% Encoding: UTF-8 @COMMENT{BibTeX export based on data in FAU CRIS: https://cris.fau.de/} @COMMENT{For any questions please write to cris-support@fau.de} @inproceedings{faucris.223037306, abstract = {The Er:YAG laser has gained significant interest in the field of oral surgery due to its high water absorptivity, precision and patient acceptance. However, its application is limited by the lack of a contact-free feedback system which would enable safe laser guidance. In this work, a potential new, robust feedback modality based on speckle-analysis is presented which detects the acoustic signals produced during laser surgery. Oral soft- and hard tissue samples are investigated ex-vivo for its differentiation capability using the speckle modality. This technique might help to broaden the clinical application of Er:YAG laser}, author = {Lengenfelder, Benjamin and Schwarzkopf, Karen and Oetter, Nicolai and Mehari, Fanuel and Eschner, Eric and Klämpfl, Florian and Stelzle, Florian and Kesting, Marco Rainer and Zalevsky, Zeev and Schmidt, Michael}, booktitle = {Opto-Acoustic Methods and Applications in Biophotonics IV; 110771L (2019)}, date = {2019-06-23/2019-06-27}, doi = {10.1117/12.2526578}, editor = {SPIE}, faupublication = {yes}, keywords = {Laser surgery; Er:YAG laser; tissue differentiation}, peerreviewed = {Yes}, title = {{Acoustic} differentiation of dental soft and hard tissues using remote speckle-analysis during {Er}:{YAG} ablation}, venue = {Munich}, year = {2019} } @article{faucris.121890164, abstract = {The use of remote optical feedback systems represents a promising approach for minimally invasive, nerve-sparing laser surgery. Autofluorescence properties can be exploited for a fast, robust identification of nervous tissue. With regard to the crucial step towards clinical application, the impact of laser ablation on optical properties in the vicinity of structures of the head and neck has not been investigated up to now. We acquired 24,298 autofluorescence spectra from 135 tissue samples (nine ex vivo tissue types from 15 bisected pig heads) both before and after ER:YAG laser ablation. Sensitivities, specificities, and area under curve(AUC) values for each tissue pair as well as the confusion matrix were statistically calculated for pre-ablation and post-ablation autofluorescence spectra using principal component analysis (PCA), quadratic discriminant analysis (QDA), and receiver operating characteristics (ROC). The confusion matrix indicated a highly successful tissue discrimination rate before laser exposure, with an average classification error of 5.2%. The clinically relevant tissue pairs nerve/cancellous bone and nerve/salivary gland yielded an AUC of 100% each. After laser ablation, tissue discrimination was feasible with an average classification accuracy of 92.1% (average classification error 7.9%). The identification of nerve versus cancellous bone and salivary gland performed very well with an AUC of 100 and 99%, respectively. Nerve-sparing laser surgery in the area of the head and neck by means of an autofluorescence-based feedback system is feasible even after ER-YAG laser-tissue interactions. These results represent a crucial step for the development of a clinically applicable feedback tool for laser surgery interventions in the oral and maxillofacial region.}, author = {Stelzle, Florian and Rohde, Maximilian and Riemann, Max and Oetter, Nicolai and Adler, Werner and Tangermann-Gerk, Katja and Schmidt, Michael and Knipfer, Christian}, doi = {10.1007/s10103-017-2240-8}, faupublication = {yes}, journal = {Lasers in Medical Science}, note = {EVALuna2:24433}, pages = {1289-1300}, peerreviewed = {Yes}, title = {{Autofluorescence} spectroscopy for nerve-sparing laser surgery of the head and neck-the influence of laser-tissue interaction}, volume = {32}, year = {2017} } @article{faucris.123289144, abstract = {Oral Squamous Cell Carcinoma (OSCC) is a common type of cancer of the oral epithelium. Despite their high impact on mortality, su cient screening methods for early diagnosis of OSCC often lack accuracy and thus OSCCs are mostly diagnosed at a late stage. Early detection and accurate outline estimation of OSCCs would lead to a better curative outcome and a reduction in recurrence rates after surgical treatment. Confocal Laser Endomicroscopy (CLE) records sub-surface micro-anatomical images for in vivo cell structure analysis. Recent CLE studies showed great prospects for a reliable, real-time ultrastructural imaging of OSCC in situ. We present and evaluate a novel automatic approach for OSCC diagnosis using deep learning technologies on CLE images. The method is compared against textural feature-based machine learning approaches that represent the current state of the art. For this work, CLE image sequences (7894 images) from patients diagnosed with OSCC were obtained from 4 speci c locations in the oral cavity, including the OSCC lesion. The present approach is found to outperform the state of the art in CLE image recognition with an area under the curve (AUC) of 0.96 and a mean accuracy of 88.3% (sensitivity 86.6%, speci city 90%).
}, author = {Aubreville, Marc and Knipfer, Christian and Oetter, Nicolai and Jaremenko, Christian and Rodner, Erik and Denzler, Joachim and Bohr, Christopher and Neumann, Helmut and Stelzle, Florian and Maier, Andreas}, doi = {10.1038/s41598-017-12320-8}, faupublication = {yes}, journal = {Scientific Reports}, keywords = {Cancer imaging, translational research, deep learning}, pages = {s41598-017}, peerreviewed = {Yes}, title = {{Automatic} {Classification} of {Cancerous} {Tissue} in {Laserendomicroscopy} {Images} of the {Oral} {Cavity} using {Deep} {Learning}}, url = {https://www.nature.com/articles/s41598-017-12320-8.pdf}, volume = {7}, year = {2017} } @inproceedings{faucris.111147124, abstract = {Confocal laser endomicroscopy is a recently introduced advanced imaging technique which enables microscopic imaging of the mucosa in-vivo. This technique has already been applied successfully during diagnosis of gastrointestinal diseases. Whereas for this purpose several computer aided diagnosis approaches exist, we present a classification system that is able to differentiate between healthy and pathological images of the oral cavity. Varying textural features of small rectangular regions are evaluated using random forests and support vector machines. Preliminary results reach up to 99.2% classification rate. This indicates that an automatic classification system to differentiate between healthy and pathological mucosa of the oral cavity is feasible.