共聚焦激光内镜系统解读：喉及咽共聚焦成像评分。
Systematic interpretation of confocal laser endomicroscopy: larynx and pharynx confocal imaging score.
机构信息
Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, University Hospital, Erlangen, Germany.
Institute of Pathology, Friedrich-Alexander-Universität Erlangen-Nürnberg, University Hospital, Erlangen, Germany.
出版信息
Acta Otorhinolaryngol Ital. 2022 Feb;42(1):26-33. doi: 10.14639/0392-100X-N1643. Epub 2022 Feb 7.
OBJECTIVE
Development and validation of a confocal laser endomicroscopy (CLE) classification score for the larynx and pharynx.
METHODS
Thirteen patients (154 video sequences, 9240 images) with laryngeal or pharyngeal SCC were included in this prospective study between October 2020 and February 2021. Each CLE sequence was correlated with the gold standard of histopathological examination. Based on a dataset of 94 video sequences (5640 images), a scoring system was developed. In the remaining 60 sequences (3600 images), the score was validated by four CLE experts and four head and neck surgeons who were not familiar with CLE.
RESULTS
Tissue homogeneity, cell size, borders and clusters, capillary loops and the nucleus/cytoplasm ratio were defined as the scoring criteria. Using this score, the CLE experts obtained an accuracy, sensitivity, and specificity of 90.8%, 95.1%, and 86.4%, respectively, and the CLE non-experts of 86.2%, 86.4%, and 86.1%. Interobserver agreement Fleiss' kappa was 0.8 and 0.6, respectively.
CONCLUSIONS
CLE can be reliably evaluated based on defined and reproducible imaging features, which demonstrate a high diagnostic value. CLE can be easily integrated into the intraoperative setting and generate real-time, in-vivo microscopic images to demarcate malignant changes.
目的
开发和验证用于喉和咽部的共聚焦激光内窥镜（CLE）分类评分系统。
方法
本前瞻性研究纳入了 2020 年 10 月至 2021 年 2 月期间 13 名患有喉或咽部 SCC 的患者（154 个视频序列，9240 个图像）。每个 CLE 序列均与组织病理学检查的金标准相关联。基于 94 个视频序列（5640 个图像）的数据集，开发了评分系统。在其余 60 个序列（3600 个图像）中，由四位 CLE 专家和四位不熟悉 CLE 的头颈部外科医生对评分进行了验证。
结果
组织均匀性、细胞大小、边界和簇、毛细血管环以及核/细胞质比被定义为评分标准。使用该评分系统，CLE 专家的准确性、敏感性和特异性分别为 90.8%、95.1%和 86.4%，而 CLE 非专家的准确性、敏感性和特异性分别为 86.2%、86.4%和 86.1%。观察者间一致性 Fleiss' kappa 分别为 0.8 和 0.6。
结论
基于定义明确且可重复的成像特征，CLE 可以可靠地进行评估，其具有较高的诊断价值。CLE 可轻松集成到术中环境中，并生成实时、体内微观图像，以划定恶性变化的范围。
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