Contact and Compact Endoscopy in ENT

Contact Endoscopy Contact Endoscopy

1. Contact Endoscopy & Compact Endoscopy in ENT Dr. Lakhan M S

2. Contact Endoscopy

3. Non Invasive Optical technique Real time visualisation In situ examination of Pattern of vascularisation Cellular architecture of the superficial layers of the mucosa.

4. Hamou , 1979 Cervical & Uterine epithelial cells. Andrea et al, 1990 Pathologies of larynx

5. Magnified images -Hopkins’ rod-lens endoscope placed on the surface of the dye stained mucosal tissue. Allows assessment of precancerous and cancerous lesions in vivo Has significant potential in the histopathologic diagnosis of many suspicious head and neck mucosal lesions without tissue biopsy.

6. Endoscopes Karl Storz , Germany 7215 AA 7215 BA

7. Diameters of scopes- 4mm 5.5 mm Length- 23 cm 18 cm Straight forward(O degree) & Forward-Oblique telescopes(30 degree) Magnification- 1x 60x & 150x High intensity xenon light source Real time photographic & video documentation

8. O degree & 30 degree endoscope

9. O degree & 30 degree endoscope

10. Zero degree contact microlaryngoscope KarlStorz

11. magnifying endoscope 0° placed in contact against the mucosal surface, Documented magnified cytological images (at 60x or 150x) are recorded Vascular patterns were studied without staining as the stain prevents penetration of light into submucosal plane where the blood vessels lie.

12. Staining of the superficial cells of the mucosa with a contrast dye, 1% methylene blue

13. Features Studied homogeneousness of distribution of cells number of cells per field uniformity of nucleus staining, hyperchromatism , nuclear cytoplasmic ratio, Nuclear & cellular pleomorphism , prominent nucleoli, presence of mitotic figures pattern of distribution, branching & coiling of blood vessels. rate of flow of RBCs inside the blood vessels seen on CE of unstained lesion.

14. Assess Vocal cord Nasal Mucosa Nasopharynx Oral Cavity Oropharynx Trachea

15. For Oral Cavity & other accessible areas can be used in outpatient dept Laryngeal Mucosa passage of CE through a suspension laryngoscope under Anaesthesia .

16. Larynx Done under GA Transition from ciliated to squamous epithelium can be observed.

17. Larynx Abnormality Metaplastic substitution of ciliated epithelium by squamous in chronic smokers,GERD patients. Chronic laryngitis- epithelial cells have larger nuclei than normal & an increased nuclear:cytoplasmic ratio.

18. Larynx Keratosis detected easily- different stages of keratinization can be seen. Leukoplakia - heterogeneity of cell populations with nuclei of different colour,size & shape.

19. Larynx Carcinoma- extreme heterogeneity of nuclear size, shape & staining characteristics. Enables assessment of transitional zone between normal & abnormal mucosa -a better evaluation of early stage disease. Laryngeal papillomata assessment & management- Typical vascular loops in the core of pappillomata.also koilocytes .

20. Normal VC Early Laryng Ca

21. Advanced Laryngeal Cancer

22. Normal VC Squamous Ca

23. Contact Endoscopy-Nasal Cavity Normal- Squamous epithelium-anterior tip & inferior border of Inferior turbinate, septum & nasal vestibule. Ciliated epithelium- most of nasal cavity. Duct orifices of the gland –most prominent at the anterior end of turbinate. Microvascular network

24. Abnormality- Nasal Cavity Useful in Chronic rhinosinusitis Allergic rhinitis Nasal polyposis Mucociliary diseases

25. Chronic Rhinitis Squamous epithelium covers most of inferior & middle turbinate, anterior septum. Area of keratosis predominate in the parts exposed to turbulent air flow. Overproduction of mucus.

26. Allergic Rhintis Papillae of glands larger than normal. ciliated epithelium preserved. Nasal Polyps Anterior surface covered by squamous epithelium while rest ciliated cells. Can detect metaplastic changes .

27. Oral cavity & Oropharynx Normal Oral mucosa morphology varies from site to site Masticatory mucosa covering hard palate & gingiva is keratinised epithelium Transition from keratinised epithelium in lip to non keratinised epithelium of vestibule.

28. Abnormality Diagnosis of early cancer Study of tumourmargins Assessment of response to radiotherapy & Chemotherapy

29. Nasopharynx Used in Long term followup of patients treated for Nasopharyngeal Carcinoma.

30. Nasopharynx Normally Squamous epithelium in central & inferior part of posterior wall. Orifices of glandular duct throughout nose.

31. Nasopharynx Abnormality Irregular vascular pattern- atypical vessels,thrombosis,blood cell aggregates & increased vascular fragility. Tissue fragile & bleed easily if probed firmly. Malignancy- anisokaryosis,heterochromasia & hyperchromasia

32. Advantages of Contact Endoscopy Non invasive, simple, quick, repeatable, in vivo examination of cellular architecture and vascular pattern of mucosa.

33. Advantages of Contact Endoscopy Large and multiple areas examined quickly & in the same sitting. Avoids tissue damage and changes in cells which can occur due to biopsy and processing of tissue for histopathological examination. Suspicious lesions thus can be followed up serially. Can help in deciding precise site for taking biopsy by identifying areas of cellular atypia which may improve the yield of biopsy.

34. Advantages Can help in deciding margins of resection during tumour removal by differentiating tumour. Results are known immediately. Can be employed both in out patient department and operation theatre.

35. Advantages Can be combined with other techniques like autofluorescence (Compact Endoscopy). Video and still images can be stored and reviewed as many time as necessary

36. Limitations Inability to detect very early dysplasia differentiation of 'carcinoma in situ' from 'invasive carcinoma'.

37. Conclusion Accuracy & clinical applicability of contact endoscopes will continue to improve by - improvements in optical system, new cell dyes, markers,fluorescent products,light sources,image processing & better recording techniques. Enable CE findings to be instrumental in deciding the treatment modality both pre operatively as well as during surgery.

38. Compact Endoscopy Combination of Autofluorescence & Contact Endoscopy

39. Compact Endoscopy In autofluorescence endoscopy, an emission spectrum fixed wavelength(375 to 440 nm), & autofluorescence is measured in green spectrum between 470 and 800 nm. Appearance & degree of autofluorescence depend on structure of the examined tissue, mainly content of fluorophores .

40. Compact Endoscopy Normal mucosa -bright green autofluorescence *translucent elastic fibers in the lamina propria . Significant decrease in fluorescence intensity - in areas with dysplastic & cancerous changes After visualization of the dysplastic or cancerous hot spots by autofluorescence , contact endoscopy was performed.

41. Compact endoscopy - useful method in the detection and delineation of Precancerous & Cancerous lesions. -complementary tool supplementing Microlaryngoscopy .

42. Thank You