}, address = {Berlin Heidelberg}, author = {Jaremenko, Christian and Maier, Andreas and Steidl, Stefan and Hornegger, Joachim and Oetter, Nicolai and Knipfer, Christian and Stelzle, Florian and Neumann, Helmut}, booktitle = {Bildverarbeitung für die Medizin 2015}, date = {2015-03-15/2015-03-17}, doi = {10.1007/978-3-662-46224-9}, faupublication = {yes}, isbn = {9783662462232}, note = {UnivIS-Import:2017-12-18:Pub.2015.tech.IMMD.IMMD5.classi{\_}8}, pages = {479-485}, peerreviewed = {unknown}, publisher = {Springer}, title = {{Classification} of {Confocal} {Laser} {Endomicroscopic} {Images} of the {Oral} {Cavity} to {Distinguish} {Pathological} from {Healthy} {Tissue}}, url = {https://www5.informatik.uni-erlangen.de/Forschung/Publikationen/2015/Jaremenko15-COC.pdf}, venue = {Lübeck}, year = {2015} } @article{faucris.248085862, abstract = {Objective: Confocal laser endomicroscopy (CLE), with a magnification of up to 1000 ×, offers the possibility to visualize intercellular spaces in vivo. CLE has already established itself in different disciplines. This article gives an overview of the current research on CLE in the diagnosis of the head and neck squamous cell carcinoma. Material and methods: Material and methods: Systematic bibliographic research in the following online databases: PubMed, MEDLINE, Thompson Reuters Web of Science, SPIE using the following keywords: confocal laser endomicroscopy, CLE, endomicroscopy, head and neck, larynx. Evaluation of the scientific relevance according to defined criteria. Results: All studies were analyzed concerning the clinical application, clinical findings, and computer-aided data processing. Conclusions: The recently published data suggest that CLE has a high potential to improve the diagnosis of malignant mucosal lesions in the upper aerodigestive tract.}, author = {Sievert, Matti and Auberville, Marc and Oetter, Nicolai and Stelzle, Florian and Maier, Andreas and Mantsopoulos, Konstantinos and Iro, Heinrich and Goncalves, Miguel}, doi = {10.1055/a-1339-1635}, faupublication = {yes}, journal = {Laryngo-Rhino-Otologie}, keywords = {CLE; confocal laser endomicroscopy; head and neck malignancy; image analysis; laryngeal carcinoma}, note = {CRIS-Team Scopus Importer:2021-01-22}, peerreviewed = {Yes}, title = {{Confocal} laser endomicroscopy of head and neck squamous cell carcinoma: a systematic review {Konfokale} {Laser}-{Endomikroskopie} des {Kopf}-{Hals}-{Plattenepithelkarzinoms}: eine systematische {Übersicht}}, year = {2021} } @article{faucris.280323305, abstract = {BACKGROUND: Due to the SARS-CoV-2 pandemic and the accompanying contact restrictions, a new challenge arose for dental education. Despite the limited overall situation, it must be ensured that, in addition to theoretical content, practical skills in particular continue to be taught. Therefore, the aim of this study was to develop and implement an online hands-on course for dental students that ensures practical training, even during the pandemic. METHODS: The newly developed course was held from April 2020 to March 2021. A total of six groups (each consisting of approximately 40-50 students) took part in the course. The participating students were in their 3rd, 4th or 5th year of study. The course taught theoretical basics (via an online platform) and promoted the learning of practical/surgical techniques on models such as bananas, pork bellies, or chicken thighs with live demonstrations (via ZOOM) and interactive post-preparation by students at home (and in a rotating small group of 3-7 students on site). Student self-evaluation (at the beginning and end of the course) and course evaluation were performed using questionnaires. The learning success was analyzed (through self-evaluations) using Wilcoxon signed-rank tests (significance level alpha = 0.05). RESULTS: Concerning students´ self-evaluations, the theoretical knowledge, general surgical skills (such as surgical instrument handling), and specific surgical skills (such as performing a kite flap) improved during the course, with significant results (p < 0.001 for each). About 60% of the students rated the course overall as excellent (grades 9 or 10 on a Likert scale of 1 to 10). The technical implementation of the course was rated with a median of 9 (= very good, on a Likert scale of 1 to 10). 38.5% described the applicability of the skills learned for their later professional life as extremely good. CONCLUSIONS: The results of this work suggest that, within the limitations of this study, the introduced concept of an online hands-on course could be an appropriate form of teaching practical dental skills, even during a pandemic. Further research is needed in the field of digital education for dental students.}, author = {Oetter, Nicolai and Möst, Tobias and Weber, Manuel and Buchbender, Mayte and Rohde, Maximilian and Foerster, Yannick and Bauerschmitz, Charlotte and Röschmann, Nico and Adler, Werner and Rau, Andrea and Meyerolbersleben, Marion and Kesting, Marco Rainer and Lutz, Rainer}, doi = {10.1186/s12909-022-03638-7}, faupublication = {yes}, journal = {BMC Medical Education}, keywords = {Asynchronous; Coronavirus; Dentistry; Digital; Education; Pandemic; Synchronous}, note = {Created from Fastlane, Scopus look-up}, pages = {591-}, peerreviewed = {Yes}, title = {{COVID}-19 pandemic and its impact on dental education: digitalization - progress or regress? {Example} of an online hands-on course}, volume = {22}, year = {2022} } @article{faucris.211593961, abstract = {Probe-based confocal laser endomicroscopy (pCLE) is a subcellular in vivo imaging technique capable of producing images that enable diagnosis of malign structural modifications in epithelial tissue. Images acquired with pCLE are, however, often tainted by significant artifacts that impair diagnosis. This is especially detrimental for automated image analysis, which is why said images are often excluded from recognition pipelines.\nWe present an approach for the automatic detection of motion artifacts in pCLE images and apply this methodology to a data set of 15 thousand images of epithelial tissue acquired in the oral cavity and the vocal folds. The approach is based on transfer learning from intermediate endpoints within a pre-trained Inception v3 network with tailored preprocessing. For detection within the non-rectangular pCLE images, we perform pooling within the activation maps of the network and evaluate this at different network depths.\nWe achieved area under the ROC curve values of 0.92 with the proposed method, compared to 0.80 for the best feature-based machine learning approach. Our overall accuracy with the presented approach is 94.8%.\nOver traditional machine learning approaches with state-of-the-art features, we achieved significantly improved overall performance.