Abstract
Background
The efficacy of ablative surgery for head and neck squamous cell carcinoma (HNSCC) depends critically on obtaining negative margins. Although intraoperative “frozen section” analysis of margins is a valuable adjunct, it is expensive, time-consuming, and highly dependent on pathologist expertise. Optical imaging has potential to improve the accuracy of margins by identifying cancerous tissue in real time. Our goal was to determine the accuracy and inter-rater reliability of head and neck cancer specialists using high-resolution microendoscopic (HRME) images to discriminate between cancerous and benign mucosa.
Methods
Thirty-eight patients diagnosed with head and neck squamous cell carcinoma (HNSCC) were enrolled in this single-center study. HRME was used to image each specimen after application of proflavine, with concurrent standard histopathologic analysis. Images were evaluated for quality control, and a training set containing representative images of benign and neoplastic tissue was assembled. After viewing training images, seven head and neck cancer specialists with no previous HRME experience reviewed 36 test images and were asked to classify each.
Results
The mean accuracy of all reviewers in correctly diagnosing neoplastic mucosa was 97 % (95 % confidence interval (CI), 94–99 %). The mean sensitivity and specificity were 98 % (97–100 %) and 92 % (87–98 %), respectively. The Fleiss kappa statistic for inter-rater reliability was 0.84 (0.77–0.91).
Conclusions
Medical professionals can be quickly trained to use HRME to discriminate between benign and neoplastic mucosa in the head and neck. With further development, the HRME shows promise as a method of real-time margin determination at the point of care.
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Acknowledgments
The authors thank Dr. Vishal Gupta, Dr. Michelle Kim, Dr. Marshall Posner, Dr. Krys Misiukiwicz, Dr. Kenneth Altman, and Dr. Benjamin Malkin of the Mount Sinai School of Medicine for participating in the grading of HRME data. We also thank Dr. Richard Schwarz of Rice University for the helpful comments and critiques during the preparation of this manuscript. This project was funded in part by the National Cancer Institute (NCI) Bioengineering Research Partnerships (BRP) Grant 2R01CA103830-06A1, a competitive research grant from Intuitive Surgical, Inc., and by the Doris Duke Charitable Foundation.
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Vila, P.M., Park, C.W., Pierce, M.C. et al. Discrimination of Benign and Neoplastic Mucosa with a High-Resolution Microendoscope (HRME) in Head and Neck Cancer. Ann Surg Oncol 19, 3534–3539 (2012). https://doi.org/10.1245/s10434-012-2351-1
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DOI: https://doi.org/10.1245/s10434-012-2351-1