NonInvasive Optical Imaging of Vocal Cord Microstructure

描述(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，这会使患者面临全身麻醉、TVC损伤和潜在的医源性声门性语音障碍的风险。不幸的是，许多TVC病变没有活检就无法诊断，尤其是早期TVC癌，慢性喉炎在临床上往往无法与恶性肿瘤区分开来。这项应用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层析成像(OCT)来提供TVC的高分辨率横断面图像。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)的组织横断面图像，深度可达3毫米。这项研究的具体目的包括：1)设计一台与手术显微镜相耦合的高速OCT仪器；2)获得人体TVC微观结构的活体形态测量(例如，上皮厚度、Reinke间隙等)；以及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名在加州大学欧文医学中心接受喉镜检查的成年患者，为期两年。在60%以上的病例中，可获得组织活检标本，以便与常规组织学相关联。由于这些患者中的许多人将接受活检来诊断癌症，这项研究还将提供OCT在诊断早期TVC癌中的疗效的初步信息，早期TVC癌的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设备还将使用偏振敏感OCT提供特定组织属性的功能图像，包括双折射(胶原组织)，以及使用光学多普勒断层扫描技术提供微观血流。我们希望我们的仪器能够：1)成像声带微结构，包括基底膜的完整性；2)勾勒出良性和恶性TVC肿瘤的浅层和深层范围；以及3)促进TVC的实时图像引导显微手术，从而实现更准确的组织活检或手术。此外，OCT成像将提供一种用3D图像记录TVC病理演变的方法，从而补充传统的内窥镜和频闪镜检查。OCT在喉显微手术中的应用可能会减少传统技术所伴随的对微细结构的创伤，从而减少医源性发声障碍。

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.