\nPURPOSE\nMETHODS\nRESULTS\nCONCLUSION}, author = {Aubreville, Marc and Stöve, Maike and Oetter, Nicolai and Goncalves, Miguel and Knipfer, Christian and Neumann, Helmut and Bohr, Christopher and Stelzle, Florian and Maier, Andreas}, doi = {10.1007/s11548-018-1836-1}, faupublication = {yes}, journal = {International Journal of Computer Assisted Radiology and Surgery}, month = {Jan}, pages = {31-42}, peerreviewed = {Yes}, title = {{Deep} learning-based detection of motion artifacts in probe-based confocal laser endomicroscopy images.}, volume = {14}, year = {2019} } @article{faucris.287252441, abstract = {Purpose: Probe-based confocal laser endomicroscopy (pCLE) allows imaging of the laryngeal mucosa in a thousand-fold magnification. However, the existence of multiple nondiagnostic frames might hinder the performance of automated systems, especially in post-processing and analysis algorithms. This study aims to investigate the feasibility of building a baseline for the identification of diagnostic frames and to evaluate the influence of sequence information in this task. Materials and methods: We included eight patients with squamous cell carcinoma (SCC) and planned total laryngectomy between October 2020 and February 2021. One hundred frames were randomly selected out of 21,272 pCLE frames of the tumor and healthy mucosa during surgery. Three experts were asked to classify these frames into diagnostic and nondiagnostic ones with different subtypes under two settings, i.e., isolated frames or short video sequences. Inter-rater and intra-rater consistency were analyzed with Cohen's kappa coefficients. Results: Among all raters, regarding the classification of diagnostic frames, an average agreement of κ = 0.79 has been achieved. The overall consistency for the subtypes of nondiagnostic frames is κ = 0.75 and κ = 0.57, respectively. Conclusions: The high level of consistency regarding the identification of diagnostic frames shows the reliability of the classification results and builds the foundation for future automatic algorithms.}, author = {Pan, Zhaoya and Breininger, Katharina and Aubreville, Marc and Stelzle, Florian and Maier, Andreas and Oetter, Nicolai and Mantsopoulos, Konstantinos and Iro, Heinrich and Goncalves, Miguel and Sievert, Matti}, doi = {10.1016/j.amjoto.2022.103779}, faupublication = {yes}, journal = {American Journal of Otolaryngology}, keywords = {Classification system; Confocal laser endomicroscopy; Head and neck cancer; Larynx; Non-invasive histological imaging; Pharynx}, note = {CRIS-Team Scopus Importer:2023-01-06}, peerreviewed = {Yes}, title = {{Defining} a baseline identification of artifacts in confocal laser endomicroscopy in head and neck cancer imaging}, volume = {44}, year = {2023} } @article{faucris.106330224, abstract = {Confocal laser endomicroscopy (CLE) is an optical biopsy method allowing in vivo microscopic imaging at 1000-fold magnification. It was the aim to evaluate CLE in the human oral cavity for the differentiation of physiological/carcinomatous mucosa and to establish and validate, for the first time, a scoring system to facilitate CLE assessment.The study consisted of 4 phases: (1) CLE-imaging (in vivo) was performed after the intravenous injection of fluorescein in patients with histologically confirmed carcinomatous oral mucosa; (2) CLE-experts (n = 3) verified the applicability of CLE in the oral cavity for the differentiation between physiological and cancerous tissue compared to the gold standard of histopathological assessment; (3) based on specific patterns of tissue changes, CLE-experts (n = 3) developed a classification and scoring system (DOC-Score) to simplify the diagnosis of oral squamous cell carcinomas; (4) validation of the newly developed DOC-Score by non-CLE-experts (n = 3); final statistical evaluation of their classification performance (comparison to the results of CLE-experts and the histopathological analyses).Experts acquired and edited 45 sequences (260 s) of physiological and 50 sequences (518 s) of carcinomatous mucosa (total: 95 sequences/778 s). All sequences were evaluated independently by experts and non-experts (based on the newly proposed classification system). Sensitivity (0.953) and specificity (0.889) of the diagnoses by experts as well as sensitivity (0.973) and specificity (0.881) of the non-expert ratings correlated well with the results of the present gold standard of tissue histopathology. Experts had a positive predictive value (PPV) of 0.905 and a negative predictive value (NPV) of 0.945. Non-experts reached a PPV of 0.901 and a NPV of 0.967 with the help of the DOC-Score. Inter-rater reliability (Fleiss` kappa) was 0.73 for experts and 0.814 for non-experts. The intra-rater reliability (Cronbach's alpha) of the experts was 0.989 and 0.884 for non-experts.CLE is a suitable and valid method for experts to diagnose oral cancer. Using the DOC-Score system, an accurate chair-side diagnosis of oral cancer is feasible with comparable results to the gold standard of histopathology-even in daily clinical practice for non-experienced raters.}, author = {Oetter, Nicolai and Knipfer, Christian and Rohde, Maximilian and von Wilmowsky, Cornelius and Maier, Andreas and Brunner, Kathrin and Adler, Werner and Neukam, Friedrich Wilhelm and Neumann, Helmut and Stelzle, Florian}, doi = {10.1186/s12967-016-0919-4}, faupublication = {yes}, journal = {Journal of Translational Medicine}, note = {EVALuna2:2055}, pages = {159}, peerreviewed = {Yes}, title = {{Development} and validation of a classification and scoring system for the diagnosis of oral squamous cell carcinomas through confocal laser endomicroscopy}, volume = {14}, year = {2016} } @article{faucris.248374069, abstract = {Objective: This pilot study aimed to assess the feasibility of intraoperative assessment of safe margins with Confocal Laser Endomicroscopy (CLE) during planned partial or total laryngectomy. Methods: Eight patients with confirmed larynx squamous cell carcinoma (SCC) and planned partial or total laryngectomy were included in this study in March 2020. Two head and neck surgeons and one pathologist were asked to classify carcinoma or healthy epithelium in a sample of 94 representative sequences (5.640 images), blinded to the histological results (H&E staining). Results: Healthy mucosa areas showed epithelium with cells of uniform size and shape with distinct cytoplasmic membranes and regular vessel architecture. CLE optical biopsy of SCC demonstrated a disorganized arrangement of variable cellular morphology. We calculated an accuracy, sensitivity, specificity, PPV, and NPV of 80.1%, 72.3%, 87.9%, 85.7%, and 76.1%, respectively. A distinct transition between healthy appearing tissue and suspicious lesions could also be detected. Conclusion: CLE can be easily integrated into the intraoperative setting, generate real-time, in-vivo microscopic images of the larynx for evaluation and demarcation of cancer. If validated in further studies, CLE could eventually contribute to a less radical approach by enabling a more precise evaluation of the cancer margin.