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Cavalcanti TC, Lew HM, Lee K, Lee SY, Park MK, Hwang JY. Intelligent smartphone-based multimode imaging otoscope for the mobile diagnosis of otitis media. BIOMEDICAL OPTICS EXPRESS 2021; 12:7765-7779. [PMID: 35003865 PMCID: PMC8713661 DOI: 10.1364/boe.441590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 11/10/2021] [Accepted: 11/10/2021] [Indexed: 06/14/2023]
Abstract
Otitis media (OM) is one of the most common ear diseases in children and a common reason for outpatient visits to medical doctors in primary care practices. Adhesive OM (AdOM) is recognized as a sequela of OM with effusion (OME) and often requires surgical intervention. OME and AdOM exhibit similar symptoms, and it is difficult to distinguish between them using a conventional otoscope in a primary care unit. The accuracy of the diagnosis is highly dependent on the experience of the examiner. The development of an advanced otoscope with less variation in diagnostic accuracy by the examiner is crucial for a more accurate diagnosis. Thus, we developed an intelligent smartphone-based multimode imaging otoscope for better diagnosis of OM, even in mobile environments. The system offers spectral and autofluorescence imaging of the tympanic membrane using a smartphone attached to the developed multimode imaging module. Moreover, it is capable of intelligent analysis for distinguishing between normal, OME, and AdOM ears using a machine learning algorithm. Using the developed system, we examined the ears of 69 patients to assess their performance for distinguishing between normal, OME, and AdOM ears. In the classification of ear diseases, the multimode system based on machine learning analysis performed better in terms of accuracy and F1 scores than single RGB image analysis, RGB/fluorescence image analysis, and the analysis of spectral image cubes only, respectively. These results demonstrate that the intelligent multimode diagnostic capability of an otoscope would be beneficial for better diagnosis and management of OM.
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Affiliation(s)
- Thiago C Cavalcanti
- Department of Information and Communication Engineering, Daegu Gyeongbuk Institute of Science and Technology, Daegu, Republic of Korea
| | - Hah Min Lew
- Department of Information and Communication Engineering, Daegu Gyeongbuk Institute of Science and Technology, Daegu, Republic of Korea
| | - Kyungsu Lee
- Department of Information and Communication Engineering, Daegu Gyeongbuk Institute of Science and Technology, Daegu, Republic of Korea
| | - Sang-Yeon Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Moo Kyun Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Republic of Korea
- co-first authors
| | - Jae Youn Hwang
- Department of Information and Communication Engineering, Daegu Gyeongbuk Institute of Science and Technology, Daegu, Republic of Korea
- co-first authors
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2
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Wisotzky EL, Arens P, Dommerich S, Hilsmann A, Eisert P, Uecker FC. Determination of the optical properties of cholesteatoma in the spectral range of 250 to 800 nm. BIOMEDICAL OPTICS EXPRESS 2020; 11:1489-1500. [PMID: 32206424 PMCID: PMC7075596 DOI: 10.1364/boe.384742] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 02/13/2020] [Accepted: 02/14/2020] [Indexed: 05/04/2023]
Abstract
Cholesteatoma of the ear can lead to life-threatening complications and its only treatment is surgery. The smallest remnants of cholesteatoma can lead to recurrence of this disease. Therefore, the optical properties of this tissue are of high importance to identify and remove all cholesteatoma during therapy. In this paper, we determine the absorption coefficient µ a and scattering coefficient µ s ' of cholesteatoma and bone samples in the wavelength range of 250 nm to 800 nm obtained during five surgeries. These values are determined by high precision integrating sphere measurements in combination with an optimized inverse Monte Carlo simulation (iMCS). To conserve the optical behavior of living tissues, the optical spectroscopy measurements are performed immediately after tissue removal and preparation. It is shown that in the near-UV and visible spectrum clear differences exist between cholesteatoma and bone tissue. While µ a is decreasing homogeneously for cholesteatoma, it retains at the high level for bone in the region of 350 nm to 580 nm. Further, the results for the cholesteatoma measurements correspond to published healthy epidermis data. These differences in the optical parameters reveal the future possibility to detect and identify, automatically or semi-automatically, cholesteatoma tissue for active treatment decisions during image-guided surgery leading to a better surgical outcome.
