[Noninvasive imaging using autofluorescence endoscopy: Value for the early detection of laryngeal cancer]

Autofluorescence Image-Guided Endoscopy in the Management of Upper Aerodigestive Tract Tumors

At this juncture, autofluorescence and narrow-band imaging have resurfaced in the medicine arena in parallel with current technology advancement. The emergence of newly developed optical instrumentation in addition to the discovery of new fluorescence biomolecules have contributed to a refined management of diseases and tumors, especially in the management of upper aerodigestive tract tumors. The advancement in multispectral imaging and micro-endoscopy has also escalated the trends further in the setting of the management of this tumor, in order to gain not only the best treatment outcomes but also facilitate early tumor diagnosis. This includes the usage of autofluorescence endoscopy for screening, diagnosis and treatment of this tumor. This is crucial, as microtumoral deposit at the periphery of the gross tumor can be only assessed via an enhanced endoscopy and even more precisely with autofluorescence endoscopic techniques. Overall, with this new technique, optimum management can be achieved for these patients. Hence, the treatment outcomes can be improved and patients are able to attain better prognosis and survival.

Hemoglobin Absorption Spectral Imaging (H.A.S.I.): a novel optical staining technique for microlaryngoscopy

PURPOSE

Optical image enhancement techniques are widely used in endoscopy to improve the visualization of blood vessels for diagnostic and therapeutic purposes. These techniques are monitor-based and therefore not available for direct microscopy. In this study, a novel optical microscope filter, Hemoglobin absorption spectral imaging (H.A.S.I.) was tested for use in microlaryngoscopy.

METHODS

A novel dichroic filter was designed to improve contrast in small blood vessels by highlighting transmission in the spectrum range of hemoglobin absorption maxima. A surgical microscope equipped with the novel H.A.S.I. filter was installed in one operating room in our institution. 68 consecutive patients referred to our ENT department for endoscopy were examined using white light and the novel H.A.S.I. filter during microlaryngoscopy. Surgeons described the blood vessels of the vocal cords using a classification chart and assessed for suspected malignancy using both white light and H.A.S.I.

RESULTS

77 consecutive microlaryngoscopies were performed on 68 patients. 142 vocal cords were visualized in microlaryngoscopy and the blood vessels classified according to the chart. With white light, 152 blood vessel characteristics were documented and 157 with H.A.S.I. Notably, pathologies like benign horizontal blood vessel changes, leukoplakia, and vertical blood vessel changes like dots and loops were seen more frequently with H.A.S.I. Finally, seven lesions were treated by transoral laser microsurgery (TLM) with H.A.S.I. to test the practicability of the method for microlaryngoscopic laser surgery.

CONCLUSION

This is the first study describing H.A.S.I. as an optical staining method for microlaryngoscopy. In our experience, the method was practical and improved the evaluation of vocal cord blood vessels. In some cases, the use of H.A.S.I. led to a change in diagnosis and treatment. Also, H.A.S.I. was found to be helpful in microlaryngeal laser surgery for demarcating resection margins. This is, to our knowledge, the first optical staining method integrated into a surgical microscope and can be conveniently used during microlaryngeal laser surgery and does not require further equipment.

LPCANet: Classification of Laryngeal Cancer Histopathological Images Using a CNN with Position Attention and Channel Attention Mechanisms

Laryngeal cancer is one of the most common malignant tumors in otolaryngology, and histopathological image analysis is the gold standard for the diagnosis of laryngeal cancer. However, pathologists have high subjectivity in their diagnoses, which makes it easy to miss diagnoses and misdiagnose. In addition, according to a literature search, there is currently no computer-aided diagnosis (CAD) algorithm that has been applied to the classification of histopathological images of laryngeal cancer. Convolutional neural networks (CNNs) are widely used in various other cancer classification tasks. However, the potential global and channel relationships of images may be ignored, which will affect the feature representation ability. Simultaneously, due to the lack of interpretability, the results are often difficult to accept by pathologists. we propose a laryngeal cancer classification network (LPCANet) based on a CNN and attention mechanisms. First, the original histopathological images are sequentially cropped into patches. Then, the patches are input into the basic ResNet50 to extract the local features. Then, a position attention module and a channel attention module are added in parallel to capture the spatial dependency and the channel dependency, respectively. The two modules produce the fusion feature map to enhance the feature representation and improve network classification performance. Moreover, the fusion feature map is extracted and visually analyzed by the grad-weighted class activation map (Grad_CAM) to provide a certain interpretability for the final results. The three-class classification performance of LPCANet is better than those of the five state-of-the-art classifiers (VGG16, ResNet50, InceptionV3, Xception and DenseNet121) on the two original resolutions (534 * 400 and 1067 * 800). On the 534 * 400 data, LPCANet achieved 73.18% accuracy, 74.04% precision, 73.15% recall, 72.9% F1-score, and 0.8826 AUC. On the 1067 * 800 data, LPCANet achieved 83.15% accuracy, 83.5% precision, 83.1% recall, 83.1% F1-score, and 0.9487 AUC. The results show that LPCANet enhances the feature representation by capturing the global and channel relationships and achieves better classification performance. In addition, the visual analysis of Grad_CAM makes the results interpretable, which makes it easier for the results to be accepted by pathologists and allows the method to become a second tool for auxiliary diagnosis.

