Download PDF
Laryngorhinootologie 2021; 100(10): 818-823
DOI: 10.1055/a-1418-9175
Originalarbeit

Endonasale konfokale Laserendomikroskopie – erste Anwendung und Validierung von Malignitätskriterien

Confocal laser endomicroscopy – first application and validation of malignancy criteria
Nina Wenda 
1   ORL HNS, HELIOS Dr. Horst Schmidt Kliniken Wiesbaden, Germany
,
Ralf Kiesslich
2   Gastroenterology, HELIOS Dr. Horst Schmidt Kliniken Wiesbaden, Germany
,
Jan Gosepath
1   ORL HNS, HELIOS Dr. Horst Schmidt Kliniken Wiesbaden, Germany
› Author AffiliationsSupported by: Stiftung Tumorforschung Kopf-Hals Wiesbaden (15 000 €)
› Further Information
Also available at
    Permissions and Reprints

Zusammenfassung

Hintergrund Die konfokale Laserendomikroskopie (CLE) ist eine Methode zur In-vivo-Echtzeit-Visualisierung von Schleimhautveränderungen auf zellulärer Ebene. Erste Untersuchungen bei Kopf-Hals-Karzinomen beschrieben die oropharyngeale Anwendbarkeit. Ziel dieser Untersuchung ist es, anhand der im Oropharynx validierten Kriterien zu klären, ob diese auf die endonasalen Schleimhäute übertragen werden können.

Methode Wir verwendeten die CLE mit intravenöser Fluorescein-Färbung vor und während der endoskopischen Operation bei einem Patienten mit einem sinunasalen invertierten Papillom sowie einem Patienten mit einem endonasalen Plattenepithelkarzinom. Wir verglichen die zelluläre Darstellung der pathologischen Veränderungen mit der der gesunden Schleimhaut der Gegenseite desselben Patienten sowie mit unseren früheren Befunden im Oropharynx.

Ergebnisse Die endonasale CLE erwies sich als im operativen Setting gut durchführbar und die Übertragung von Malignitätskriterien in Analogie zur histologischen Untersuchung konnte optisch gut nachvollzogen werden. Darüber hinaus ergaben sich zusätzliche Kriterien zur geweblichen Dignitätsbeurteilung.

Schlussfolgerung Unsere Ergebnisse legen nahe, dass die endonasale CLE eine wertvolle Erweiterung des diagnostischen Repertoires durch eine zusätzliche Echtzeitanalyse der Nasenschleimhaut darstellt. Dies ist von besonderem Wert in chirurgisch anspruchsvollen anatomischen Bereichen wie den Nasennebenhöhlen. Weitere Untersuchungen und eine Validierung dieser Ergebnisse werden notwendig sein, um die Sicherheit der Methode beurteilen zu können.

Abstract

Objectives Confocal laser endomicroscopy (CLE) is a method for real-time in vivo visualization of mucosal changes on a cellular level. First investigations on head and neck carcinoma described the oropharyngeal application. The aim of this investigation is to elucidate, based on the criteria validated in the oropharynx, whether these can be transferred to endonasal mucosa.

Methods CLE was performed with intravenous fluorescein staining in endoscopic sinus surgery in one patient with sinonasal inverted papilloma and another with squamous cell carcinoma. We compared cellular visualization of pathological changes to those of healthy mucosa in the same specimen as well to our former findings in the oropharynx.

Results Endonasal CLE proved to be well feasible in the surgical setting and the transfer of malignancy criteria in analogy to histological examination could be optically retraced. Furthermore, additional criteria for tissue dignity assessment were obtained.

Conclusion Our results suggest that endonasal CLE represents a valuable extension of the diagnostic repertoire available to date by an additional real-time analysis of nasal mucosa. This is of particular value in surgically challenging anatomical areas such as the paranasal sinuses. Further investigation and validation will be necessary.

Schlüsselwörter

konfokale Laserendomikroskopie - endonasale Tumorchirurgie - endonasale Karzinome - endonasale Neoplasien - Echtzeit-Darstellung

Key words

confocal laserendomicroscopy - endonasal sinus surgery - endonasal neoplasm


Publication History

Received: 28 August 2020

Accepted: 08 March 2021

Article published online:
26 March 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • Literatur

