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Diagnostic accuracy of in vivo early tumor imaging from probe-based confocal laser endomicroscopy versus histologic examination in head and neck squamous cell carcinoma

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Abstract

Objectives

Probe-based confocal laser endomicroscopy (pCLE) is a noninvasive and real-time imaging technique allowing acquisition of in situ images of the tissue microarchitecture during oral surgery. We aimed to assess the diagnostic performance of pCLE combined with patent blue V (PB) in improving the management of early oral cavity, oro/hypopharyngeal, and laryngeal cancer by imaging squamous cell carcinoma in vivo.

Materials and methods

The prospective study enrolled 44 patients with early head and neck lesions. All patients underwent white-light inspection or panendoscopy depending on the lesion’s location, followed by pCLE imaging of the tumor core and its margins after topical application of PB. Each zone imaged by pCLE was interpreted at distance of the exam by three pathologists blinded to final histology.

Results

Most imaged zones could be presented to pathologists; the final sensitivity and specificity of pCLE imaging in head and neck cancers was 73.2–75% and 30–57.4%, respectively. During imaging, head and neck surgeons encountered some challenges that required resolving, such as accessing lesions with the flexible optical probe, achieving sufficiently precise imaging on the targeted tissues, and heterogeneous tissue staining by fluorescent dye.

Conclusion

Final sensitivity scores were reasonable but final specificity scores were low. pCLE zones used to calculate specificity were acquired in areas of tumor margins, and the poor quality of the images acquired in these areas explains the final low specificity scores.

Clinical relevance

Practical adjustments and technical training are needed to analyze head and neck lesions in various anatomical sites in real-time by pCLE.

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Data availability

Data from this clinical trial are available from the authors and can be requested by filling out the data request form for Gustave Roussy clinical trials at https://redcap.gustaveroussy.fr/redcap/surveys/?s=DYDTLPE4AM. The trial steering committee and the sponsor will review the requests on a case-by-case basis. In case of approval, a specific agreement between the sponsor and the researcher may be required for data transfer.

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Acknowledgements

The authors wish to thank Prof. Christian Betz for his advice concerning Albarran lever use. At Gustave Roussy, the authors wish to thank the clinical research board for their work on the MEC-ORL clinical trial, Thibault Raoult and Angokai Moussa for their work in the data management of the study, Dr. Safaa Asmandar for her suggestions that improved the manuscript before submission, and the technicians of the department of biopathology for their processing of MEC-ORL patients’ histological specimens.

Funding

The work was supported by the French INCa agency (French National Institute for Cancer), grant PHRC 2012–149 Cancer 2012-DGOS-INCa.

Author information

Author notes

  1. Muriel Abbaci and Odile Casiraghi, contributed equally to this work, and Sebastien Vergez and Aline Maillard contributed equally to this work.

Authors and Affiliations

  1. Gustave Roussy, Université Paris-Saclay, USM AMMICa, Plateforme Imagerie et Cytométrie, Villejuif, France

    Muriel Abbaci, Frederic De Leeuw & Corinne Laplace-Builhé

  2. CEA, CNRS, Inserm, Laboratoire d’Imagerie Biomédicale Multimodale Paris Saclay, Université Paris-Saclay, 91401, Orsay, France

    Muriel Abbaci & Corinne Laplace-Builhé

  3. Gustave Roussy, Département de Biologie Et Pathologie Médicale, Université Paris-Saclay, Villejuif, France

    Odile Casiraghi, Aïcha Ben Lakhdar, Carine Ngo & Malek Ferchiou

  4. Département de Chirurgie Cervico-Faciale, Hôpital Régional de Toulouse, Toulouse, France

    Sebastien Vergez & Serge Koscielny

  5. Service de Biostatistique Et D’Épidémiologie, Gustave Roussy, Université Paris-Saclay, 94805, Villejuif, France

    Aline Maillard & Sabine Crestani

  6. CESP Inserm U1018, Université Paris-Sud, Université Paris-Saclay, 94805, Villejuif, France

    Aline Maillard & Sabine Crestani

  7. Gustave Roussy, Département de Cancérologie Et de Chirurgie Cervico-Faciale, Université Paris-Saclay, Villejuif, France

    Nathaniel Assouly, Stephane Temam & Ingrid Breuskin

Authors
  1. Muriel Abbaci
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  2. Odile Casiraghi
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Contributions

Breuskin I, Laplace-Builhe C, Temam S, and Koscielny S contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Breuskin I, Abbaci M, Casiraghi O, Vergez S, Maillard A, Ben Lakhdar A, De Leeuw F, Crestani S, Ngo C, Ferchiou M, and Assouly N. The first draft of the manuscript was written by Abbaci, Breuskin, and Casiraghi, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Ingrid Breuskin.

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Ethical approval

This article contains studies with human participants performed by the authors applicable in international, national, and institutional guidelines. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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The authors declare no competing interests.

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Abbaci, M., Casiraghi, O., Vergez, S. et al. Diagnostic accuracy of in vivo early tumor imaging from probe-based confocal laser endomicroscopy versus histologic examination in head and neck squamous cell carcinoma. Clin Oral Invest 26, 1823–1833 (2022). https://doi.org/10.1007/s00784-021-04156-4

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