Confocal Laser Endomicroscopy in the Detection of Head and Neck Precancerous Lesions.
This study aimed to determine the feasibility of using probe-based confocal laser endomicroscopy (pCLE) in the diagnostic differentiation of non-neoplastic lesions from precancerous and cancerous lesions of head and neck patients.



Diagnostic test evaluation.



Louisiana State University Health Shreveport.



Intravenous injection of fluorescein was given to patients with precancerous and cancerous head and neck lesions (n = 21) followed by the use of a 1.8-mm GastroFlex probe in the oral cavity with subsequent biopsies of selected areas. Probe-based confocal laser endomicroscopy images were compared to histologic evaluation of visualized sites using sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV).



The dorsal surface of the tongue was not well visualized. The remaining nonkeratinized subsites, including the buccal mucosa, floor of mouth, and ventral tongue, were well visualized. Diagnoses based on pCLE images correlated well with the gold standard diagnoses based on tissue histology. The overall sensitivity for diagnosis of dysplasia versus nondysplasia was 80.0% (95% confidence interval [CI], 62.0-98.0), specificity and PPV were 100%, and the NPV was 80.0% (95% CI, 60.0-100.0). The overall specificity, sensitivity, PPV, and NPV for pCLE diagnosis of carcinoma versus nondysplasia were 100%. The overall sensitivity for diagnosis of carcinoma versus dysplasia was 85.7% (95% CI, 73.0-99.0), specificity and PPV were 100%, and the NPV was 80.0% (95% CI, 60.0-100.0).



The pCLE is a promising method for differentiating between nondysplastic, precancerous, and cancerous lesions of the head and neck.
Department of Otolaryngology-Head & Neck Surgery, Louisiana State University Health Shreveport, Shreveport, Louisiana, USA Feist-Weiller Cancer Center, Louisiana State University Health Shreveport, Shreveport, Louisiana, USA cnatha@lsuhsc.edu.
Cherie-Ann O
CA
Nathan
Louisiana State University Health Shreveport School of Medicine, Shreveport, Louisiana, USA.
Nadine M
NM
Kaskas
Department of Otolaryngology-Head & Neck Surgery, Louisiana State University Health Shreveport, Shreveport, Louisiana, USA.
Xiaohui
X
Ma
Department of Otolaryngology-Head & Neck Surgery, Louisiana State University Health Shreveport, Shreveport, Louisiana, USA Department of Pathology, Louisiana State University Health Shreveport, Shreveport, Louisiana, USA.
Shubnum
S
Chaudhery
Department of Otolaryngology-Head & Neck Surgery, Louisiana State University Health Shreveport, Shreveport, Louisiana, USA Feist-Weiller Cancer Center, Louisiana State University Health Shreveport, Shreveport, Louisiana, USA.
Timothy
T
Lian
Department of Otolaryngology-Head & Neck Surgery, Louisiana State University Health Shreveport, Shreveport, Louisiana, USA.
Tara
T
Moore-Medlin
Feist-Weiller Cancer Center, Louisiana State University Health Shreveport, Shreveport, Louisiana, USA.
Runhua
R
Shi
Department of Otolaryngology-Head & Neck Surgery, Louisiana State University Health Shreveport, Shreveport, Louisiana, USA Feist-Weiller Cancer Center, Louisiana State University Health Shreveport, Shreveport, Louisiana, USA.
Vikas
V
Mehta
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D002294:Carcinoma, Squamous Cell / Q000473:pathology*; D003937:Diagnosis, Differential; D004938:Esophageal Neoplasms / Q000473:pathology; D005260:Female; D006257:Head / Q000473:pathology; D006258:Head and Neck Neoplasms / Q000473:pathology*; D006801:Humans; D008297:Male; D018613:Microscopy, Confocal / Q000379:methods; D008875:Middle Aged; D009333:Neck / Q000473:pathology; D009361:Neoplasm Invasiveness; D011230:Precancerous Conditions / Q000473:pathology*; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity
CellVizio; GastroFlex; HNSCC; optical biopsy; pCLE