Gough Whitlam on maintaining enthusiasm for a course (in his...

Gough Whitlam on maintaining enthusiasm for a course (in his case the dismissal) in our case CLE

The inability to clearly define surgical margins intraoperatively in OSCC patients isthe number one reason for the recurrence of primary tumours and leading to a debilitatingrecurrence and associated metastasis [15]. The current practices which help in determiningsurgical margins include visualisation, palpation, or frozen section histopathology [16].Although frozen sections are accurate, they are associated with multiple drawbacks,including compromising the tissue integrity and being time consuming [17]. Avoidingunnecessary resection of healthy tissues is of utmost importance to the surgeons, due tothe functional limitations post-operatively and severe impact on the quality of life of thepatient [18,19]. This limitation also supports the requirement of an explicit and correctevaluation of the affected oral tissues preceding surgical resection.An ideal solution to these problems would-be real-time histological evaluation by aninstrument, which is non-invasive, time efficient, and sensitive enough to replace the goldstandard of histopathology. This concept has been previously explored using narrow-bandimaging [20,21], autofluorescence imaging [22,23], computed tomography [24], and confo-cal imaging [25]. The latter study was done with a handheld confocal laser endomicroscopecomprising of a bundle fibre probe (Manua Kea Cellvizio) with IV fluorescein as the flu-orescent dye. This technique allowed efficient visualization of the epithelial architecturewith a fluorescent contrast on the intraoperative display [26]. A fluorescent contrast agentintensifies the contrast of cells, which are imaged with a blue laser. Confocal Laser En-domicroscopy, aka “optical biopsy”, is used to deliver the surgeon with real-time cellularresolution digital images (1 μm to a 1000-fold magnification) during surgical procedures,

4. DiscussionCLE is a potentially useful diagnostic tool that is non-invasive and allows real-time
cellular imaging of the epithelium of the upper layers of the epithelium at resolutions
comparable to histology. The criteria for CLE diagnosis of OSCC are easy to learn and even
non-experts in the field of CLE have been able to make a precise diagnosis of OSCC by
using these criteria [56]. Previous research has indicated the efficient and precise ability of
CLE to envisage dysplastic head and neck squamous cell mucosa, with close reproducibility
of the histopathological diagnosis [61,62].
This systematic review and meta-analysis compares histopathological diagnosis from
in/ex vivo specimens to the diagnostic precision of CLE by means of analysing the results
of 6 studies which comprised a total of 361 lesions. The search strategy used wide-ranging
keywords in various relevant databases to find as many studies as possible.
The outcomes of the meta-analysis indicate a sensitivity of 95% and a specificity
of 93% when using CLE for diagnosis of OSCC. However, care must be taken while
interpreting these extraordinary values of both sensitivity and specificity. The substantial
heterogeneity indicates the direct assessment of the diagnostic accuracy of CLE amongst the
included studies improbable. CLE sensitivity for the diagnosis of OSCC ranged between
71.4% to 99.3%, and its specificity ranged between 80% and 100%. Only one of the studies referenced in the article uses OIL tech courtesy of Convivo and the MK aricles are not new.
I look forward to a paper from Melbourne Dental School on the work being done with InVivage showing "specificity and sensitivity" are not extraordinary when using OIL CLE!!!

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