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Affiliation(s)
- Eric L Wisotzky
- Fraunhofer Heinrich-Hertz-Institute, Computer Vision and Graphics, Berlin, Germany
- Humboldt-Universität zu Berlin, Visual Computing, Berlin, Germany
- Eric L. Wisotzky and Philipp Arens contribute as joint first author
| | - Philipp Arens
- Charité - Universitätsmedizin Berlin, Department of Otorhinolaryngology, Berlin, Germany
- Eric L. Wisotzky and Philipp Arens contribute as joint first author
| | - Steffen Dommerich
- Charité - Universitätsmedizin Berlin, Department of Otorhinolaryngology, Berlin, Germany
| | - Anna Hilsmann
- Fraunhofer Heinrich-Hertz-Institute, Computer Vision and Graphics, Berlin, Germany
| | - Peter Eisert
- Fraunhofer Heinrich-Hertz-Institute, Computer Vision and Graphics, Berlin, Germany
- Humboldt-Universität zu Berlin, Visual Computing, Berlin, Germany
| | - Florian C Uecker
- Charité - Universitätsmedizin Berlin, Department of Otorhinolaryngology, Berlin, Germany
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3
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Monroy GL, Won J, Dsouza R, Pande P, Hill MC, Porter RG, Novak MA, Spillman DR, Boppart SA. Automated classification platform for the identification of otitis media using optical coherence tomography. NPJ Digit Med 2019; 2:22. [PMID: 31304369 PMCID: PMC6550205 DOI: 10.1038/s41746-019-0094-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 02/27/2019] [Indexed: 02/06/2023] Open
Abstract
The diagnosis and treatment of otitis media (OM), a common childhood infection, is a significant burden on the healthcare system. Diagnosis relies on observer experience via otoscopy, although for non-specialists or inexperienced users, accurate diagnosis can be difficult. In past studies, optical coherence tomography (OCT) has been used to quantitatively characterize disease states of OM, although with the involvement of experts to interpret and correlate image-based indicators of infection with clinical information. In this paper, a flexible and comprehensive framework is presented that automatically extracts features from OCT images, classifies data, and presents clinically relevant results in a user-friendly platform suitable for point-of-care and primary care settings. This framework was used to test the discrimination between OCT images of normal controls, ears with biofilms, and ears with biofilms and middle ear fluid (effusion). Predicted future performance of this classification platform returned promising results (90%+ accuracy) in various initial tests. With integration into patient healthcare workflow, users of all levels of medical experience may be able to collect OCT data and accurately identify the presence of middle ear fluid and/or biofilms.
