title: Discrimination of benign and neoplastic mucosa with a high-resolution microendoscope (HRME) in head and neck cancer.
abstract: BACKGROUND
  The efficacy of ablative surgery for head and neck squamous cell carcinoma (HNSCC) depends critically on obtaining negative margins. Although intraoperative "frozen section" analysis of margins is a valuable adjunct, it is expensive, time-consuming, and highly dependent on pathologist expertise. Optical imaging has potential to improve the accuracy of margins by identifying cancerous tissue in real time. Our goal was to determine the accuracy and inter-rater reliability of head and neck cancer specialists using high-resolution microendoscopic (HRME) images to discriminate between cancerous and benign mucosa.
  
  
  METHODS
  Thirty-eight patients diagnosed with head and neck squamous cell carcinoma (HNSCC) were enrolled in this single-center study. HRME was used to image each specimen after application of proflavine, with concurrent standard histopathologic analysis. Images were evaluated for quality control, and a training set containing representative images of benign and neoplastic tissue was assembled. After viewing training images, seven head and neck cancer specialists with no previous HRME experience reviewed 36 test images and were asked to classify each.
  
  
  RESULTS
  The mean accuracy of all reviewers in correctly diagnosing neoplastic mucosa was 97% (95% confidence interval (CI), 94-99%). The mean sensitivity and specificity were 98% (97-100%) and 92% (87-98%), respectively. The Fleiss kappa statistic for inter-rater reliability was 0.84 (0.77-0.91).
  
  
  CONCLUSIONS
  Medical professionals can be quickly trained to use HRME to discriminate between benign and neoplastic mucosa in the head and neck. With further development, the HRME shows promise as a method of real-time margin determination at the point of care.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Mount Sinai School of Medicine, New York, NY, USA.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Vila
authors.forename: Chan W
authors.initials: CW
authors.lastname: Park
authors.forename: Mark C
authors.initials: MC
authors.lastname: Pierce
authors.forename: Gregg H
authors.initials: GH
authors.lastname: Goldstein
authors.forename: Lauren
authors.initials: L
authors.lastname: Levy
authors.forename: Vivek V
authors.initials: VV
authors.lastname: Gurudutt
authors.forename: Alexandros D
authors.initials: AD
authors.lastname: Polydorides
authors.forename: James H
authors.initials: JH
authors.lastname: Godbold
authors.forename: Marita S
authors.initials: MS
authors.lastname: Teng
authors.forename: Eric M
authors.initials: EM
authors.lastname: Genden
authors.forename: Brett A
authors.initials: BA
authors.lastname: Miles
authors.forename: Sharmila
authors.initials: S
authors.lastname: Anandasabapathy
authors.forename: Ann M
authors.initials: AM
authors.lastname: Gillenwater
authors.forename: Rebecca
authors.initials: R
authors.lastname: Richards-Kortum
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Sikora
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000473:pathology*; D019723:Endoscopes; D004724:Endoscopy; D005336:Fiber Optic Technology; D005456:Fluorescent Dyes; D006258:Head and Neck Neoplasms / Q000473:pathology*; D006801:Humans; D007089:Image Enhancement / Q000295:instrumentation*; D008853:Microscopy / Q000295:instrumentation; D009092:Mucous Membrane / Q000473:pathology*; D015588:Observer Variation; D011237:Predictive Value of Tests; D011370:Proflavine; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D000077195:Squamous Cell Carcinoma of Head and Neck
chemical_list: D005456:Fluorescent Dyes; D011370:Proflavine