Peterson Gary, Zanoni Daniella Karassawa, Ardigo Marco, Migliacci Jocelyn C, Patel Snehal G, Rajadhyaksha Milind
Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York, 10022, USA.
Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, 10065, USA.
Lasers Surg Med. 2019 Jul;51(5):439-451. doi: 10.1002/lsm.23090. Epub 2019 May 8.
Reflectance confocal microscopy (RCM) is a developing approach for noninvasive detection of oral lesions with label-free contrast and cellular-level resolution. For access into the oral cavity, confocal microscopes are being configured with small-diameter telescopic probes and small objective lenses. However, a small probe and objective lens allows for a rather small field-of-view relative to the large areas of tissue that must be examined for diagnosis. To extend the field-of-view for intraoral RCM imaging, we are investigating a video-mosaicking approach.
A relay telescope and objective lens were adapted to an existing confocal microscope for access into the oral cavity. Imaging was performed using metal three-dimensional-printed objective lens front-end caps with coverslip windows to contact and stabilize the tissue and set depth. Four healthy volunteers (normal oral mucosa), one patient (with an amalgam tattoo) in a clinical setting, and 20 anesthetized patients (with oral squamous cell carcinoma [OSCC]) in a surgical setting were imaged. Instead of the usual still RCM images, videos were recorded and then processed into video-mosaics. Thirty video-mosaics were read and qualitatively assessed by an expert reader of RCM images of the oral mucosa.
Whereas the objective lens' native field-of-view is 0.75 mm × 0.75 mm, the video-mosaics display larger areas, ranging from 2 mm × 2 mm to 4 mm × 2 mm, with resolution, morphologic detail, and image quality that is preserved relative to that observed in the original videos (individual images). Video-mosaics in healthy volunteers' and the patients' images showed cellular morphologic patterns in the lower epithelium and at the epithelial junction, and connective tissue along with capillary loops and blood flow in the deeper lamina propria. In OSCC, tumor nests could be observed along with normal looking mucosa in margin areas.
Video-mosaicking is a reasonably quick and efficient approach for extending the field-of-view of RCM imaging, which can, to some extent, overcome the inherent limitation of an intraoral probe's small field-of-view. Reading video-mosaics can mimic the procedure for examining pathology: initial visualization of the spatial cellular and morphologic patterns of the tumor and the spread of tumor margins over larger areas of the lesion, followed by digitally zooming (magnifying) for closer inspection of suspicious areas. However, faster processing of videos into video-mosaics will be necessary, to allow examination of video-mosaics in real-time at the bedside. Lasers Surg. Med. 51:439-451, 2019. © 2019 Wiley Periodicals, Inc.
反射式共聚焦显微镜（RCM）是一种用于口腔病变无创检测的发展中的方法，具有无标记对比度和细胞水平分辨率。为了进入口腔，共聚焦显微镜配置了小直径的伸缩式探头和小物镜。然而，相对于为诊断必须检查的大面积组织而言，小探头和小物镜的视野相当小。为了扩展口腔内RCM成像的视野，我们正在研究一种视频拼接方法。
将一个中继望远镜和物镜适配到现有的共聚焦显微镜上以进入口腔。使用带有盖玻片窗口的金属三维打印物镜前端帽进行成像，以接触并稳定组织并设定深度。对4名健康志愿者（正常口腔黏膜）、1名临床环境中的患者（有汞合金纹身）以及20名手术环境中的麻醉患者（有口腔鳞状细胞癌[OSCC]）进行成像。记录的不是通常的静态RCM图像，而是视频，然后将其处理成视频拼接图像。由一名口腔黏膜RCM图像的专家读者读取30张视频拼接图像并进行定性评估。
物镜的原始视野为0.75毫米×0.75毫米，而视频拼接图像显示的区域更大，范围从2毫米×2毫米到4毫米×2毫米，其分辨率、形态细节和图像质量相对于原始视频（单个图像）中观察到的情况得以保留。健康志愿者和患者图像中的视频拼接图像显示了下上皮和上皮交界处的细胞形态模式，以及更深层固有层中的结缔组织、毛细血管袢和血流。在OSCC中，在边缘区域可以观察到肿瘤巢以及外观正常的黏膜。
视频拼接是扩展RCM成像视野的一种相当快速且有效的方法，它在一定程度上可以克服口腔内探头小视野的固有局限性。读取视频拼接图像可以模拟检查病理的过程：首先可视化肿瘤的空间细胞和形态模式以及肿瘤边缘在病变较大区域的扩散，然后进行数字变焦（放大）以更仔细地检查可疑区域。然而，需要更快地将视频处理成视频拼接图像，以便在床边实时检查视频拼接图像。激光外科医学。51:439 - 451，2019。©2019威利期刊公司。