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Affiliation(s)
- Guillermo L Monroy
- 1Department of Bioengineering, University of Illinois at Urbana-Champaign, Urbana, IL USA.,2Beckman Institute for Advanced Science and Technology, Urbana, IL USA
| | - Jungeun Won
- 1Department of Bioengineering, University of Illinois at Urbana-Champaign, Urbana, IL USA.,2Beckman Institute for Advanced Science and Technology, Urbana, IL USA
| | - Roshan Dsouza
- 2Beckman Institute for Advanced Science and Technology, Urbana, IL USA
| | - Paritosh Pande
- 2Beckman Institute for Advanced Science and Technology, Urbana, IL USA
| | - Malcolm C Hill
- 3Carle Foundation Hospital, Otolaryngology, Urbana, IL USA.,4Carle Illinois College of Medicine, Urbana, IL USA
| | - Ryan G Porter
- 3Carle Foundation Hospital, Otolaryngology, Urbana, IL USA.,4Carle Illinois College of Medicine, Urbana, IL USA
| | - Michael A Novak
- 3Carle Foundation Hospital, Otolaryngology, Urbana, IL USA.,4Carle Illinois College of Medicine, Urbana, IL USA
| | - Darold R Spillman
- 2Beckman Institute for Advanced Science and Technology, Urbana, IL USA
| | - Stephen A Boppart
- 1Department of Bioengineering, University of Illinois at Urbana-Champaign, Urbana, IL USA.,2Beckman Institute for Advanced Science and Technology, Urbana, IL USA.,3Carle Foundation Hospital, Otolaryngology, Urbana, IL USA.,4Carle Illinois College of Medicine, Urbana, IL USA.,5Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, IL USA
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4
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Optical imaging with a high-resolution microendoscope to identify sinonasal pathology. Am J Otolaryngol 2018; 39:383-387. [PMID: 29622347 DOI: 10.1016/j.amjoto.2018.03.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 03/19/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVES High-resolution microendoscopy (HRME) is an optical imaging modality that allows real time imaging of epithelial tissue and structural changes within. We hypothesize that HRME, using proflavine, a contrast agent that preferentially stains cell nuclei and allows detection of cellular morphologic changes, can distinguish sinonasal pathology from uninvolved mucosa, potentially enabling real-time surgical margin differentiation. STUDY DESIGN Ex vivo imaging of histopathologically confirmed samples of sinonasal pathology and uninvolved, normal sinus epithelium. SETTING Single tertiary-level institution. SUBJECTS AND METHODS Five inverted papillomas, one oncocytic papilloma, two uninvolved sinus epithelia specimens, and three inflammatory polyps were imaged ex vivo with HRME after surface staining with proflavine. Following imaging, the specimens were submitted for hematoxylin and eosin staining to allow histopathological correlation. RESULTS Results show that sinonasal pathology and normal sinus epithelia have distinct HRME imaging characteristics. Schneiderian papilloma specimens show increased nuclear-to-cytoplasmic ratio, nuclear crowding, and small internuclear separation, whereas normal sinus epithelia specimens show small, bright nuclei with dark cytoplasm and relatively large internuclear separation. Inflammatory polyps, however, have varying imaging characteristics, that resemble both Schneiderian papilloma and normal sinus epithelia. CONCLUSIONS This study demonstrates the feasibility of HRME imaging to discriminate sinonasal pathology from normal sinus epithelia. While the system performed well in the absence of inflammation, discrimination of inflamed tissue was inconsistent, creating a significant limitation for this application. Novel imaging systems such as HRME with alternative contrast agents may assist with real-time surgical margin differentiation, enabling complete surgical resection of inverted papilloma and reducing recurrence rates.
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Monroy GL, Hong W, Khampang P, Porter RG, Novak MA, Spillman DR, Barkalifa R, Chaney EJ, Kerschner JE, Boppart SA. Direct Analysis of Pathogenic Structures Affixed to the Tympanic Membrane during Chronic Otitis Media. Otolaryngol Head Neck Surg 2018; 159:117-126. [PMID: 29587128 DOI: 10.1177/0194599818766320] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Objective To characterize otitis media-associated structures affixed to the mucosal surface of the tympanic membrane (TM) in vivo and in surgically recovered in vitro samples. Study Design Prospective case series without comparison. Setting Outpatient surgical care center. Subjects and Methods Forty pediatric subjects scheduled for tympanostomy tube placement surgery were imaged intraoperatively under general anesthesia. Postmyringotomy, a portable optical coherence tomography (OCT) imaging system assessed for the presence of any biofilm affixed to the mucosal surface of the TM. Samples of suspected microbial infection-related structures were collected through the myringotomy incision. The sampled site was subsequently reimaged with OCT to confirm collection from the original image site on the TM. In vitro analysis based on confocal laser scanning microscope (CLSM) images of fluorescence in situ hybridization-tagged samples and polymerase chain reaction (PCR) provided microbiological characterization and verification of biofilm activity. Results OCT imaging was achieved for 38 of 40 subjects (95%). Images from 38 of 38 (100%) of subjects observed with OCT showed the presence of additional microbial infection-related structures. Thirty-four samples were collected from these 38 subjects. CLSM images provided evidence of clustered bacteria in 32 of 33 (97%) of samples. PCR detected the presence of active bacterial DNA signatures in 20 of 31 (65%) of samples. Conclusion PCR and CLSM analysis of fluorescence in situ hybridization-stained samples validates the presence of active bacteria that have formed into a middle ear biofilm that extends across the mucosal layer of the TM. OCT can rapidly and noninvasively identify middle ear biofilms in subjects with severe and persistent cases of otitis media.
