Assessment of the sensitivity and specificity of tissue-specific-based and anatomical-based optical biomarkers for rapid detection of human head and neck squamous cell carcinoma.

OBJECTIVES: We propose the use of morphological optical biomarkers for rapid detection of human head and neck squamous cell carcinoma (HNSCC) by leveraging the underlying tissue characteristics in aerodigestive tracts. MATERIALS AND METHODS: Diffuse reflectance spectra were obtained from malignant and contra-lateral normal tissues of 57 patients undergoing panendoscopy and biopsy. Oxygen saturation, total hemoglobin concentration, and the reduced scattering coefficient were extracted. Differences in malignant and normal tissues were examined based on two different groupings: anatomical site and morphological tissue type. RESULTS AND CONCLUSIONS: Measurements were acquired from 252 sites, of which 51 were pathologically classified as SCC. Optical biomarkers exhibited statistical differences between malignant and normal samples. Contrast was enhanced when parsing tissues by morphological classification rather than anatomical subtype for unpaired comparisons. Corresponding linear discriminant models using multiple optical biomarkers showed improved predictive ability when accounting for morphological classification, particularly in node-positive lesions. The false-positive rate was retrospectively found to decrease by 34.2% in morphologically- vs. anatomically-derived predictive models. In glottic tissue, the surgeon exhibited a false-positive rate of 45.7% while the device showed a lower false-positive rate of 12.4%. Additionally, comparisons of optical parameters were made to further understand the physiology of tumor staging and potential causes of high surgeon false-positive rates. Optical spectroscopy is a user-friendly, non-invasive tool capable of providing quantitative information to discriminate malignant from normal head and neck tissues. Predictive models demonstrated promising results for real-time diagnostics. Furthermore, the strategy described appears to be well suited to reduce the clinical false-positive rate.

Detection of squamous cell carcinoma and corresponding biomarkers using optical spectroscopy.

OBJECTIVES: Investigate the use of optical reflectance spectroscopy to differentiate malignant and nonmalignant tissues in head and neck lesions and characterize corresponding oxygen tissue biomarkers that are associated with pathologic diagnosis. STUDY DESIGN: Cross-sectional study. SETTING: Tertiary Veterans Administration Medical Center. SUBJECTS AND METHODS: All patients undergoing panendoscopy with biopsy for suspected head and neck cancer were eligible. Prior to taking tissue samples, the optical probe was placed at 3 locations to collect diffuse reflectance data. These locations were labeled "tumor," "immediately adjacent," and "distant normal tissue." Biopsies were taken of each of these respective sites. The diffuse reflectance spectra were analyzed, and biomarker-specific absorption data were extracted using an inverse Monte Carlo algorithm for malignant and nonmalignant tissues. Histopathological analysis was performed and used as the gold standard to analyze the optical biomarker data. RESULTS: Twenty-one patients with mucosal squamous cell carcinoma of the head and neck were identified and selected to participate in the study. Statistically significant differences in oxygen saturation (P = .001) and oxygenated hemoglobin (P = .019) were identified between malignant and nonmalignant tissues. CONCLUSION: This study established proof of principle that optical spectroscopy can be used in the head and neck areas to detect malignant tissue. Furthermore, tissue biomarkers were correlated with a diagnosis of malignancy.

Computer modeling and navigation in maxillofacial surgery.

PURPOSE OF REVIEW: To review the accuracy and effectiveness of current technology available for computer-aided maxillofacial surgery. RECENT FINDINGS: New developments in computer technology can help surgeons with preoperative planning and intraoperative navigation in the management of maxillofacial injuries. SUMMARY: Computer-aided surgery is improving the surgical outcomes in maxillofacial reconstruction, particularly in complex cases. Several recent articles are presented that explore the clinical outcomes using computer-aided surgery, investigate the precision of various intraoperative optical navigation systems, compare several registration strategies and examine the impact of natural facial asymmetry on planning and reconstruction. In all cases, preoperative computed tomography (CT) data are imported to computer modeling programs in which virtual reconstructions can be performed. These reconstructions are then used by intraoperative navigation systems to guide the surgeon and increase the precision of surgical outcomes. Evaluation of various registration strategies used to orient navigation systems to patient anatomical markers demonstrates that the optimum strategy is dependent on injury type. Some degree of error when repairing maxillofacial injuries is negated by the fact that people have naturally asymmetrical craniofacial skeletons.