NonInvasive Optical Imaging of Vocal Cord Microstructure

描述（由申请人提供）：许多真声带（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语言障碍的风险。不幸的是，许多TVC病变在没有活检的情况下无法诊断，尤其是早期TVC癌，慢性喉炎在临床上通常与恶性肿瘤难以区分。本应用程序通过开发一种非接触式成像设备来解决这个问题，该设备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）的组织横截面图像，深度可达3毫米。本研究的具体目的包括：1)设计一种与手术显微镜耦合的高速OCT仪器；2)获得人体TVC显微结构的体内形态测量（如上皮厚度、赖因克间隙等）；3)将活体OCT图像与活检获得的组织学相关联。这项研究将招募大约125名在加州大学欧文分校医学中心接受喉部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常规组织学相关联。由于这些患者中的许多人将进行活检来诊断癌症，因此本研究也将为OCT诊断早期TVC癌的有效性提供试点信息，其中主要特征是基底膜的侵犯。除了TVC显微解剖的结构信息外，OCT设备还将提供特定组织特性的功能图像，包括双折射（胶原组织），使用偏振敏感的OCT，以及使用光学多普勒断层扫描的显微血流。我们希望我们的仪器能够：1)成像声带微观结构，包括基底膜的完整性；2)明确良性和恶性TVC肿瘤的浅表和深部范围；3)促进实时图像引导TVC显微手术，使组织活检或手术更准确。此外，OCT成像将提供一种用3d图像记录TVC病理演变的方法，从而补充了传统的内窥镜和频闪镜检查。OCT在喉微创手术中的应用可以减少医源性发声障碍，因为它减少了伴随传统技术而来的对脆弱结构的创伤。

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.