Value of tissue homogeneity in confocal laser endomicroscopy for the diagnosis of squamous cell carcinoma of the larynx and hypopharynx

Background Confocal laser endomicroscopy (CLE) provides imaging of the laryngeal mucosa at a thousand-fold magnification. In this study, differences in tissue homogeneity between healthy mucosa and squamous cell carcinoma (SCC) were analyzed.

Materials and methods Five patients with planned laryngectomy enrolled in this study between October 2020 and February 2021. We performed CLE images of the tumor and healthy mucosa. Image homogeneity was analyzed by measuring signal intensity in four regions (ROI) in each image in a total of 60 sequences and correlated to the H&E staining. In addition, the subjective evaluation of seven investigators regarding tissue homogeneity was recorded.

Results 3600 images correlated with benign mucosa and 1980 images correlated with SCC. The ROIs of benign mucosa and SCC had a mean and standard deviation (SD) of signal intensity of 232.1 ± 3.34 and 467.3 ± 9.72, respectively (P < .001). The mean SD between the four ROIs was 39.1 ± 1.03 for benign and 101.5 ± 2.6 for SCC images (P < .001). Examiner-dependent analysis yielded a sensitivity and specificity of 81.8% and 86.2%.

Conclusions SCC shows significant tissue inhomogeneity compared with healthy epithelium. The results support the importance of this feature in identifying SCC in CLE examination.

Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) grant number GO 3182/2-1, MA 4898/17-1, OE 743/1-1, STE 1877/7-1; Project Number 439264659.

Publication History

Article published online:
24 May 2022