Endoscopic in vivo cellular imaging of superficial squamous cell carcinoma of the head and neck by using an integrated endocytoscopy system (with video)

BackgroundRecently, some patients have been found to have superficial squamous cell carcinoma (SCC) of the head and neck region during GI endoscopy; however, endoscopic biopsy from a lesion in the head and neck region is troublesome. An endocytoscopy system has been reported to enable optical biopsy of an esophageal lesion.ObjectiveTo evaluate the feasibility of in vivo cellular imaging with an integrated endocytoscopy system for patients with superficial SCC of the head and neck.DesignExperimental pilot study.SettingUniversity hospital.PatientsThis study involved 12 patients who were found to have superficial SCC of the head and neck during GI endoscopy.InterventionEndocytoscopic images were taken of each lesion and of the surrounding mucosa. The images were later reviewed by 1 pathologist and 2 endoscopists who were unaware of any other findings.Main Outcome MeasurementsCorrelation between endocytoscopy diagnosis and histologic diagnosis.ResultsAdequate endocytoscopic images could be obtained in 11 of the 12 patients (15 of 16 lesions). For endocytoscopic images of 15 lesions and 12 areas of surrounding mucosa, the overall accuracy of endocytoscopic diagnosis in differentiating between nonmalignant and malignant histopathology by the pathologist, endoscopist 1, and endoscopist 2 were 96%, 96%, and 96%, respectively. The kappa value for interobserver agreement was 0.77.LimitationsSingle-center experience, small number of patients.ConclusionAn endocytoscopy system has the potential to be used as an optical biopsy for superficial head and neck lesions.