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Am J Otolaryngol. 2018 Jul - Aug;39(4):383-387. doi: 10.1016/j.amjoto.2018.03.025. Epub 2018 Mar 20.

Optical imaging with a high-resolution microendoscope to identify sinonasal pathology.

Author information

1
Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States. Electronic address: sarah.kidwai@mountsinai.org.
2
Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
3
Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
4
Department of Bioengineering, Rice University, Houston, TX, United States.

Abstract

OBJECTIVES:

High-resolution microendoscopy (HRME) is an optical imaging modality that allows real time imaging of epithelial tissue and structural changes within. We hypothesize that HRME, using proflavine, a contrast agent that preferentially stains cell nuclei and allows detection of cellular morphologic changes, can distinguish sinonasal pathology from uninvolved mucosa, potentially enabling real-time surgical margin differentiation.

STUDY DESIGN:

Ex vivo imaging of histopathologically confirmed samples of sinonasal pathology and uninvolved, normal sinus epithelium.

SETTING:

Single tertiary-level institution.

SUBJECTS AND METHODS:

Five inverted papillomas, one oncocytic papilloma, two uninvolved sinus epithelia specimens, and three inflammatory polyps were imaged ex vivo with HRME after surface staining with proflavine. Following imaging, the specimens were submitted for hematoxylin and eosin staining to allow histopathological correlation.

RESULTS:

Results show that sinonasal pathology and normal sinus epithelia have distinct HRME imaging characteristics. Schneiderian papilloma specimens show increased nuclear-to-cytoplasmic ratio, nuclear crowding, and small internuclear separation, whereas normal sinus epithelia specimens show small, bright nuclei with dark cytoplasm and relatively large internuclear separation. Inflammatory polyps, however, have varying imaging characteristics, that resemble both Schneiderian papilloma and normal sinus epithelia.

CONCLUSIONS:

This study demonstrates the feasibility of HRME imaging to discriminate sinonasal pathology from normal sinus epithelia. While the system performed well in the absence of inflammation, discrimination of inflamed tissue was inconsistent, creating a significant limitation for this application. Novel imaging systems such as HRME with alternative contrast agents may assist with real-time surgical margin differentiation, enabling complete surgical resection of inverted papilloma and reducing recurrence rates.

KEYWORDS:

Inflammatory polyp; Inverted papilloma; Nose and paranasal sinuses; Optical imaging; Rhinology

PMID:
29622347
DOI:
10.1016/j.amjoto.2018.03.025
[Indexed for MEDLINE]

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