title: High-resolution microendoscope imaging of inverted papilloma and normal sinonasal mucosa: evaluation of interobserver concordance.
abstract: BACKGROUND
  High-resolution microendoscopy (HRME) enables real-time imaging of epithelial tissue. The utility of this novel imaging modality for inverted papilloma has not been previously described. This study examines the ability of otolaryngologists to differentiate between images of inverted papilloma and normal sinonasal mucosa obtained with a HRME.
  
  
  METHODS
  Inverted papilloma and normal sinonasal mucosa specimens were stained with a contrast agent, proflavine. HRME images were subsequently captured. Histopathological diagnosis was obtained for each sample. Quality-controlled images were used to assemble a training set. After reviewing the training images, 6 otolaryngologists without prior HRME experience reviewed and classified test images.
  
  
  RESULTS
  Five samples of inverted papilloma and 2 normal sinonasal mucosa samples were collected. Four representative images from each specimen were used for the 28-image test set. The mean accuracy among all reviewers was 89.9% (95% confidence interval [CI], 84.3% to 94.0%). The sensitivity to correctly identify inverted papilloma was 86.7% (95% CI, 79.2% to 92.2%), and the specificity was 92.9% (95% CI, 89.0% to 100.0%). The Fleiss kappa interrater reliability score was 0.80 (95% CI, 0.70 to 0.89).
  
  
  CONCLUSIONS
  Inverted papilloma and normal sinonasal mucosa have distinct HRME imaging characteristics. Otolaryngologists can be successfully trained to distinguish between inverted papilloma and normal sinonasal mucosa. HRME is a feasible tool for identification of inverted papilloma. By conducting future in vivo trials, HRME potentially may enable real-time surgical margin determination during surgical excision of inverted papilloma.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Arjun K
authors.initials: AK
authors.lastname: Parasher
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Kidwai
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Victor J
authors.initials: VJ
authors.lastname: Schorn
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Erden
authors.initials: E
authors.lastname: Goljo
authors.affiliation: Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Alan D
authors.initials: AD
authors.lastname: Weinberg
authors.affiliation: Department of Bioengineering, Rice University, Houston, TX.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Richards-Kortum
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX.
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Sikora
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Alfred Marc
authors.initials: AM
authors.lastname: Iloreta
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Satish
authors.initials: S
authors.lastname: Govindaraj
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Brett A
authors.initials: BA
authors.lastname: Miles
mesh_terms: D053705:Capsule Endoscopes / Q000706:statistics & numerical data; D004724:Endoscopy; D006801:Humans; D009297:Nasal Mucosa / Q000473:pathology*; D009669:Nose Neoplasms / Q000175:diagnosis* / Q000473:pathology; D015588:Observer Variation; D010036:Otolaryngology; D018308:Papilloma, Inverted / Q000175:diagnosis* / Q000473:pathology; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
keywords: inverted papilloma; optical imaging; sinonasal tumors; sinus mucosa; surgical margins