Jerjes_edit.qxp 22/10/08 2:44 pm Page 58
Head and Neck Cancer
Figure 1: Swept-source Fourier-domain Optical Coherence Figure 4: Hyperkeratosis with Lichenoid Reaction of the Lateral
Tomography Provided by Michelson Diagnostics (left), Sample Border of the Tongue Illustrated by Optical Coherence
Arm Scanning Laser and a Digital Camera (top right) and Tomography (top) and Conventional Histology (bottom)
Manually Adjustable Stage to Facilitate Scanning of the Tissue
Sample (bottom right)
Figure 2: Speckled Erythroplakia of the Dorsal Tongue, Strongly
Suggestive of Oral Cancer
H+E x 20 magnification. Optical coherence tomography (OCT) shows thickening of the
keratin layer, associated with epithelial hyperplasia and focal thickening of the basement
membrane. These features corresponded to conventional histology images.
BM = basement membrane; KL = keratin layer; LP = lamina propria; SSE = stratified
squamous epithelium.
Figure 3: Optical Coherence Tomography Image of the Ventral
microendoscopy, elastic scattering spectroscopy and optical
Surface of the Tongue coherence tomography.
1–8,14–16
Elastic scattering spectroscopy (ESS)
has proved to be a promising method for detecting pre-malignant and
malignant changes in oral tissues with high sensitivity and specificity.
Several head and neck tissues, including lymph nodes and bones,
have been interrogated using ESS, which detects changes at the
cellular and subcellular level, with very promising results.
2,5–7
Fluorescence spectroscopy, unlike ESS, can identify changes through
the fluorophores detected in the tissue, and has been found to be
very accurate in detecting oral dysplasia.
4
Raman spectroscopy can
detect biochemical changes in tissue, but it has limited clinical
applications due to its weak signal. The first application of
microendoscopy in the head and neck was described by Upile et al. at
University College Hospital, London: resected tumour margins were
examined and the results were impressive; however, a fundamental
The area in the box shows a focal disruption of the surface keratin layer and mild thinning
(atrophy) of the epithelium. understanding of histopathology is essential for achieving a high
BM = basement membrane; BV = blood vessel; GD = glandular duct; LP = lamina propria;
SSE = stratified squamous epithelium.
sensitivity and specificity.
8
trauma and the workload of already strained pathology departments Optical Coherence Tomography
and services.
1–3
Optical coherence tomography (OCT), first applied in 1991 by Huang
et al., is a non-invasive, interferometric (superimposing or interfering
Optical biopsies can be acquired through different modalities; each waves) tomographic imaging modality that allows millimetre
has its own mechanism of action and requires different modes of data penetration with micrometre-scale axial and lateral resolution. The
analysis. Several optical diagnostic techniques have been employed time-resolved technique is extensively used clinically in ophthalmology.
with variable success rates. The main techniques currently utilised in OCT has been applied in the head and neck in an attempt to detect
the detection of oral dysplasia are fluorescence, Raman spectroscopy, areas of inflammation, dysplasia and cancer; results were promising,
58 EUROPEAN ONCOLOGY
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84 |
Page 85 |
Page 86 |
Page 87 |
Page 88 |
Page 89 |
Page 90 |
Page 91 |
Page 92 |
Page 93 |
Page 94 |
Page 95 |
Page 96 |
Page 97 |
Page 98 |
Page 99