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Affiliation(s)
- Guillermo L Monroy
- 1 Department of Bioengineering, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA.,2 Beckman Institute for Advanced Science and Technology, Urbana, Illinois, USA
| | - Wenzhou Hong
- 3 Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | - Ryan G Porter
- 4 Department of Otolaryngology-Head and Neck Surgery, Carle Foundation Hospital, Urbana, Illinois, USA.,5 Carle-Illinois College of Medicine, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Michael A Novak
- 4 Department of Otolaryngology-Head and Neck Surgery, Carle Foundation Hospital, Urbana, Illinois, USA.,5 Carle-Illinois College of Medicine, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Darold R Spillman
- 2 Beckman Institute for Advanced Science and Technology, Urbana, Illinois, USA
| | - Ronit Barkalifa
- 2 Beckman Institute for Advanced Science and Technology, Urbana, Illinois, USA
| | - Eric J Chaney
- 2 Beckman Institute for Advanced Science and Technology, Urbana, Illinois, USA
| | | | - Stephen A Boppart
- 1 Department of Bioengineering, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA.,2 Beckman Institute for Advanced Science and Technology, Urbana, Illinois, USA.,5 Carle-Illinois College of Medicine, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
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Dahroug B, Tamadazte B, Weber S, Tavernier L, Andreff N. Review on Otological Robotic Systems: Toward Microrobot-Assisted Cholesteatoma Surgery. IEEE Rev Biomed Eng 2018; 11:125-142. [PMID: 29994589 DOI: 10.1109/rbme.2018.2810605] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Otologic surgical procedures over time have become minimally invasive due to the development of medicine, microtechniques, and robotics. This trend then provides an expected reduction in the patient's recovery time and improvement in the accuracy of diagnosis and treatment. One of the most challenging difficulties that such techniques face are precise control of the instrument and supply of an ergonomic system to the surgeon. The objective of this literature review is to present requirements and guidelines for a surgical robotic system dedicated to middle ear surgery. This review is particularly focused on cholesteatoma surgery (diagnosis and surgical tools), which is one of the most frequent pathologies that urge for an enhanced treatment. This review also presents the current robotic systems that are implemented for otologic applications.
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7
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Towards monitoring dysplastic progression in the oral cavity using a hybrid fiber-bundle imaging and spectroscopy probe. Sci Rep 2016; 6:26734. [PMID: 27220821 PMCID: PMC4879668 DOI: 10.1038/srep26734] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 05/06/2016] [Indexed: 02/06/2023] Open
Abstract
Intraepithelial dysplasia of the oral mucosa typically originates in the proliferative cell layer at the basement membrane and extends to the upper epithelial layers as the disease progresses. Detection of malignancies typically occurs upon visual inspection by non-specialists at a late-stage. In this manuscript, we validate a quantitative hybrid imaging and spectroscopy microendoscope to monitor dysplastic progression within the oral cavity microenvironment in a phantom and pre-clinical study. We use an empirical model to quantify optical properties and sampling depth from sub-diffuse reflectance spectra (450–750 nm) at two source-detector separations (374 and 730 μm). Average errors in recovering reduced scattering (5–26 cm−1) and absorption coefficients (0–10 cm−1) in hemoglobin-based phantoms were approximately 2% and 6%, respectively. Next, a 300 μm-thick phantom tumor model was used to validate the probe’s ability to monitor progression of a proliferating optical heterogeneity. Finally, the technique was demonstrated on 13 healthy volunteers and volume-averaged optical coefficients, scattering exponent, hemoglobin concentration, oxygen saturation, and sampling depth are presented alongside a high-resolution microendoscopy image of oral mucosa from one volunteer. This multimodal microendoscopy approach encompasses both structural and spectroscopic reporters of perfusion within the tissue microenvironment and can potentially be used to monitor tumor response to therapy.
