title: Interobserver agreement of confocal laser endomicroscopy for detection of head and neck neoplasia.
abstract: OBJECTIVE
  We have described the feasibility of using the probe-based confocal laser endomicroscopy (pCLE) in differentiating benign from malignant lesions of the head and neck. Therefore, we wanted to determine the interobserver agreement of pCLE offline images of noncancerous, precancerous, and cancerous lesions of the head and neck.
  
  
  METHODS
  Single tertiary referral center.
  
  
  METHODS
  In the feasibility study, image criteria for nondysplasia, dysplasia, and cancer were defined. The pCLE was performed before lesions were biopsied. Fifty offline images and 10 videos of good quality were selected. Seven surgeons and one pathologist were asked to review and categorize the images into the three categories above. The overall accuracy of 29 offline pCLE images and six videos were compared with histopathology. Interobserver agreement and accuracy kappa (κ) scores were measured with 95% confidence intervals (CI).
  
  
  RESULTS
  There were six nondysplasia, seven dysplasia, and 11 squamous cell carcinoma (SCCA) cases, each with multiple images. There was substantial agreement between the eight reviewers on the pCLE images and videos (κ = 0.66; 95% CI 0.51-0.82 and κ = 0.71; 95% CI 0.42-0.97, respectively). The overall agreement with the final histopathology was also substantial for both the images and video sequences (κ = 0.70; 95% CI 0.50-0.88 and κ = 0.73; 95% CI 0.39-1.00, respectively).
  
  
  CONCLUSIONS
  The ability to differentiate normal mucosa, dysplasia, and invasive SCCA using pCLE with high accuracy and reliability was demonstrated. This technology has the potential to decrease sampling error of lesions in the head and neck. This is the first study to test the reliability of this technology in mucosal lesions of the head and neck.
  
  
  METHODS
  NA. Laryngoscope, 126:632-637, 2016.
authors.affiliation: Louisiana State University Health Shreveport School of Medicine, Louisiana State University Health Shreveport, Shreveport, Louisiana, U.S.A.
authors.forename: Charles
authors.initials: C
authors.lastname: Moore
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Shreveport, Shreveport, Louisiana, U.S.A.|Feist-Weiller Cancer Center, Louisiana State University Health Shreveport, Shreveport, Louisiana, U.S.A.
authors.forename: Vikas
authors.initials: V
authors.lastname: Mehta
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Shreveport, Shreveport, Louisiana, U.S.A.
authors.forename: Xiaohui
authors.initials: X
authors.lastname: Ma
authors.affiliation: Louisiana State University Health Shreveport School of Medicine, Louisiana State University Health Shreveport, Shreveport, Louisiana, U.S.A.|Department of Pathology, Louisiana State University Health Shreveport, Shreveport, Louisiana, U.S.A.
authors.forename: Shabnum
authors.initials: S
authors.lastname: Chaudhery
authors.affiliation: Feist-Weiller Cancer Center, Louisiana State University Health Shreveport, Shreveport, Louisiana, U.S.A.
authors.forename: Runhua
authors.initials: R
authors.lastname: Shi
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Shreveport, Shreveport, Louisiana, U.S.A.
authors.forename: Tara
authors.initials: T
authors.lastname: Moore-Medlin
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Shreveport, Shreveport, Louisiana, U.S.A.|Feist-Weiller Cancer Center, Louisiana State University Health Shreveport, Shreveport, Louisiana, U.S.A.
authors.forename: Timothy
authors.initials: T
authors.lastname: Lian
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Shreveport, Shreveport, Louisiana, U.S.A.|Feist-Weiller Cancer Center, Louisiana State University Health Shreveport, Shreveport, Louisiana, U.S.A.
authors.forename: Cherie-Ann O
authors.initials: CA
authors.lastname: Nathan
mesh_terms: D001707:Biopsy, Needle; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000473:pathology*; D016001:Confidence Intervals; D005240:Feasibility Studies; D005260:Female; D006258:Head and Neck Neoplasms / Q000175:diagnosis / Q000473:pathology*; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D018613:Microscopy, Confocal / Q000379:methods; D009092:Mucous Membrane / Q000473:pathology* / Q000648:ultrastructure; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D015588:Observer Variation; D012017:Referral and Consultation / Q000706:statistics & numerical data; D062606:Tertiary Care Centers; D014741:Video Recording
keywords: Head and neck; larynx; oral cavity