Confocal laser endomicroscopy for evaluation of resection margins in head and neck surgery – on par with gold standard histopathology?

Introduction The technology of confocal laser endomicroscopy (CLE) allows for real-time imaging of the mucosal layer and its morphological changes in the context of malignant alterations on a cellular level. The investigation and evaluation of its applicability in the different areas of head and neck surgery in comparison with the current gold standard of histopathological examination are the aims of this study.

Material and Methods We examined 15 patients with histologically confirmed malignancies of the head and neck region. For this purpose, we performed CLE (CellvizioÒ, Mauna Kea Technologies, Paris, France) after intravenous application of fluorescein as a contrast agent in endonasal-endoscopic, transoral as well as open surgical resections. We examined the resection margins prior to removal of respective specimens for histopathological evaluation.

Results Visualization of resection margins by CLE proved successful for all considered oral, pharyngeal, endolaryngeal and endonasal tumors including malignancies of skullbase. Increased production of mucus and saliva as well as peritumoral hemorrhages were limiting factors for image quality and thus for assessability.

We were able to demonstrate a high correlation of histologic results with resection margins identified as tumor-free via CLE.

Conclusion The results of this study demonstrate the versatile applicability of CLE in head and neck surgery. The possibility of real-time intraoperative cellular visualization and validation of the macroscopic resection margins could perspectively avoid excessive resections and thus enable maximum preservation of healthy tissue in terms of function.

Stiftung Tumorforschung Kopf-Hals

Publication History

Article published online:
24 May 2022