Früherkennung von Kopf-Hals-Tumoren

Andreas O. H. Gerstner

doi:10.1055/s-2007-995536

Laryngo-Rhino-Otologie, Table of Contents

Laryngorhinootologie 2008; 87: S1-S20
DOI: 10.1055/s-2007-995536

Früherkennung

Früherkennung von Kopf-Hals-Tumoren

Entwicklung, aktueller Stand und PerspektivenAndreas O. H. Gerstner¹

¹Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde/Chirurgie, Universitätsklinikum Bonn

Abstract

Zusammenfassung

Überleben und Lebensqualität bei den Krebserkrankungen im Kopf-Hals-Bereich hängen direkt von der Größe bei Erstdiagnose ab. Zusätzlich zur Primärprävention, bei der weitere Anstrengungen erforderlich sind, müssen die Möglichkeiten der Früherkennung verbessert werden. Allerdings fehlt es zum einen in Deutschland an der für ein erfolgreiches Screening erforderlichen Infrastruktur, zum anderen haben die bisher etablierten Untersuchungsverfahren eine zu niedrige Sensitivität und Spezifität. Die Fortschritte, die aktuell im Bereich der Endoskopietechnik, der Nachweismethoden und der Probengewinnung erzielt wurden, eröffnen jedoch Perspektiven im Bereich der Sekundärprävention. Mittels Chromoendoskopie und Narrowband Imaging können Schleimhautveränderungen leichter erkannt werden, mittels konfokaler Endomikroskopie und optischer Kohärenztomografie lassen sich optische „Schnitte” durch das Gewebe legen, und das hyperspektrale Imaging erlaubt eine Gewebsklassifikation anhand spektraler Signaturen. Diese Verfahren ermöglichen somit eine „optische Biopsie”. Auch die Palette der quantitativen und objektiven Parameter, die an minimal-invasiv gewonnenen Proben gemessen werden können, wurde größer und könnte die Grundlage für eine verlässliche Klassifikation der Schleimhautveränderungen sein (multiparametrische Zytometrie, quantitative Histologie). Schließlich könnten Ansätze der Proteomics und der Lab-on-the-Chip-Technologie eine bessere Identifikation der Hochrisikopatienten gewährleisten. Sensitivität und Spezifität all dieser Verfahren wurden jedoch noch nicht geprüft. Vor diesem Hintergrund und angesichts des ungeklärten Nutzen-Risiko-Verhältnisses sowohl für den Einzelnen als auch für die Solidargemeinschaft ist es jedoch bis zu einem Bevölkerungs-basierten Screeningprogramm noch ein weiter Weg.

Schlüsselwörter

Quantitative Histologie - Human Cytome Project - Hyperspectral Imaging - Optische Kohärenztomografie OCT

Full Text

References

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PD Dr. Andreas O. H. Gerstner

Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde/Chirurgie, Universitätsklinikum Bonn

Sigmund-Freud-Straße 25
53105 Bonn

Email: gerstaoh@web.de