}, author = {Sievert, Matti and Oetter, Nicolai and Aubreville, Marc and Stelzle, Florian and Maier, Andreas and Eckstein, Markus and Mantsopoulos, Konstantinos and Gostian, Antoniu Oreste and Mueller, Sarina K. and Koch, Michael and Agaimy, Abbas and Iro, Heinrich and Goncalves, Miguel}, doi = {10.1016/j.anl.2021.01.005}, faupublication = {yes}, journal = {Auris Nasus Larynx}, keywords = {Confocal laser endomicroscopy; Laryngeal cancer; Safe surgical margins}, note = {CRIS-Team Scopus Importer:2021-01-29}, peerreviewed = {Yes}, title = {{Feasibility} of intraoperative assessment of safe surgical margins during laryngectomy with confocal laser endomicroscopy: {A} pilot study}, year = {2021} } @article{faucris.111685684, abstract = {While the oral health-related quality of life (OHRQoL) is known to be reduced in patients with cleft lip and palate (CLP), its inter-dependency with the soft tissue characteristics of the CLP area remains unclear. This study aimed to evaluate the soft tissue characteristics in the treated cleft area in order to investigate whether gingival esthetics correlate with OHRQoL. Thirty-six patients with unilateral or bilateral CLP (46 cleft areas) were investigated after secondary/tertiary alveolar bone grafting and orthodontic/prosthetic implant treatment using an adapted score to rate gingival esthetics (clinical esthetic score, CES). The patient's OHRQoL was determined using the German short version of the Oral Health Impact Profile questionnaire (OHIP-G14). The results showed a significantly better rating in patients with their own teeth in situ (12.05±1.10) than in patients with implants (6.95±4.78) or prosthetics (4.00±3.58). The best OHRQoL values were achieved by patients with their own teeth integrated into the cleft area (1.32±2.31), followed by patients with implants (2.33±2.33) and prosthetics (3.75±5.87). A significant (P=0.017) correlation was found between OHIP-G14 and CES scores, suggesting an increased OHRQoL in cases with higher oral esthetics in the cleft area. The therapeutic strategy contributes to both gingival esthetics and OHRQoL. The patient's subjective perception of OHRQoL can be attributed to objective gingival esthetic ratings.}, author = {Stelzle, Florian and Rohde, Maximilian and Oetter, Nicolai and Krug, K. and Riemann, Max and Adler, Werner and Neukam, Friedrich Wilhelm and Knipfer, Christian}, doi = {10.1016/j.ijom.2017.03.020}, faupublication = {yes}, journal = {International Journal of Oral and Maxillofacial Surgery}, note = {EVALuna2:24436}, pages = {993-999}, peerreviewed = {Yes}, title = {{Gingival} esthetics and oral health-related quality of life in patients with cleft lip and palate}, volume = {46}, year = {2017} } @article{faucris.261847047, abstract = {Purpose Confocal laser endomicroscopy (CLE) allows surface imaging of the laryngeal and pharyngeal mucosa in vivo at a thousand-fold magnification. This study aims to compare irregular blood vessels and intraepithelial capillary loops in healthy mucosa and squamous cell carcinoma (SCC) via CLE.}, author = {Sievert, Matti and Eckstein, Markus and Mantsopoulos, Konstantinos and Mueller, Sarina K. and Stelzle, Florian and Aubreville, Marc and Oetter, Nicolai and Maier, Andreas and Iro, Heinrich and Goncalves, Miguel}, doi = {10.1007/s00405-021-06954-8}, faupublication = {yes}, journal = {European Archives of Oto-Rhino-Laryngology}, note = {CRIS-Team WoS Importer:2021-07-23}, peerreviewed = {Yes}, title = {{Impact} of intraepithelial capillary loops and atypical vessels in confocal laser endomicroscopy for the diagnosis of laryngeal and hypopharyngeal squamous cell carcinoma}, year = {2021} } @article{faucris.251050005, abstract = {Purpose: This pilot study aimed to assess the feasibility of intraoperative assessment of safe margins with confocal laser endomicroscopy (CLE) during oropharyngeal squamous cell carcinoma (OPSCC) surgery. Methods: We included five consecutive patients confirmed OPSCC and planned tumor resection in September and October 2020. Healthy appearing mucosa in the marginal zone, and the tumor margin, were examined with CLE and biopsy during tumor resection. A total of 12,809 CLE frames were correlated with the gold standard of hematoxylin and eosin staining. Three head and neck surgeons and one pathologist were asked to identify carcinoma in a sample of 169 representative images, blinded to the histological results. Results: Healthy mucosa showed epithelium with uniform size and shape with distinct cytoplasmic membranes and regular vessel architecture. CLE optical biopsy of OPSCC demonstrated a disorganized arrangement of variable cellular morphology. We calculated an accuracy, sensitivity, specificity, PPV, and NPV of 86%, 90%, 79%, 88%, and 82%, respectively, with inter-rater reliability and κ-value of 0.60. Conclusion: CLE can be easily integrated into the intraoperative setting, generate real-time, in-vivo microscopic images of the oropharynx for evaluation and demarcation of cancer. It can eventually contribute to a less radical approach by enabling a more precise evaluation of the cancer margin.}, author = {Sievert, Matti and Stelzle, Florian and Aubreville, Marc and Mueller, Sarina K. and Eckstein, Markus and Oetter, Nicolai and Maier, Andreas and Mantsopoulos, Konstantinos and Iro, Heinrich and Goncalves, Miguel}, doi = {10.1007/s00405-021-06659-y}, faupublication = {yes}, journal = {European Archives of Oto-Rhino-Laryngology}, keywords = {Confocal laser endomicroscopy; Head and neck malignancies; Oropharyngeal squamous cell carcinoma; Safe surgical margins}, note = {CRIS-Team Scopus Importer:2021-03-05}, peerreviewed = {Yes}, title = {{Intraoperative} free margins assessment of oropharyngeal squamous cell carcinoma with confocal laser endomicroscopy: a pilot study}, year = {2021} } @article{faucris.211796216, abstract = {BACKGROUND: Local anesthesia is an important skill and a prerequisite for most dental treatments. However, the step from theory to application on the patient is huge for the novice. Hence, a mannequin training model course was developed and implemented into the existing local anesthesia curriculum in undergraduate dental students. It was the aim of this study to evaluate the relation between training-model and real-life anesthesia performance and to measure whether a gain in skill on the model translates to the actual patient situation. METHODS: Thirty-six third-year students (14 males, 22 females, age 24 years±2.98) attended the four-day course comprising each 4 h of lectures and practical training. The student cohort gave subjective