European Archives of Oto-Rhino-Laryngology

, Volume 275, Issue 7, pp 1775–1781 | Cite as

Optical coherence tomography and confocal laser scanning microscopy as non-invasive tools in the diagnosis of sinonasal inverted papilloma: a pilot study

  • Attila Óvári
  • N. Starke
  • T. Schuldt
  • S. Schröder
  • S. Zonnur
  • A. Erbersdobler
  • E. Lankenau
  • O. Stachs
  • T. Just
  • R. Mlynski
  • B. Olzowy


Optical coherence tomography (OCT) and confocal laser scanning microscopy (CLSM) are light-based imaging techniques that allow for a visualization of microscopic tissue properties in vivo. Our study was to examine whether they allow for differentiation of inverted papilloma (IP) from nasal polyps (NP). Five cases of IP and NP, respectively, were investigated intraoperatively with OCT and CLSM. Biopsies were taken of the investigated area and were analyzed ex vivo with OCT and CLSM and then underwent HE-staining for standard light microscopy. On OCT images, IP showed the characteristic inverted character of the epithelium, that was thicker with a high degree of variability of thickness compared to the thin and homogenous epithelium of NP. In addition, the characteristic stromal edema of NP could be visualized. On CLSM images, the typical epithelial invaginations of IP appeared as crypts, while in NP the highly organized cylindric epithelium could be visualized. In vivo, OCT acquired images of sufficient quality to visualize these characteristics, while CLSM did not. Our study demonstrates that OCT and CLSM can distinguish IP from NP. Further technical development is required to apply the techniques clinically to guide intranasal biopsies or even to make them dispensable.


Inverted sinonasal papilloma Polypous chronic rhinosinusitis Optical coherence tomography Confocal laser scanning microscopy Non-invasive diagnosis 



No funding was received for this work.

Compliance with ethical standards

Conflict of interest

The co-author E. Lankenau is founder and partly share holder of the company OptoMedical Technologies GmbH which is responsible for the development and production of the OCT-Camera.


