Abstract：
OBJECTIVE: Confocal laser endomicroscopy (CLE) is an optical imaging technique that allows in vivo, real-time, microscope-like assessment of superficial lesions. Although there is substantial data on CLE use in the upper GI tract, there is limited information regarding its application in the nasal cavity and paranasal sinuses. This study aims to assess the feasibility and diagnostic metrics of CLE in the nasal cavity and paranasal sinuses regarding differentiation between healthy/benign and malignant tissue. These structures show, however, a wider variety of frequent and concomitant benign and malignant pathologies, which could pose an increased challenge for optical biopsy by CLE.
METHODS: We performed CLE on a case series of six patients with various findings in the nose (three chronic rhinosinusitis, adenocarcinoma, meningoenzephalozele, esthesionneuroblastoma). Forty-two sequences (3792 images) from various structures in the nasal cavity and/or paranasal sinuses were acquired. Biopsies were taken at corresponding locations and analyzed in hematoxylin and eosin staining as a standard of reference. Three independent examiners blinded to the histopathology assessed the sequences.
RESULTS: Healthy and inflamed mucosa could be distinguished from malignant lesions with an accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of 84.1%, 85.4%, 83.1%, 72.5%, and 92.1%, respectively, with a substantial agreement between raters (Fleiss κ = 0.62).
CONCLUSIONS: This technique shows, despite its limitations, potential as an adjunctive imaging technique during sinus surgery; however, the creation of a scoring system based on reproducible and defined characteristics in a larger more diverse population should be the focus of further research to improve its diagnostic value and clinical utility.
METHODS: NA Laryngoscope, 2024.
METHODS: We performed CLE on a case series of six patients with various findings in the nose (three chronic rhinosinusitis, adenocarcinoma, meningoenzephalozele, esthesionneuroblastoma). Forty-two sequences (3792 images) from various structures in the nasal cavity and/or paranasal sinuses were acquired. Biopsies were taken at corresponding locations and analyzed in hematoxylin and eosin staining as a standard of reference. Three independent examiners blinded to the histopathology assessed the sequences.
RESULTS: Healthy and inflamed mucosa could be distinguished from malignant lesions with an accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of 84.1%, 85.4%, 83.1%, 72.5%, and 92.1%, respectively, with a substantial agreement between raters (Fleiss κ = 0.62).
CONCLUSIONS: This technique shows, despite its limitations, potential as an adjunctive imaging technique during sinus surgery; however, the creation of a scoring system based on reproducible and defined characteristics in a larger more diverse population should be the focus of further research to improve its diagnostic value and clinical utility.
METHODS: NA Laryngoscope, 2024.
摘要：
目的：共聚焦激光显微内镜（CLE）是一种光学成像技术，可在体内，实时,浅表病变的显微镜样评估。虽然有大量的CLE在上消化道的使用数据，关于其在鼻腔和鼻旁窦中的应用的信息有限。这项研究旨在评估CLE在鼻腔和鼻旁窦中的可行性和诊断指标，以区分健康/良性和恶性组织。这些结构显示，然而,各种频繁和伴随的良性和恶性病变，这可能会增加CLE光学活检的挑战。
方法：我们对6例鼻子有不同发现的患者进行了CLE（3例慢性鼻-鼻窦炎，腺癌,meningoenzephalozele,麻醉神经母细胞瘤)。获得了来自鼻腔和/或鼻旁窦中各种结构的42个序列（3792张图像）。在相应位置进行活检,并在苏木精和曙红染色中作为参考标准进行分析。三名对组织病理学不知情的独立检查者评估了序列。
结果：健康和发炎的粘膜可以准确地与恶性病变区分开来，灵敏度,特异性，正预测值，阴性预测值为84.1%，85.4%,83.1%,72.5%,92.1%,分别,与评估者之间的实质性协议(Fleissκ=0.62)。
结论：此技术显示，尽管有其局限性,在鼻窦手术中作为辅助成像技术的潜力；然而，在更多样化的人群中建立基于可重复和明确特征的评分系统应该是进一步研究的重点,以提高其诊断价值和临床实用性.
方法：NA喉镜，2024.
方法：我们对6例鼻子有不同发现的患者进行了CLE（3例慢性鼻-鼻窦炎，腺癌,meningoenzephalozele,麻醉神经母细胞瘤)。获得了来自鼻腔和/或鼻旁窦中各种结构的42个序列（3792张图像）。在相应位置进行活检,并在苏木精和曙红染色中作为参考标准进行分析。三名对组织病理学不知情的独立检查者评估了序列。
结果：健康和发炎的粘膜可以准确地与恶性病变区分开来，灵敏度,特异性，正预测值，阴性预测值为84.1%，85.4%,83.1%,72.5%,92.1%,分别,与评估者之间的实质性协议(Fleissκ=0.62)。
结论：此技术显示，尽管有其局限性,在鼻窦手术中作为辅助成像技术的潜力；然而，在更多样化的人群中建立基于可重复和明确特征的评分系统应该是进一步研究的重点,以提高其诊断价值和临床实用性.
方法：NA喉镜，2024.
