Probe-based confocal laser endomicroscopy for optical biopsy of basal cell carcinoma of the auricle

Acta Otorhinolaryngologica Italica, vol. 46, pp. 265–271

Abstract

Objective: The resection of skin tumours of the auricle is confronted with the challenge of keeping the resection defect as small as possible and at the same time achieving a complete resection. Probe-based confocal laser endomicroscopy (CLE) is an optical procedure that enables real-time, non-invasive assessment of the epithelium with up to 1000x magnification in vivo. The aim is to evaluate the feasibility of CLE in basal cell carcinoma (BCC) of the auricle. Methods: Sixty-four video sequences (4,872 images) of CLE images of 8 different patients with BCC on the auricle were analysed. Each video sequence was assigned a histologic diagnosis. The sequences were presented to 4 physicians with experience in CLE in a blinded fashion. Dignity was assessed dichotomously using criteria such as cell size, tissue homogeneity and fibrosis. Results: BCC is characterised by inhomogeneous tissue with enlarged, poorly demarcated cells, partly interrupted by cell-free fibrosis. The assessment of dignity based on the CLE sequences achieved an average sensitivity of 86.7% and a specificity of 94.5%. The interrater reliability (Fleiss Kappa) showed substantial agreement (κ = 0.76). Conclusions: The results demonstrate the initial feasibility of intraoperative CLE for optical biopsy of facial skin tumours. The technique has the potential to serve as a non-invasive diagnostic tool in intraoperative decision making. Further studies are needed to evaluate its use as an adjunct to optimise or reduce the use of invasive frozen section pathology in the treatment of BCC.

Authors 11

1. Flurin Müller-Diesing Aachen Department of Otorhinolaryngology—Head and Neck Surgery

   RWTH Aachen University · Universitätsklinikum Aachen

   Affiliation as printed

   Department of Otorhinolaryngology, Head and Neck Surgery, Uniklinik RWTH Aachen University, Aachen, Germany

2. Matti Sievert

   Friedrich-Alexander-Universität Erlangen-Nürnberg · Universitätsklinikum Erlangen

   Affiliation as printed

   Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, University Hospital, Erlangen, Germany

3. Bharat Akhanda Panuganti

   Washington University in St. Louis

   Affiliation as printed

   Department of Otolaryngology - Head and Neck Surgery, Washington University in St. Louis, St. Louis, MO, USA

4. Marc Aubreville

   Flensburg University of Applied Sciences

   Affiliation as printed

   Flensburg University of Applied Sciences, Flensburg, Germany

5. Nils Porsche

   Flensburg University of Applied Sciences

   Affiliation as printed

   Flensburg University of Applied Sciences, Flensburg, Germany

6. Stephan Hackenberg Aachen Department of Otorhinolaryngology—Head and Neck Surgery

   RWTH Aachen University · Universitätsklinikum Aachen

   Affiliation as printed

   Department of Otorhinolaryngology, Head and Neck Surgery, Uniklinik RWTH Aachen University, Aachen, Germany

7. Manuel Stöth Aachen Department of Otorhinolaryngology—Head and Neck Surgery

   RWTH Aachen University · Universitätsklinikum Aachen

   Affiliation as printed

   Department of Otorhinolaryngology, Head and Neck Surgery, Uniklinik RWTH Aachen University, Aachen, Germany

8. Laura Ackermann Aachen Department of Otorhinolaryngology—Head and Neck Surgery

   RWTH Aachen University · Universitätsklinikum Aachen

   Affiliation as printed

   Department of Otorhinolaryngology, Head and Neck Surgery, Uniklinik RWTH Aachen University, Aachen, Germany

9. Agmal Scherzad Aachen Department of Otorhinolaryngology—Head and Neck Surgery

   RWTH Aachen University · Universitätsklinikum Aachen

   Affiliation as printed

   Department of Otorhinolaryngology, Head and Neck Surgery, Uniklinik RWTH Aachen University, Aachen, Germany

10. Till Jasper Meyer Aachen Department of Otorhinolaryngology—Head and Neck Surgery

    RWTH Aachen University · Universitätsklinikum Aachen

    Affiliation as printed

    Department of Otorhinolaryngology, Head and Neck Surgery, Uniklinik RWTH Aachen University, Aachen, Germany

11. Miguel Goncalves corresponding Aachen Department of Otorhinolaryngology—Head and Neck Surgery

    RWTH Aachen University · Universitätsklinikum Aachen

    Affiliation as printed

    Department of Otorhinolaryngology, Head and Neck Surgery, Uniklinik RWTH Aachen University, Aachen, Germany