ratings about the didactical components of the course after attendance by using the TRIL questionnaire (TRIL-mod; University of Trier). At the end of the course the performance of each student in administering an inferior alveolar nerve (IAN) block on the training model as well as on a fellow dental student was investigated using a standardized checklist. To evaluate the successful performance, the in vivo IAN-block was assessed using subjective patient-feeling, the sharp-blunt test and an objective pain- and thermal sensitivity tester (PATH). RESULTS: The course was rated with an average score of 5.25 ± 0.44 (range 1-6; 6 = best). On the training model, 69.4% of the students successfully performed an IAN-block. The in vivo assessment, objectified by the PATH test, showed a successful anesthesia in 36.9% of the cases. The assessment of local anesthesia by using the sharp blunt test and the subjective patient feeling significantly correlated with these findings (k = 0.453-0.751, p < 0.05). The model performance did not correlate with the performance on the patient (k = 0.137, p = 0.198). CONCLUSIONS: Although subjective ratings of the course were high, the anesthesia success rate on mannequin models did not imply an equal performance on the in vivo setting. As local anesthesia training models are a valuable didactic complement, the focus of the training should be on to the actual real life situation. Chair side feedback should be offered to the students using one of the presented evaluation methods.}, author = {Knipfer, Christian and Rohde, Maximilian and Oetter, Nicolai and Muench, Tim and Kesting, Marco Rainer and Stelzle, Florian}, doi = {10.1186/s12909-018-1389-6}, faupublication = {yes}, journal = {Bmc Medical Education}, note = {EVALuna2:35693}, peerreviewed = {Yes}, title = {{Local} anaesthesia training for undergraduate students - how big is the step from model to man?}, volume = {18}, year = {2018} } @article{faucris.119428804, abstract = {Complete maxillary edentulism and prosthetic rehabilitation with removable full dentures are known to affect speech intelligibility. The aim of this study was to prospectively investigate the long-term effect of time on speech intelligibility in patients being rehabilitated with newly fabricated full maxillary dentures.Speech was recorded in a group of 14 patients (male = 9, female = 5; mean age ± standard deviation [SD] = 66.14 ± 7.03 years) five times within a mean period of 4 years (mean ± SD: 47.50 ± 18.16 months; minimum/maximum: 24/68 months) and in a control group of 40 persons with healthy dentition (male = 30, female = 10; mean age ± SD = 59 ± 12 years). All 14 participants had their inadequate removable full maxillary dentures replaced with newly fabricated dentures. Speech intelligibility was measured by means of a polyphone-based speech recognition system that automatically computed the percentage of accurately spoken words (word accuracy [WA]) at five different points in time: 1 week prior to prosthetic maxillary rehabilitation (both with and without inadequate dentures in situ) and at 1 week, 6 months, and a mean of 48 months after the insertion of newly fabricated full maxillary dentures.Speech intelligibility of the patients significantly improved after 6 months of adaptation to the new removable full maxillary dentures (WA = 66.93% ± 9.21%) compared to inadequate dentures in situ (WA = 60.12% ± 10.48%). After this period, no further significant change in speech intelligibility was observed. After 1 week of adaptation, speech intelligibility of the rehabilitated patients aligned with that of the control group (WA = 69.79% ± 10.60%) and remained at this level during the examination period of 48 months.The provision of new removable full maxillary dentures can improve speech intelligibility to the level of a healthy control group on a long-term basis.}, author = {Stelzle, Florian and Riemann, Max and Klein, Alfred and Oetter, Nicolai and Rohde, Maximilian and Maier, Andreas and Eitner, Stephan and Neukam, Friedrich Wilhelm and Knipfer, Christian}, doi = {10.11607/ijp.5239}, faupublication = {yes}, journal = {International Journal of Prosthodontics}, note = {EVALuna2:24437}, pages = {419-425}, peerreviewed = {Yes}, title = {{Long}-term {Outcome} of {Speech} {Intelligibility} in {Maxillary} {Dental} {Rehabilitation} with {Full} {Dentures}: {A} {Prospective} {Study} {Using} {Automatic} {Speech} {Quantification}}, volume = {30}, year = {2017} } @inproceedings{faucris.203853940, address = {Berlin, Heidelberg}, author = {Stöve, Maike and Aubreville, Marc and Oetter, Nicolai and Knipfer, Christian and Neumann, Helmut and Stelzle, Florian and Maier, Andreas}, booktitle = {Bildverarbeitung für die Medizin 2018. Informatik aktuell.}, date = {2018-03-11/2018-03-13}, doi = {10.1007/978-3-662-56537-7{\_}85}, edition = {1}, faupublication = {yes}, isbn = {978-3-662-56536-0}, note = {UnivIS-Import:2018-09-11:Pub.2018.tech.IMMD.IMMD5.motion}, pages = {328-333}, peerreviewed = {Yes}, publisher = {Springer Vieweg, Berlin, Heidelberg}, title = {{Motion} {Artifact} {Detection} in {Confocal} {Laser} {Endomicroscopy} {Images}}, url = {https://www5.informatik.uni-erlangen.de/Forschung/Publikationen/2018/Stoeve18-MAD.pdf}, venue = {Erlangen, Germany}, year = {2018} } @article{faucris.250574752, abstract = {Oral squamous cell carcinoma (OSCC) is one of the most prevalent cancers and frequently preceded by non-malignant lesions. Using Shifted-Excitation Raman Difference Spectroscopy (SERDS), principal component and linear discriminant analysis in native tissue specimens, 9500 raw Raman spectra of OSCC, 4300 of non-malignant lesions and 4200 of physiological mucosa were evaluated. Non-malignant lesions were distinguished from physiological mucosa with a classification accuracy of 95.3% (95.4% sensitivity, 95.2% specificity, area under the curve (AUC) 0.99). Discriminating OSCC from non-malignant lesions showed an accuracy of 88.4% (93.7% sensitivity, 76.7% specificity, AUC 0.93). OSCC was identified against physiological mucosa with an accuracy of 89.8% (93.7% sensitivity, 81.0% specificity, AUC 0.90). These findings underline the potential of SERDS for the diagnosis of oral cavity lesions.