvasive Läsionen mit einer Sensitivität von 88.9% und einer Spezifität von 89.0% unterschieden werden währenddem die verblindete Bewertung zu Sensitivitäten von 100%/66.7%/77.8% und Spezifitäten von 75.8%/71.4%/70.3% führte. Dysplasien führten im Gegensatz zu Hyperplasien zu einer signifikant erhöhten Intensitätsabnahme über das Epithel. Die Intensitätszunahme zwischen Epithel und Lamina propria war bei Dysplasien stärker ausgeprägt als bei Hyperplasien (38,7% vs. 18,9%), allerdings nicht statistisch signifikant. Diskussion: Die OCT ist geeignet zur Verbesserung der Tumorfrühdiagnostik im oberen Aerodigestivtrakt

Towards Automatic Lesion Classification in the Upper Aerodigestive Tract Using OCT and Deep Transfer Learning Methods

Early detection of cancer is crucial for treatment and overall patient survival. In the upper aerodigestive tract (UADT) the gold standard for identification of malignant tissue is an invasive biopsy. Recently, non-invasive imaging techniques such as confocal laser microscopy and optical coherence tomography (OCT) have been used for tissue assessment. In particular, in a recent study experts classified lesions in the UADT with respect to their invasiveness using OCT images only. As the results were promising, automatic classification of lesions might be feasible which could assist experts in their decision making. Therefore, we address the problem of automatic lesion classification from OCT images. This task is very challenging as the available dataset is extremely small and the data quality is limited. However, as similar issues are typical in many clinical scenarios we study to what extent deep learning approaches can still be trained and used for decision support.Comment: Accepted for publication at CARS 201

Confocal laser endomicroscopy in head and neck cancer: steps forward?

Purpose of review Confocal laser endomicroscopy (CLE) is a novel, noninvasive technique used to obtain microanatomical images of the inner lining of hollow organs. It has been used in a variety of clinical specialties to aid in the diagnosis and treatment planning of inflammatory and neoplastic processes. Our intent is to provide an up-to-date review of the literature in the setting of head and neck diseases as well as describing our own initial results and areas of future research. Recent findings With increasing experience using CLE in the upper aerodigestive tract (UADT), evidence is mounting that this method can be a useful adjunct to standard endoscopy and other diagnostic techniques. Recent publications have shown that by using CLE, microanatomical structures of healthy and diseased mucosa can easily be identified, allowing for a differentiation of dysplastic/neoplastic and benign mucosal lesions. Standardized diagnostic protocols as well as clinically relevant classification systems for the UADT have not yet been described. Summary CLE is an imaging modality that allows real-time visualization of mucosal cellular architecture and other histologic characteristics. First reports on its use in the UADT have yielded promising results, but the true value of this method is yet to be determined

Audiological results and subjective benefit of an active transcutaneous bone-conduction device in patients with congenital aural atresia

PURPOSE To review functional and subjective benefit after implantation of an active transcutaneous bone conduction device (BCD) in patients with congenital microtia with atresia or stenosis of the external auditory canal. METHODS Retrospective chart analysis and questionnaire on the subjective impression of hearing ( Speech, Spatial and Qualities of Hearing Scale (SSQ-B) of patients treated between 2012 and 2015. RESULTSRESULTS 18 patients (24 ears) with conductive or mixed hearing loss in unilateral (n = 10) or bilateral (n = 8) atresia were implanted with a BCD. No major complications occurred after implantation. Preoperative unaided air conduction pure tone average at 0.5, 1, 2 and 4 kHz (PTA 4 ) was 69.2 ± 11.7 dB, while postoperative aided PTA 4 was 33.4 ± 6.3 dB, resulting in a mean functional hearing gain of 35.9 +/- 15.6 dB. Preoperatively, the mean monosyllabic word recognition score was 22.9 % ± 22.3 %, which increased to 87.1 % +/- 15.1 % in the aided condition. The Oldenburger Sentence Test at S0N0 revealed a decrease in signal-to-noise-ratio from - 0.58 ± 4.40 dB in the unaided to - 5.67 ± 3.21 dB in the postoperative aided condition for all patients investigated. 15 of 18 patients had a subjective benefit showing a positive SSQ-B score (mean 1.7). CONCLUSION The implantation of an active bone conduction device brings along subjective and functional benefit for patients with conductive or combined hearing loss

Ni endoscopic classification for Storz Professional Image Enhancement System (SPIES) endoscopy in the detection of upper aerodigestive tract (UADT) tumours

The diagnostic procedure for upper aerodigestive tract (UADT) tumours is by white light endoscopy (WLE) combined with biopsy. However, WLE has difficulty identifying minute epithelial changes which hinders early diagnosis. Storz Professional Image Enhancement System (SPIES) is designed to enhance the visualization of microvasculature on the mucosal surface and detect any epithelial changes. In this study, we aimed to evaluate the use of Ni endoscopic classification with SPIES endoscopy in the detection of UADT tumours. Fifty-nine patients with suspected UADT tumours underwent WLE followed by SPIES endoscopy. All the tumours were biopsied and sent for histopathological examination (HPE). The kappa index (kappa) was used to evaluate the agreement between the methods. The level of agreement between SPIES using Ni classification and HPE showed almost perfect agreement as compared to moderate agreement between WLE and HPE. The sensitivity and specificity for WLE and HPE were 77.5% and 84.2% respectively with positive predictive value (PPV) of 91.2% and negative predictive value (NPV) of 64%. The sensitivity and specificity for SPIES endoscopy using Ni classification and HPE were 97.5% and 94.7% respectively with PPV of 97.5% and NPV of 94.7%. SPIES endoscopy using Ni classification is a valid tool for earlier tumour detection

Confocal laser endomicroscopy in head and neck cancer: steps forward?

Purpose of review Confocal laser endomicroscopy (CLE) is a novel, noninvasive technique used to obtain microanatomical images of the inner lining of hollow organs. It has been used in a variety of clinical specialties to aid in the diagnosis and treatment planning of inflammatory and neoplastic processes. Our intent is to provide an up-to-date review of the literature in the setting of head and neck diseases as well as describing our own initial results and areas of future research. Recent findings With increasing experience using CLE in the upper aerodigestive tract (UADT), evidence is mounting that this method can be a useful adjunct to standard endoscopy and other diagnostic techniques. Recent publications have shown that by using CLE, microanatomical structures of healthy and diseased mucosa can easily be identified, allowing for a differentiation of dysplastic/neoplastic and benign mucosal lesions. Standardized diagnostic protocols as well as clinically relevant classification systems for the UADT have not yet been described. Summary CLE is an imaging modality that allows real-time visualization of mucosal cellular architecture and other histologic characteristics. First reports on its use in the UADT have yielded promising results, but the true value of this method is yet to be determined

Spatiotemporal correlation of optical coherence tomography in-vivo images of rabbit airway for the diagnosis of edema.

Detection of an early stage of subglottic edema is vital for airway management and prevention of stenosis, a life-threatening condition in critically ill neonates. As an observer for the task of diagnosing edema in vivo, we investigated spatiotemporal correlation (STC) of full-range optical coherence tomography (OCT) images acquired in the rabbit airway with experimentally simulated edema. Operating the STC observer on OCT images generates STC coefficients as test statistics for the statistical decision task. Resulting from this, the receiver operating characteristic (ROC) curves for the diagnosis of airway edema with full-range OCT in-vivo images were extracted and areas under ROC curves were calculated. These statistically quantified results demonstrated the potential clinical feasibility of the STC method as a means to identify early airway edema