  • 1 Lund VJ, Stammberger H, Nicolai P. et al. European position paper on endoscopic management of tumours of the nose, paranasal sinuses and skull base. Rhinol Suppl 2010; 22: 1-143
    PubMedGoogle Scholar
  • 2 De Almeida JR, Su SY, Koutourousiou M. et al. Endonasal endoscopic surgery for squamous cell carcinoma of the sinonasal cavities and skull base: Oncologic outcomes based on treatment strategy and tumor etiology. Head Neck 2015; 37 (08) 1163-1169
    CrossrefPubMedGoogle Scholar
  • 3 Mirza S, Bradley PJ, Acharya A. et al. Sinonasal inverted papillomas: recurrence, and synchronous and metachronous malignancy. J Laryngol Otol 2007; 121 (09) 857-864
    CrossrefPubMedGoogle Scholar
  • 4 Woodworth BA, Bhargave GA. Clinical outcomes of endoscopic and endoscopic-assisted resection of inverted papillomas: a 15-year experience. American journal of rhinology 2007; 21 (05) 591-600
    CrossrefPubMedGoogle Scholar
  • 5 Kiesslich R, Canto MI. Confocal laser endomicroscopy. Gastrointest Endosc Clin N Am 2009; 19 (02) 261-272
    CrossrefPubMedGoogle Scholar
  • 6 Kiesslich R, Burg J, Vieth M. et al. Confocal laser endoscopy for diagnosing intraepithelial neoplasias and colorectal cancer in vivo. Gastroenterology 2004; 127 (03) 706-713
    CrossrefPubMedGoogle Scholar
  • 7 Pogorzelski B, Hanenkamp U, Goetz M. et al. Systematic intraoperative application of confocal endomicroscopy for early detection and resection of squamous cell carcinoma of the head and neck: a preliminary report. Arch Otolaryngol Head Neck Surg 2012; 138 (04) 404-411
    CrossrefPubMedGoogle Scholar
  • 8 Fugazza A, Gaiani F, Carra MC. et al Confocal Laser Endomicroscopy in Gastrointestinal and Pancreatobiliary Diseases: A Systematic Review and Meta-Analysis. Biomed Res Int 2016: 4638683
    Google Scholar
  • 9 Goorsenberg A, Kalversa KA, Annema J. et al Advances in Optical Coherence Tomography and Confocal Laser Endomicroscopy in Pulmonary Diseases. Respiration 2020; 99 (03) 190-205
    CrossrefPubMedGoogle Scholar
  • 10 Watermann A, Gieringer R, Bauer AM. et al Fluorescein- and EGFR-Antibody Conjugated Silica Nanoparticles for Enhancement of Real-time Tumor Border Definition Using Confocal Laser Endomicroscopy in Squamous Cell Carcinoma of the Head and Neck. Nanomaterials 2019; 9 (10) 1378
    CrossrefPubMedGoogle Scholar
  • 11 Teubner D, Kiesslich R, Matsumoto T. et al. Beyond standard image-enhanced endoscopy confocal endomicroscopy. Gastrointest Endosc Clin N Am 2014; 24 (03) 427-434
    CrossrefPubMedGoogle Scholar
  • 12 Wang TD, Friedland S, Sahbaie P. et al. Functional imaging of colonic mucosa with a fibered confocal microscope for real-time in vivo pathology. Clin Gastroenterol Hepatol 2007; 5 (11) 1300-1305
    CrossrefPubMedGoogle Scholar
  • 13 Jennings BJ, Mathews DE. Adverse reactions during retinal fluorescein angiography. J Am Optom Assoc 1994; 65 (07) 465-471
    PubMedGoogle Scholar
  • 14 Haxel BR, Goetz M, Kiesslich R. et al. Confocal endomicroscopy: a novel application for imaging of oral and oropharyngeal mucosa in human. Eur Arch Otorhinolaryngol 2010; 267 (03) 443-448
    Google Scholar
  • 15 Nathan CA, Kaskas NM, Ma X. et al. Confocal Laser Endomicroscopy in the Detection of Head and Neck Precancerous Lesions. Otolaryngol Head Neck Surgery 2014; 151 (01) 73-80
    CrossrefPubMedGoogle Scholar
  • 16 Wu L, Yu H, Zhou R. et al. Probe-based confocal laser endomicroscopy for diagnosis of nasopharyngeal carcinoma in vivo. Laryngoscope 2019; 129 (04) 897-902
    CrossrefPubMedGoogle Scholar
  • 17 Goncalves M, Aubreville M, Mueller SK. et al. Probe-based confocal laser endomicroscopy in detecting malignant lesions of vocal folds. Acta Otorhinolaryngol Ital 2019; 39 (06) 10-12
    CrossrefPubMedGoogle Scholar
  • 18 Tirelli G, Piovesana M, Gatto A. et al NBI utility in the pre-operative and intra-operative assessment of oral cavity and oropharyngeal carcinoma. Am J Otolaryngol 2017; 38 (01) 65-71
    CrossrefPubMedGoogle Scholar
  • 19 Petersen KB, Kjaergaard T. Role of narrow band imaging in the diagnostics of sinonasal pathology. BMJ Case Rep 2017 Apr 28
    Google Scholar