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8
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Pandey R, Paidi SK, Kang JW, Spegazzini N, Dasari RR, Valdez TA, Barman I. Discerning the differential molecular pathology of proliferative middle ear lesions using Raman spectroscopy. Sci Rep 2015; 5:13305. [PMID: 26289566 PMCID: PMC4542608 DOI: 10.1038/srep13305] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 07/13/2015] [Indexed: 11/10/2022] Open
Abstract
Despite its widespread prevalence, middle ear pathology, especially the development of proliferative lesions, remains largely unexplored and poorly understood. Diagnostic evaluation is still predicated upon a high index of clinical suspicion on otoscopic examination of gross morphologic features. We report the first technique that has the potential to non-invasively identify two key lesions, namely cholesteatoma and myringosclerosis, by providing real-time information of differentially expressed molecules. In addition to revealing signatures consistent with the known pathobiology of these lesions, our observations provide the first evidence of the presence of carbonate- and silicate-substitutions in the calcium phosphate plaques found in myringosclerosis. Collectively, these results demonstrate the potential of Raman spectroscopy to not only provide new understanding of the etiology of these conditions by defining objective molecular markers but also aid in margin assessment to improve surgical outcome.
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Affiliation(s)
- Rishikesh Pandey
- Laser Biomedical Research Center, Massachusetts Institute of Technology, Cambridge, Massachusetts, 02139, USA
| | - Santosh Kumar Paidi
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, Maryland 21218, USA
| | - Jeon Woong Kang
- Laser Biomedical Research Center, Massachusetts Institute of Technology, Cambridge, Massachusetts, 02139, USA
| | - Nicolas Spegazzini
- Laser Biomedical Research Center, Massachusetts Institute of Technology, Cambridge, Massachusetts, 02139, USA
| | - Ramachandra Rao Dasari
- Laser Biomedical Research Center, Massachusetts Institute of Technology, Cambridge, Massachusetts, 02139, USA
| | - Tulio Alberto Valdez
- Otolaryngology, Head and Neck Surgery, University of Connecticut, 263 Farmington Ave, Farmington, Connecticut, 06030, USA.,Otolaryngology, Head and Neck Surgery, Connecticut Children's Medical Center, 282 Washington St, Hartford, Connecticut, 06106, USA
| | - Ishan Barman
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, Maryland 21218, USA.,Department of Oncology, Johns Hopkins University, Baltimore, Maryland 21287, USA
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Parasher AK, Kidwai SM, Schorn VJ, Goljo E, Weinberg AD, Richards-Kortum R, Sikora AG, Iloreta AM, Govindaraj S, Miles BA. High-resolution microendoscope imaging of inverted papilloma and normal sinonasal mucosa: evaluation of interobserver concordance. Int Forum Allergy Rhinol 2015; 5:1136-40. [PMID: 26228817 DOI: 10.1002/alr.21603] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 06/18/2015] [Accepted: 06/23/2015] [Indexed: 11/05/2022]
Abstract
BACKGROUND High-resolution microendoscopy (HRME) enables real-time imaging of epithelial tissue. The utility of this novel imaging modality for inverted papilloma has not been previously described. This study examines the ability of otolaryngologists to differentiate between images of inverted papilloma and normal sinonasal mucosa obtained with a HRME. METHODS Inverted papilloma and normal sinonasal mucosa specimens were stained with a contrast agent, proflavine. HRME images were subsequently captured. Histopathological diagnosis was obtained for each sample. Quality-controlled images were used to assemble a training set. After reviewing the training images, 6 otolaryngologists without prior HRME experience reviewed and classified test images. RESULTS Five samples of inverted papilloma and 2 normal sinonasal mucosa samples were collected. Four representative images from each specimen were used for the 28-image test set. The mean accuracy among all reviewers was 89.9% (95% confidence interval [CI], 84.3% to 94.0%). The sensitivity to correctly identify inverted papilloma was 86.7% (95% CI, 79.2% to 92.2%), and the specificity was 92.9% (95% CI, 89.0% to 100.0%). The Fleiss kappa interrater reliability score was 0.80 (95% CI, 0.70 to 0.89). CONCLUSION Inverted papilloma and normal sinonasal mucosa have distinct HRME imaging characteristics. Otolaryngologists can be successfully trained to distinguish between inverted papilloma and normal sinonasal mucosa. HRME is a feasible tool for identification of inverted papilloma. By conducting future in vivo trials, HRME potentially may enable real-time surgical margin determination during surgical excision of inverted papilloma.