Expression levels and clinical significance of miR-203 and miR-133b in laryngeal carcinoma

The present study aimed to investigate the expression levels and clinical significance of microRNA (miR)-203 and miR-133b in laryngeal carcinoma. A total of 154 patients with laryngeal carcinoma (research group) along with 100 healthy individuals (control group) were enrolled in the study. The patients were admitted to Yidu Central Hospital of Weifang (Weifang, China) from February 2016 to October 2018. Fasting venous blood (5 ml) was extracted from all subjects to determine the expression levels of serum miR-203 and miR-133b by reverse transcription-quantitative polymerase chain reaction (PCR) and to compare them among patients with different pathological characteristics. Receiver operating characteristic (ROC) curves were plotted to analyze the diagnostic values of miR-203 and miR-133b for laryngeal carcinoma. The research group showed significantly lower expression levels of miR-203 and miR-133b than the control group (P<0.05). According to ROC curve analysis, when the cut-off value was 0.659, the sensitivity and specificity of miR-203 in diagnosing laryngeal carcinoma were 60.00 and 90.26%, respectively, whereas when the cut-off value was 1.398, the sensitivity and specificity of miR-133b were 55.00 and 87.66%, respectively. The sensitivity and specificity of the joint detection were 70.00 and 83.77%, respectively, when the cut-off value was 0.416. In the research group, miR-203 was expressed significantly different in patients with different pathological stages and tumor types (P<0.050). The expression of miR-133b varied significantly in patients with different pathological stages, differentiation degrees and lymph node metastasis (P<0.050). In conclusion, miR-203 and miR-133b were expressed at low levels in patients with laryngeal carcinoma. The expression of miR-203 was related to tumor-node-metastasis (TNM) stage and tumor type, whereas the expression of miR-133b was related to TNM stage, differentiation degree, as well as lymph node metastasis. Joint detection of miR-203 and miR-133b is expected to be an excellent marker for the diagnosis and treatment of laryngeal carcinoma.

The role of autofluorescence, photodynamic diagnosis and Photodynamic therapy in malignant tumors of the duodenum

This article presents the current state of knowledge and a review of the literature in terms of the prevalence, etiopathogenesis, differential diagnosis, management, prognosis, and treatment of malignant tumors of the duodenum. The role of autofluorescence and photodynamic diagnosis as an emerging treatment method for rarely o ccurring duodenal malignant neoplasms .. We selected publications which can be found in databases such as The National Center for Biotechnology Information, U.S. National Library of Medicine (PubMed), The American Chemical Society, The American Association of Pharmaceutical Sciences and The American Society for Photobiology and The Canada Institute for Scientific and Technical Information.

Highly Accurate Detection of Cancer In Situ with Intraoperative, Label-Free, Multimodal Optical Spectroscopy

Effectiveness of surgery as a cancer treatment is reduced when all cancer cells are not detected during surgery, leading to recurrences that negatively impact survival. To maximize cancer cell detection during cancer surgery, we designed an in situ intraoperative, label-free, optical cancer detection system that combines intrinsic fluorescence spectroscopy, diffuse reflectance spectroscopy, and Raman spectroscopy. Using this multimodal optical cancer detection system, we found that brain, lung, colon, and skin cancers could be detected in situ during surgery with an accuracy, sensitivity, and specificity of 97%, 100%, and 93%, respectively. This highly sensitive optical molecular imaging approach can profoundly impact a wide range of surgical and noninvasive interventional oncology procedures by improving cancer detection capabilities, thereby reducing cancer burden and improving survival and quality of life. Cancer Res; 77(14); 3942-50. ©2017 AACR.