}, author = {Matthies, Levi and Gebrekidan, Medhanie and Tegtmeyer, Jasper F. and Oetter, Nicolai and Rohde, Maximilian and Vollkommer, Tobias and Smeets, Ralf and Wilczak, Waldemar and Stelzle, Florian and Gosau, Martin and Braeuer, Andreas S. and Knipfer, Christian}, doi = {10.1364/BOE.409456}, faupublication = {yes}, journal = {Biomedical Optics Express}, note = {CRIS-Team Scopus Importer:2021-02-26}, pages = {836-851}, peerreviewed = {Yes}, title = {{Optical} diagnosis of oral cavity lesions by label-free {Raman} spectroscopy}, volume = {12}, year = {2021} } @article{faucris.117662864, abstract = {Prospective speech intelligibility assessments lack objectivity in patients undergoing surgery for oral squamous cell carcinoma (OSCC) of the tongue.Speech intelligibility was measured based on word recognition by means of an automatic and objective speech recognition system preoperatively, and 14 to 20 days, and 3 months, 6 months, and 12 months postoperatively. The study comprised 25 patients with OSCC of the tongue and a healthy control group (n = 40).Patients yielded significant speech impairments compared to the healthy control group both before surgery and after 12 months (p <= .002). The speech intelligibility of the patients decreased significantly 14 to 20 days after surgery (p < .001) but realigned to preoperative values after 12 months (p = .159). Preservation of the tip of the tongue resulted in significantly higher word recognition after 12 months (p = .007; ?word recognition = 16.29).Having OSSC of the tongue results in a significant impairment of speech intelligibility. The preservation of the tip of the tongue seems to be a central factor concerning the recovery of speech. © 2015 Wiley Periodicals, Inc. Head Neck, 2015.}, author = {Riemann, Max and Knipfer, Christian and Rohde, Maximilian and Adler, Werner and Schuster, Maria and Nöth, Elmar and Oetter, Nicolai and Shams, Nima and Neukam, Friedrich Wilhelm and Stelzle, Florian}, doi = {10.1002/hed.23994}, faupublication = {yes}, journal = {Head and Neck-Journal For the Sciences and Specialties of the Head and Neck}, note = {EVALuna2:5479}, peerreviewed = {Yes}, title = {{Oral} squamous cell carcinoma of the tongue: {Prospective} and objective speech evaluation of patients undergoing surgical therapy}, year = {2014} } @inproceedings{faucris.106699604, abstract = {Deep learning technologies such as convolutional neural networks (CNN) provide powerful methods for image recognition and have recently been employed in the field of automated carcinoma detection in confocal laser endomicroscopy (CLE) images. CLE is a (sub-)surface microscopic imaging technique that reaches magnifications of up to 1000x and is thus suitable for in vivo structural tissue analysis. In this work, we aim to evaluate the prospects of a priorly developed deep learning-based algorithm targeted at the identification of oral squamous cell carcinoma with regard to its generalization to further anatomic locations of squamous cell carcinomas in the area of head and neck. We applied the algorithm on images acquired from the vocal fold area of five patients with histologically verified squamous cell carcinoma and presumably healthy control images of the clinically normal contra-lateral vocal cord. We find that the network trained on the oral cavity data reaches an accura}, author = {Aubreville, Marc and Goncalves, Miguel and Knipfer, Christian and Oetter, Nicolai and Würfl, Tobias and Neumann, Helmut and Stelzle, Florian and Bohr, Christopher and Maier, Andreas}, booktitle = {Proceedings of the 11th International Joint Conference on Biomedical Engineering Systems and Technologies (BIOSTEC 2018)}, date = {2018-01-19/2018-01-21}, doi = {10.5220/0006534700270034}, editor = {Sheldon Wiebe, Hugo Gamboa,Ana Fred, Sergi Bermúdez i Badia}, faupublication = {yes}, isbn = {978-989-758-278-3}, month = {Jan}, pages = {27-34}, peerreviewed = {Yes}, publisher = {SCITEPRESS – Science and Technology Publications, Lda}, title = {{Patch}-based {Carcinoma} {Detection} on {Confocal} {Laser} {Endomicroscopy} {Images} - {A} {Cross}-{Site} {Robustness} {Assessment}}, url = {http://www.scitepress.org/DigitalLibrary/Link.aspx?doi=10.5220/0006534700270034}, venue = {Funchal}, year = {2018} } @article{faucris.215446560, abstract = {Background This study seeks to identify those factors that influence the pre-therapeutic speech intelligibility in patients with oral squamous cell carcinoma (OSCC).}, author = {Stelzle, Florian and Oetter, Nicolai and Göllner, Luisa and Adler, Werner and Rohde, Maximilian and Maier, Andreas and Matthies, Levi and Kesting, Marco Rainer and Knipfer, Christian}, doi = {10.1002/hed.25527}, faupublication = {yes}, journal = {Head and Neck-Journal For the Sciences and Specialties of the Head and Neck}, note = {CRIS-Team WoS Importer:2019-04-04}, pages = {1063-1069}, peerreviewed = {Yes}, title = {{Speech} intelligibility in patients with oral cancer: {An} objective baseline evaluation of pretreatment function and impairment}, volume = {41}, year = {2019} } @article{faucris.280340731, abstract = {Introduction: Confocal laser endomicroscopy (CLE) is an optical imaging technique that allows in vivo microscope-like images of the upper aerodigestive tract's mucosa in 1000-fold magnification. The assessment of morphological tissue characteristics for the correct differentiation between healthy and malignoma suspected mucosa requires strict evaluation criteria. This study aims to validate a score for oral cavity squamous cell carcinoma (OCSCC) diagnostic. Methods: We performed CLE and examined a total of twelve patients. All 95 sequences (778 s, 6224 images) originate from the area of the primary tumor 260 s, 2080 images) and unsuspicious mucosa of the oral cavity (518 s, 4144 images). Specimen were taken at corresponding locations and analyzed histologically in H&E staining as a reference standard. A total of eight examiners (four experienced and four inexperienced) evaluated the sequences based on a scoring system. The primary endpoints are sensitivity, specificity, and accuracy. Secondary endpoints are inter-rater reliability and receiver operator characteristics. Results: Healthy mucosa showed epithelium with uniform size and shape with distinct cytoplasmic membranes and regular vessel architecture. CLE of malignant cells demonstrated a disorganized arrangement of variable cellular morphology. We calculated an accuracy, sensitivity, specificity, PPV, and NPV of 88.7 %, 90.1 %, 87.4 %, 87.5 %, and 90.0 %, respectively, with inter-rater reliability and κ-value of 0.775, and an area under the curve of 0.935. Conclusions: The results confirm that this scoring system is applicable in the oral cavity mucosa to classify benign and malignant tissue.