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Affiliation(s)
- Arjun K Parasher
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Sarah M Kidwai
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Victor J Schorn
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Erden Goljo
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Alan D Weinberg
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Andrew G Sikora
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX
| | - Alfred Marc Iloreta
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Satish Govindaraj
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Brett A Miles
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
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Patsias A, Giraldez-Rodriguez L, Polydorides AD, Richards-Kortum R, Anandasabapathy S, Quang T, Sikora AG, Miles B. Feasibility of transoral robotic-assisted high-resolution microendoscopic imaging of oropharyngeal squamous cell carcinoma. Head Neck 2015; 37:E99-102. [PMID: 25327825 DOI: 10.1002/hed.23892] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2014] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Transoral robotic-assisted oncologic surgery of the head and neck offers promising functional results. Nonetheless, the efficacy of oncologic surgery remains critically dependent on obtaining negative margins. We aimed to integrate a miniaturized high-resolution fiber-optic microendoscope (HRME), which provides real-time histological assessment, with the da Vinci robotic system (Intuitive Surgical, Sunnyvale, CA). METHODS Three patients undergoing transoral robotic surgery (TORS) were prospectively enrolled in this study. Optical imaging of the oropharynx was performed intraoperatively with the robotic-assisted HRME. RESULTS All patients underwent the procedure successfully with no complications. The HRME was successfully integrated with the da Vinci robotic system. Several sites of the oropharynx and associated malignancy were imaged, which correlated with the standard histopathological analysis. CONCLUSION Transoral robotic-assisted HRME imaging of the oropharynx is a safe and technically feasible approach, providing a real-time histological assessment and may serve as a valuable aid in oncologic surgery.
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Affiliation(s)
- Alexis Patsias
- Department of Otolaryngology - Head and Neck Surgery, Head and Neck Cancer Translational Research Program, The Icahn School of Medicine at Mount Sinai, New York, New York
| | - Laureano Giraldez-Rodriguez
- Department of Otolaryngology - Head and Neck Surgery, Head and Neck Cancer Translational Research Program, The Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | | | - Timothy Quang
- Department of Bioengineering, Rice University, Houston, Texas
| | - Andrew G Sikora
- Department of Otolaryngology - Head and Neck Surgery, Head and Neck Cancer Translational Research Program, The Icahn School of Medicine at Mount Sinai, New York, New York
| | - Brett Miles
- Department of Otolaryngology - Head and Neck Surgery, Head and Neck Cancer Translational Research Program, The Icahn School of Medicine at Mount Sinai, New York, New York
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Miles BA, Patsias A, Quang T, Polydorides AD, Richards-Kortum R, Sikora AG. Operative margin control with high-resolution optical microendoscopy for head and neck squamous cell carcinoma. Laryngoscope 2015; 125:2308-16. [PMID: 26059758 DOI: 10.1002/lary.25400] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2015] [Indexed: 12/27/2022]
Abstract