  1. 1.
    Fokkens WJ, Lund VJ, Mullol J, Bachert C, Alobid I, Baroody F et al (2012) EPOS 2012: European position paper on rhinosinusitis and nasal polyps 2012. A summary for otorhinolaryngologists. Rhinology 50:1–298PubMedCrossRefGoogle Scholar
  2. 2.
    Van Crombruggen K, Van Bruaene N, Holtappels G, Bachert C (2010) Chronic sinusitis and rhinitis: clinical terminology “Chronic Rhinosinusitis” further supported. Rhinology 48:54–58PubMedGoogle Scholar
  3. 3.
    Lund VJ, Stammberger H, Nicolai P, Castelnuovo P, Beal T, Beham A et al (2010) European position paper on endoscopic management of tumours of the nose, paranasal sinuses and skull base: chap. 6-1-1 inverted papilloma. Rhinol Suppl 22:1–143PubMedGoogle Scholar
  4. 4.
    Arslan HH, Hidir Y, Durmaz A, Karslioglu Y, Tosun F, Gerek M (2011) Unexpected tumor incidence in surgically removed unilateral and bilateral nasal polyps. J Craniofac Surg 22:751–754CrossRefPubMedGoogle Scholar
  5. 5.
    Tritt S, McMains KC, Kountakis SE (2008) Unilateral nasal polyposis: clinical presentation and pathology. Am J Otolaryngol 29:230–232CrossRefPubMedGoogle Scholar
  6. 6.
    Mirza S, Bradley PJ, Acharya A, Stacey M, Jones NS (2007) Sinonasal inverted papillomas: recurrence, and synchronous and metachronous malignancy. J Larngol Otol 121:857–864Google Scholar
  7. 7.
    Lisan Q, Laccourreye O, Bonfils P (2016) Sinonasal inverted papilloma: from diagnosis to treatment. Eur Ann Otorhinolaryngol Head Neck Dis 133:337–341CrossRefPubMedGoogle Scholar
  8. 8.
    Just T, Lankenau E, Prall F, Hüttmann G, Pau HW, Sommer K (2010) Optical coherence tomography allows for the reliable identification of laryngeal epithelial dysplasia and for precise biopsy: a clinicopathological study of 61 patients undergoing microlaryngoscopy. Laryngoscope 120:1964–1970CrossRefPubMedGoogle Scholar
  9. 9.
    Just T, Lankenau E, Hüttmann G, Pau HW (2009) Intra-operative application of optical coherence tomography with an operating microscope. J Laryngol Otol 123:1027–1030CrossRefPubMedGoogle Scholar
  10. 10.
    Just T, Pau HW (2013) Intra-operative application of confocal endomicroscopy using a rigid endoscope. J Laryngol Otol 127:599–604CrossRefPubMedGoogle Scholar
  11. 11.
    Olzowy B, Starke N, Schuldt T, Hüttmann G, Lankenau E, Just T (2013) Optical coherence tomography and confocal endomicroscopy for rhinologic pathologies: a pilot study. In: Proc. SPIE 8805, head and neck optical diagnostics 880505 (24 June 2013).
  12. 12.
    Welzel J, Reinhardt C, Lankenau E, Winter C, Wolff HH (2004) Changes in function and morphology of normal human skin: evaluation using optical coherence tomography. Br J Dermatol 150:220–225CrossRefPubMedGoogle Scholar
  13. 13.
    Armstrong WB, Ridgway JM, Vokes DE, Guo S, Perez J, Jackson RP, Gu M, Su J, Crumley RL, Shibuya TY, Mahmood U, Chen Z, Wong BJ (2016) Optical coherence tomography of laryngeal cancer. Laryngoscope 116:1107–1113CrossRefGoogle Scholar
  14. 14.
    Just T, Stave J, Kreutzer HJ, Guthoff R, Pau HW (2007) Confocal microscopic evaluation of epithelia of the larynx [German]. Laryngorhinootologie 86:644–648CrossRefPubMedGoogle Scholar
  15. 15.
    Hyams VJ (1971) Papillomas of the nasal cavity and paranasal sinuses. A clinicopathological study of 315 cases. Ann Otolaryngol 80:192–206Google Scholar
  16. 16.
    Hadar T, Yaniv E, Shvili Y, Koren R, Shvero J (2009) Histopathological changes of the nasal mucosa induced by smoking. Inhal toxicol 21:1119–1122CrossRefPubMedGoogle Scholar
  17. 17.
    Mahmood U, Ridgway J, Jackson R, Guo S, Su J, Armstrong W, Shibuya T, Crumley R, Chen Z, Wong B (2006) In vivo optical coherence tomography of the nasal mucosa. Am J Rhinol 20:155–159PubMedCrossRefGoogle Scholar
  18. 18.
    Oltmanns U, Palmowski K, Wielputz M, Kahn N, Baroke E, Eberhardt R, Wege S, Wiebel M, Kreuter M, Herth FJ, Mall MA (2016) Optical coherence tomography detects structural abnormalities of the nasal mucosa in patients with cystic fibrosis. J Cyst Fibr 15:216–222CrossRefGoogle Scholar
  19. 19.
    Hunt JL, Bell D, Sarioglu S (2017) Tumors of the nasal cavity, paranasal sinuses and skull base: sinonasal papillomas: Sinonasal papilloma, inverted type. In: El-Naggar AK, Chan JKC, Grandis JR, Takata T, Slootweg PJ (eds) WHO classification of head and neck tumours. IARC, Lyon, pp 28–31Google Scholar
  20. 20.
    Stammberger H (1983) New aspects in the genesis of inverted papillomas. Laryngol Rhinol Otol (Stuttg) 62:249–255CrossRefGoogle Scholar
  21. 21.
    Stammberger H (1983) New aspects of the histogenesis of inverted papilloma. 2. Comparative studies. Laryngol Rhinol Otol (Stuttg) 62:422–426CrossRefGoogle Scholar
  22. 22.
    Fokkens WJ, Lund VJ, Mullol JEA (2007) EPOS 2007 European position paper on rhinosinusitis and nasal polyps. Rhinology 45:1–139Google Scholar
  23. 23.
    Hellquist HB (1996) Nasal polyps update. Histopathology. Allergy Asthma Proc 17:237–242CrossRefPubMedGoogle Scholar
  24. 24.
    Vrabec DP (1975) The inverted Schneiderian papilloma: a clinical and pathological study. Laryngoscope 85:186–220CrossRefPubMedGoogle Scholar
  25. 25.
    Mills SE, Stelow EB, Hunt JLAFIP. Atlas of Tumor Pathology (2012) Fourth series, fascicle 17: tumors of the upper aerodigestive tract and ear. American Registry of Pathology, Silver Spring, pp 22–29Google Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Otorhinolaryngology, Head and Neck Surgery “Otto Koerner”University Medical Center, RostockRostockGermany
  2. 2.Department of TraumatologySüdstadt Medical CenterRostockGermany
  3. 3.Institute of PathologyUniversity Medical CenterRostockGermany
  4. 4.OptoMedical Technologies GmbHLübeckGermany
  5. 5.Department of OphtalmologyUniversity Medical CenterRostockGermany
  6. 6.Department of Otorhinolaryngology, Head and Neck SurgeryKMG-Klinikum GmbHGüstrowGermany
  7. 7.HNO-Zentrum LandsbergLandsbergGermany

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