}, author = {Sievert, Matti and Oetter, Nicolai and Mantsopoulos, Konstantinos and Gostian, Antoniu-Oreste and Mueller, Sarina K. and Koch, Michael and Thimsen, Vivian and Stelzle, Florian and Eckstein, Markus and Iro, Heinrich and Goncalves, Miguel and Balk, Matthias}, doi = {10.1016/j.oraloncology.2022.105978}, faupublication = {yes}, journal = {Oral Oncology}, keywords = {Carcinoma, Squamous cell/diagnosis; Confocal laser endomicroscopy; Early detection of cancer*; Endoscopy; Fluorescence; Fluorescent dyes; Head and neck cancer; Head and neck neoplasms/diagnosis; Head and neck neoplasms/pathology*; Humans; Lasers; Margins of excision; Microscopy, Confocal/methods*; Mouth neoplasms*/diagnosis; Optical biopsy; Oral cavity squamous cell carcinoma; Safe surgical margins}, note = {CRIS-Team Scopus Importer:2022-08-12}, peerreviewed = {Yes}, title = {{Systematic} classification of confocal laser endomicroscopy for the diagnosis of oral cavity carcinoma}, volume = {132}, year = {2022} } @article{faucris.271376573, abstract = {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 phar-yngeal SCC were included in this prospective study between October 2020 and February 2021. Each CLE sequence was correlated with the gold standard of histopathological ex-amination. 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 nu-cleus/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.}, author = {Sievert, Matti and Mantsopoulos, Konstantinos and Müller-Hübner, Sarina and Eckstein, Markus and Rupp, Robin and Aubreville, Marc and Stelzle, Florian and Oetter, Nicolai and Maier, Andreas and Iro, Heinrich and Goncalves, Miguel}, doi = {10.14639/0392-100X-N1643}, faupublication = {yes}, journal = {Acta Otorhinolaryngologica Italica}, keywords = {Classification system; Confocal laser endomicroscopy; Head and neck cancer; Larynx; Non-invasive histological imaging; Pharynx}, note = {CRIS-Team Scopus Importer:2022-03-25}, pages = {26-33}, peerreviewed = {Yes}, title = {{Systematic} interpretation of confocal laser endomicroscopy: larynx and pharynx confocal imaging score {Interpretazione} sistematica dell’endomicroscopia confocale laser: punteggio endomicroscopico confocale laringeo e faringeo}, volume = {42}, year = {2022} } @article{faucris.259304696, abstract = {Free flap monitoring and early detection of malperfusion are a central aspect in reconstructive surgery. Warm ischemia, measured as the time a certain tissue is able to survive without any additional medical or thermal treatment, ranges from hours in muscle and nerval tissue up to days in bony tissue. Hence, meticulous flap monitoring is essential to discover early signs of malperfusion and decide upon timely re-intervention. Besides clinical examination techniques and Doppler sonography, a multitude of mostly experimental procedures are available to evaluate free flap perfusion. Particularly in older patients, the assessment of the skin island in microvascular grafts is a demanding task because the natural loss of elasticity, the reduction of subcutaneous tissue, and the decrease in water content limit the visibility of capillary filling and favor hematomas. We report a case of a 90-year-old woman with an extensive cutaneous squamous cell carcinoma of the right zygomatic and lateral orbital region without any locoregional or distant metastasis. Due to the resilient health status, we decided for a surgical approach with consecutive microvascular radial forearm flap reconstruction. On account of the difficult assessment of elderly skin after microvascular transplantation, we decided on additional flap monitoring by thermal heat imaging during the operation and aftercare. This case report discusses the successful application of thermal heat imaging in a clinical non-assessable free flap and discusses the application of dynamic infrared thermography as a monitoring tool in microvascular free flap surgery.}, author = {Frohwitter, Gesche and Nobis, Christopher-Philipp and Weber, Manuel and Oetter, Nicolai and Rau, Andrea and Kesting, Marco Rainer and Lutz, Rainer}, doi = {10.1097/GOX.0000000000003440}, faupublication = {yes}, journal = {Plastic and Reconstructive Surgery Global Open}, note = {CRIS-Team WoS Importer:2021-05-28}, peerreviewed = {Yes}, title = {{Thermal} {Imaging} in a {Clinically} {Non}-assessable {Free} {Flap} {Reconstruction} of the {Face}}, volume = {9}, year = {2021} } @article{faucris.286684849, abstract = {Laser surgery provides a number of advantages over conventional surgery. However, it implies large risks for sensitive tissue structures due to its characteristic non-tissue-specific ablation. The present study investigates the discrimination of nine different ex vivo tissue types by using uncorrected (raw) autofluorescence spectra for the development of a remote feedback control system for tissue-selective laser surgery. Autofluorescence spectra (excitation wavelength 377 ± 50 nm) were measured from nine different ex vivo tissue types, obtained from 15 domestic pig cadavers. For data analysis, a wavelength range between 450 nm and 650 nm was investigated. Principal Component Analysis (PCA) and Quadratic Discriminant Analysis (QDA) were used to discriminate the tissue types. ROC analysis showed that PCA, followed by QDA, could differentiate all investigated tissue types with AUC results between 1.00 and 0.97. Sensitivity reached values between 93% and 100% and specificity values between 94% and 100%. This ex vivo study shows a high differentiation potential for physiological tissue types when performing autofluorescence spectroscopy followed by PCA and QDA. The uncorrected autofluorescence spectra are suitable for reliable tissue discrimination and have a high potential to meet the challenges necessary for an optical feedback system for tissue-specific laser surgery. © 2013 by the authors; licensee MDPI, Basel, Switzerland.}, author = {Stelzle, Florian and Knipfer, Christian and Adler, Werner and Rohde, Maximilian and Oetter, Nicolai and Nkenke, Emeka and Schmidt, Michael and Tangermann-Gerk, Katja}, doi = {10.3390/s131013717}, faupublication = {yes}, journal = {Sensors}, keywords = {Autofluorescence; Fluorescence; Laser ablation; Laser surgery guidance; Remote optical measurement; Remote surgical methods; Spectra analysis}, note = {Created from Fastlane, Scopus look-up}, pages = {13717-13731}, peerreviewed = {Yes}, title = {{Tissue} discrimination by uncorrected autofluorescence spectra: {A} proof-of-principle study for tissue-specific laser surgery}, volume = {13}, year = {2013} } @inproceedings{faucris.226673543, abstract = {Squamous Cell Carcinoma (SCC) is the most common cancer type of the epithelium and is often detected at a late stage. Besides invasive diagnosis of SCC by means of biopsy and histo-pathologic assessment, Confocal Laser Endomicroscopy (CLE) has emerged as noninvasive method that was successfully used to diagnose SCC in vivo. For interpretation of CLE images, however, extensive training is required, which limits its applicability and use in clinical practice of the method. To aid diagnosis of SCC in a broader scope, automatic detection methods have been proposed. This work compares two methods with regard to their applicability in a transfer learning sense, i.e. training on one tissue type (from one clinical team) and applying the learnt classification system to another entity (different anatomy, different clinical team). Besides a previously proposed, patch-based method based on convolutional neural networks, a novel classification method on image level (based on a pre-trained Inception V.3 network with dedicated preprocessing and interpretation of class activation maps) is proposed and evaluated. The newly presented approach improves recognition performance, yielding accuracies of 91.63% on the first data set (oral cavity) and 92.63% on a joint data set. The generalization from oral cavity to the second data set (vocal folds) lead to similar area-under-the-ROC curve values than a direct training on the vocal folds data set, indicating good generalization.