OBJECTIVES/HYPOTHESIS High-resolution microendoscopy (HRME) provides real-time visualization of the mucosal surface in the upper aerodigestive tract. This technology allows noninvasive discrimination of benign and neoplastic epithelium and has potential applications for intraoperative margin detection. STUDY DESIGN Single institution, prospective, feasibility trial (phase I) of in vivo optical imaging. METHODS The study was conducted on patients with squamous cell carcinoma of the upper aerodigestive tract. High-resolution microendoscopy images obtained during surgery were correlated with histopathologic diagnosis to determine the ability of HRME to differentiate between benign and malignant mucosa. Blinded reviewers evaluated HRME images and made determinations of the status of the mucosa. Accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and interrater agreement between multiple raters were calculated to determine the accuracy of HRME imaging. RESULTS The mean accuracy of reviewers in differentiating neoplastic or benign mucosa was 95.1% (95% confidence interval [CI], 94%-96%). Sensitivity and specificity were 96% (95% CI, 94%-99%) and 95% (95 % CI, 90%-99%), respectively. The NPV was 98% (95% CI, 97%-99%), and PPV was 91% (95% CI, 85%-98%). The Fleiss kappa statistic for interrater reliability was 0.81, with a standard error of 0.014 and a 95% CI (0.78-0.84). CONCLUSION High-resolution microendoscopy allows real-time discrimination between benign and neoplastic mucosa. High levels of sensitivity and specificity can be obtained with this technology when interrogating mucosal surfaces. Despite several technical limitations, HRME shows promise as a technique for intraoperative margin control and platform for molecular imaging technologies. LEVEL OF EVIDENCE 3b.
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Affiliation(s)
- Brett A Miles
- Department of Otolaryngology-Head and Neck Surgery, Division of Head and Neck Oncology
| | - Alexis Patsias
- Department of Otolaryngology-Head and Neck Surgery, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
| | | | | | | | - Andrew G Sikora
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A
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Valdez TA, Pandey R, Spegazzini N, Longo K, Roehm C, Dasari RR, Barman I. Multiwavelength fluorescence otoscope for video-rate chemical imaging of middle ear pathology. Anal Chem 2014; 86:10454-60. [PMID: 25226556 PMCID: PMC4204905 DOI: 10.1021/ac5030232] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
![]()
A common
motif in otolaryngology is the lack of certainty regarding
diagnosis for middle ear conditions, resulting in many patients being
overtreated under the worst-case assumption. Although pneumatic otoscopy
and adjunctive tests offer additional information, white light otoscopy
has been the main tool for diagnosis of external auditory canal and
middle ear pathologies for over a century. In middle ear pathologies,
the inability to avail high-resolution structural and/or molecular
imaging is particularly glaring, leading to a complicated and erratic
decision analysis. Here, we propose a novel multiwavelength fluorescence-based
video-rate imaging strategy that combines readily available optical
elements and software components to create a novel otoscopic device.
This modified otoscope enables low-cost, detailed and objective diagnosis
of common middle ear pathological conditions. Using the detection
of congenital cholesteatoma as a specific example, we demonstrate
the feasibility of fluorescence imaging to differentiate this proliferative
lesion from uninvolved middle ear tissue based on the characteristic
autofluorescence signals. Availability of real-time, wide-field chemical
information should enable more complete removal of cholesteatoma,
allowing for better hearing preservation and substantially reducing
the well-documented risks, costs and psychological effects of repeated
surgical procedures.
