NonInvasive Optical Imaging of Vocal Cord Microstructure

描述（由申请人提供）：许多真性声带（TVC）病变的诊断和治疗需要活检或切除，这使患者面临全身麻醉、TVC损伤和潜在医源性声门言语障碍的风险。不幸的是，许多TVC病变在没有活检的情况下无法诊断，对于早期TVC癌症尤其如此，其中慢性喉炎通常在临床上无法与恶性肿瘤区分。本申请通过开发一种非接触式成像装置来解决该问题，以使用光学相干断层扫描（OCT）提供TVC的高分辨率横截面图像。OCT是一种新兴的成像方式，它使用低相干光来构建高分辨率（10-20微米），组织的横截面图像，深度可达3 mm。本研究的具体目标包括：1）设计一种连接到手术显微镜的高速OCT仪器; 2）获得人体TVC微观结构（例如，上皮厚度、Reinke间隙等）;以及3）将体内OCT图像与从活组织检查获得的组织学相关联。这项研究将招募大约125名在UC Irvine医学中心接受喉显微内窥镜检查的成年患者，为期两年。在超过60%的病例中，组织活检标本可用于与传统组织学进行相关性分析。由于这些患者中的许多人将进行活检以诊断癌症，因此本研究还将提供关于OCT诊断早期TVC癌症的有效性的初步信息，其中主要特征是基底膜的侵袭。除了TVC显微解剖结构信息外，OCT器械还将提供特定组织特性的功能图像，包括使用偏振敏感OCT的双折射（胶原组织）和使用光学多普勒断层扫描的显微血流。我们希望我们的工具：1）成像声带微结构，包括基底膜完整性; 2）描绘良性和恶性TVC肿瘤的浅表和深部范围;以及3）促进TVC的实时图像引导显微手术，允许更准确的组织活检或手术。此外，OCT成像将提供一种用3-D图像记录TVC病理演变的方法，从而补充传统的内窥镜检查和频闪检查。OCT在喉显微手术中的应用可以通过减少传统技术对微妙结构的创伤来减少医源性发音障碍。

DESCRIPTION (provided by applicant): The diagnosis and management of many true vocal cord (TVC) lesions requires biopsy or excision which exposes the patient to the risks of general anesthesia, TVC injury, and potential iatrogenic glottic speech impairment. Unfortunately, many TVC lesions cannot be diagnosed without a biopsy, and this is particularly true with early TVC cancer, where chronic laryngitis is often clinically indistinguishable from malignancy. This application addresses this problem by developing a non-contact imaging device to provide high-resolution cross-sectional images of the TVC using Optical Coherence Tomography (OCT). OCT is an emerging imaging modality that uses low-coherence light to construct high-resolution (10-20 microns), cross-sectional images of tissue to depths of up to 3 mm. The specific aims of this study include: 1) design a high speed OCT instrument coupled to a surgical microscope; 2) obtain in vivo morphometric measurement of human TVC microstructure (e.g.; thickness of epithelium, Reinke's space, etc.); and 3) correlate in vivo OCT images with histology obtained from biopsies. This study will enroll approximately 125 adult patients undergoing laryngeal microendoscopy at UC Irvine Medical Center over two years. In over 60%, a tissue biopsy specimen will be available to allow correlation with conventional histology. Since many of these patients will have a biopsy to diagnose cancer, this study will also provide pilot information on the efficacy of OCT in diagnosing early TVC cancer, where the cardinal feature is invasion of the basement membrane. In addition to structural information on TVC microanatomy, the OCT device will provide functional images of specific tissue properties, including birefringence (collagen organization), using polarization-sensitive OCT, and microscopic blood flow, using Optical Doppler Tomography. We expect our instrument to: 1) image vocal cord microstructure including basement membrane integrity; 2) delineate the superficial and deep extent of both benign and malignant TVC neoplasms; and 3) facilitate real-time image guided microsurgery of the TVC, allowing more accurate tissue biopsies or surgery. Further, OCT imaging will provide a means of documenting the evolution of TVC pathology with 3-D images, thus complementing conventional endoscopy and stroboscopy. Application of OCT to microlaryngeal surgery may reduce iatrogenic phonatory disability by reducing trauma to delicate structures that accompanies conventional techniques.