}, author = {Aubreville, Marc and Goncalves, Miguel and Knipfer, Christian and Oetter, Nicolai and Würfl, Tobias and Neumann, Helmut and Stelzle, Florian and Bohr, Christopher and Maier, Andreas}, booktitle = {Communications in Computer and Information Science}, date = {2018-01-19/2018-01-21}, doi = {10.1007/978-3-030-29196-9{\_}4}, editor = {Sergi Bermúdez i Badia, Alberto Cliquet, Sheldon Wiebe, Reyer Zwiggelaar, Paul Anderson, Ana Fred, Hugo Gamboa, Giovanni Saggio}, faupublication = {yes}, isbn = {9783030291952}, keywords = {Confocal Laser Endomicroscopy; Head and neck squamous cell carcinoma; Transfer learning}, note = {CRIS-Team Scopus Importer:2019-09-17}, pages = {67-85}, peerreviewed = {unknown}, publisher = {Springer Verlag}, title = {{Transferability} of {Deep} {Learning} {Algorithms} for {Malignancy} {Detection} in {Confocal} {Laser} {Endomicroscopy} {Images} from {Different} {Anatomical} {Locations} of the {Upper} {Gastrointestinal} {Tract}}, venue = {Funchal}, volume = {1024}, year = {2019} } @article{faucris.262677142, abstract = {Introduction: Confocal laser endomicroscopy is an optical imaging technique that allows in vivo, real-time, microscope-like images of the upper aerodigestive tract's mucosa. The assessment of morphological tissue characteristics for the correct differentiation between healthy and malignant suspected mucosa requires strict evaluation criteria. Objective: This study aims to validate an eight-point score for the correct assessment of malignancy. Methods: We performed confocal laser endomicroscopy between March and October 2020 in 13 patients. 197 sequences (11.820 images) originated from the marginal area of pharyngeal and laryngeal carcinomas. Specimens were taken at corresponding locations and analyzed in H&E staining as a standard of reference. A total of six examiners evaluated the sequences based on a scoring system; they were blinded to the histopathological examination. The primary endpoints are sensitivity, specificity, and accuracy. Secondary endpoints are interrater reliability and receiver operator characteristics. Results: Healthy mucosa showed epithelium with uniform size and shape with distinct cytoplasmic membranes and regular vessel architecture. Confocal laser endomicroscopy of malignant cells demonstrated a disorganized arrangement of variable cellular morphology. We calculated an accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of 83.2%, 81.3%, 85.5%, 86.7%, and 79.7%, respectively, with a κ-value of 0.64, and an area under the curve of 0.86. Conclusion: The results confirm that this scoring system is applicable in the laryngeal and pharyngeal mucosa to classify benign and malignant tissue. A scoring system based on defined and reproducible characteristics can help translate this experimental method to broad clinical practice in head and neck diagnosis.}, author = {Sievert, Matti and Mantsopoulos, Konstantinos and Müller-Hübner, Sarina and Rupp, Robin and Eckstein, Markus and Stelzle, Florian and Oetter, Nicolai and Maier, Andreas and Aubreville, Marc and Iro, Heinrich and Goncalves, Miguel}, doi = {10.1016/j.bjorl.2021.06.002}, faupublication = {yes}, journal = {Brazilian Journal of Otorhinolaryngology }, keywords = {Confocal laser endomicroscopy; Diagnosis; Head and neck cancer; Squamous cell carcinoma}, note = {CRIS-Team Scopus Importer:2021-08-13}, peerreviewed = {unknown}, title = {{Validation} of a classification and scoring system for the diagnosis of laryngeal and pharyngeal squamous cell carcinomas by confocal laser endomicroscopy}, year = {2021} } @article{faucris.271014982, abstract = {Purpose: Confocal laser endomicroscopy (CLE) allows imaging of the laryngeal mucosa in a thousand-fold magnification. This study analyzes differences in tissue homogeneity between healthy mucosa and squamous cell carcinoma (SCC) via CLE. Materials and methods: We included five SCC patients with planned total laryngectomy in this study between October 2020 and February 2021. We captured CLE scans of the tumor and healthy mucosa. Analysis of image homogeneity to diagnose SCC was performed by measuring the signal intensity in four regions of interest (ROI) in each frame in a total of 60 sequences. Each sequence was assigned to the corresponding histological pattern, derived from hematoxylin and eosin staining. In addition, we recorded the subjective evaluation of seven investigators regarding tissue homogeneity. Results: Out of 3600 images, 1620 (45%) correlated with benign mucosa and 1980 (55%) with SCC. ROIs of benign mucosa and SCC had a mean and standard deviation (SD) of signal intensity of, respectively, 232.1 ± 3.34 and 467.3 ± 9.72 (P < 0.001). The mean SD between the four different ROIs was 39.1 ± 1.03 for benign and 101.5 ± 2.6 for SCC frames (P < 0.001). In addition, homogeneity yielded a sensitivity and specificity of 81.8% and 86.2%, respectively, regarding the investigator-dependent analysis. Conclusions: SCC shows a significant tissue inhomogeneity in comparison to the healthy epithelium. The results support this feature’s importance in identifying malignant mucosa areas during CLE examination. However, the examiner-dependent evaluation emphasizes that homogeneity is a sub-criterion that must be considered in a broad context.}, author = {Sievert, Matti and Aubreville, Marc and Mantsopoulos, Konstantinos and Koch, Michael and Müller-Hübner, Sarina and Eckstein, Markus and Rupp, Robin and Stelzle, Florian and Oetter, Nicolai and Maier, Andreas and Iro, Heinrich and Goncalves, Miguel and Gostian, Antoniu-Oreste}, doi = {10.1007/s00405-022-07304-y}, faupublication = {yes}, journal = {European Archives of Oto-Rhino-Laryngology}, keywords = {Classification system; Confocal laser endomicroscopy; Head and neck cancer; Larynx; Non-invasive histological imaging; Pharynx}, note = {CRIS-Team Scopus Importer:2022-03-18}, peerreviewed = {Yes}, title = {{Validity} of tissue homogeneity in confocal laser endomicroscopy on the diagnosis of laryngeal and hypopharyngeal squamous cell carcinoma}, year = {2022} }