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Affiliation(s)
- Tulio A Valdez
- Otolaryngology - Head and Neck Surgery, University of Connecticut , Storrs, Connecticut 06269, United States
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Kawedia JD, Zhang YP, Myers AL, Richards-Kortum RR, Kramer MA, Gillenwater AM, Culotta KS. Physical and chemical stability of proflavine contrast agent solutions for early detection of oral cancer. J Oncol Pharm Pract 2014; 22:21-5. [PMID: 25113309 DOI: 10.1177/1078155214546564] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND PURPOSE Proflavine hemisulfate solution is a fluorescence contrast agent to visualize cell nuclei using high-resolution optical imaging devices such as the high-resolution microendoscope. These devices provide real-time imaging to distinguish between normal versus neoplastic tissue. These images could be helpful for early screening of oral cancer and its precursors and to determine accurate margins of malignant tissue for ablative surgery. Extemporaneous preparation of proflavine solution for these diagnostic procedures requires preparation in batches and long-term storage to improve compounding efficiency in the pharmacy. However, there is a paucity of long-term stability data for proflavine contrast solutions. METHODS The physical and chemical stability of 0.01% (10 mg/100 ml) proflavine hemisulfate solutions prepared in sterile water was determined following storage at refrigeration (4-8℃) and room temperature (23℃). Concentrations of proflavine were measured at predetermined time points up to 12 months using a validated stability-indicating high-performance liquid chromatography method. RESULTS Proflavine solutions stored under refrigeration were physically and chemically stable for at least 12 months with concentrations ranging from 95% to 105% compared to initial concentration. However, in solutions stored at room temperature increased turbidity and particulates were observed in some of the tested vials at 9 months and 12 months with peak particle count reaching 17-fold increase compared to baseline. Solutions stored at room temperature were chemically stable up to six months (94-105%). CONCLUSION Proflavine solutions at concentration of 0.01% were chemically and physically stable for at least 12 months under refrigeration. The solution was chemically stable for six months when stored at room temperature. We recommend long-term storage of proflavine solutions under refrigeration prior to diagnostic procedure.
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Affiliation(s)
- Jitesh D Kawedia
- Department of Pharmacy Research, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Yan-Ping Zhang
- Department of Pharmacy Research, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Alan L Myers
- Department of Pharmacy Research, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | | | - Mark A Kramer
- Department of Pharmacy Research, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Ann M Gillenwater
- Department of Head and Neck Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Kirk S Culotta
- Department of Experimental Therapeutics, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
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Bradley J, Jiang N, Levy L, Richards-Kortum R, Sikora A, Smouha E. High-resolution microendoscope images of middle ear cholesteatoma and surrounding tissue: evaluation of interobserver concordance. Otolaryngol Head Neck Surg 2014; 150:654-8. [PMID: 24415492 DOI: 10.1177/0194599813519051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Investigate how accurately otolaryngologists could differentiate between images obtained with high-resolution microendoscopy (HRME) of ex vivo cholesteatoma specimens and surrounding middle ear epithelium. STUDY DESIGN HRME images of surgically resected cholesteatoma and middle ear epithelium were obtained and otolaryngologists classified these images. SETTING Tertiary medical center. SUBJECTS AND METHODS Resected cholesteatoma and middle ear epithelium were stained with a contrast agent, proflavine, and HRME images were captured. Specimens were sent for standard histopathology and compared with HRME images. Quality-controlled images were used to assemble a training set. After viewing training images, otolaryngologists without prior cholesteatoma HRME experience reviewed and classified test images. RESULTS Ten cholesteatoma and 9 middle ear specimens were collected, of which 17 representative cholesteatoma and 19 middle ear epithelium images were extracted for a testing set. Qualitative analysis for concordance between HRME images and histological images yielded a strong correlation between modalities. The mean accuracy of all reviewers in correctly identifying images was 95% (95% confidence interval [CI], 92%-98%). The sensitivity to correctly detect cholesteatoma images was 98% (95% CI, 93%-100%), and the specificity was 92% (95% CI, 87%-97%). The Fleiss kappa interrater reliability score was 0.83, (95% CI, 0.77-0.89). CONCLUSIONS Medical professionals can quickly be trained to accurately distinguish between HRME images of cholesteatoma and normal middle ear epithelium, both of which have distinct imaging characteristics. Real-time HRME optical imaging can potentially improve the results of otologic surgery by allowing for extirpation of cholesteatomas while eliminating residual disease.
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Affiliation(s)
- James Bradley
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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