Mauna Kea Technologies (MKT) (France) is Optiscan’s purported...

Mauna Kea Technologies (MKT) (France) is Optiscan’s purported competitor. Note the word purported.

Cellvizio is their flagship product using Confocal Laser Endomicroscopy that is a real-time in vivo (in the living body) cellular imaging platform.

Although the Mauna Kea Technology is not as advanced and sophisticated as Optiscan, they are excellent at marketing.

A recent article has been published focusing on imaging of the head and neck lesion and its margins using Cellvizio. Details of which have already been posted on this forum but with limited detail and explanation. This is an attempt to expand on those previous posts. Furthermore, this is directed to the reader with limited knowledge on the topic. E.g., the general public. The ones that will provide momentum for the uptake of this technology.

The article is Titled:

Diagnostic accuracy of in vivo early tumor (sic) imaging from probe‑based confocal laser endomicroscopy versus histologic examination in head and neck squamous cell carcinoma

Reference < https://doi.org/10.1007/s00784-021-04156-4 >

Fluorescence [the emission of light by a substance that has absorbed light or other electromagnetic radiation] images were recorded using the Cellvizio fibered imaging system.

Note this report was received on 9 July 2021, accepted on 19 August 2021 and published on 12 October 2021. The emphasis here is purely that endomicroscopic imaging technology is for ever advancing. As most readers are aware, endomicroscopy is a technique for obtaining histology like images from inside the human body in real-time, also referred to as an optical biopsy.

This study enrolled 44 patients with early head and neck lesions. All patients underwent white-light inspection or panendoscopy depending on the lesion’s location, followed by probe-based confocal laser endomicroscopy imaging of the tumour core and its margins after topical application of patent blue V. Each zone imaged by the probe-based confocal laser endomicroscopy was interpreted at distance of the exam by three pathologists blinded to final histology.

Patent Blue V is a sterile dye solution for injection that belongs to the group of triphenylmethane dyes used to reveal vessels in order to improve the visualisation of certain vessels of the human body.

The report concluded that ‘final sensitivity scores were reasonable but final specificity scores were low. Probe-based confocal laser endomicroscopy zones used to calculate specificity were acquired in areas of tumour margins, and the poor quality of the images acquired in these areas explains the final low specificity scores.’

Put another way, the study design was good but the results were pretty average. The sensitivity of 73% is not high enough, usually 80-90 is more acceptable. Specificity of 30-57% is very low. There were issues in the tumour margin zones where the device was not stable enough – that is the images cannot be interpreted. The tumour margin is the whole point of the exercise. In conclusion, Cellvizio has failed.

Sensitivity is the ability of a test to correctly identify patients with a disease. In other words, a measure of how well a diagnostic test can identify true positives.

Specificity is the ability of a test to correctly identify people without the disease. In other words, a measure of how well a test can identify true negatives.

What is Mauna Kea Technologies future strategy?

Mauna Kea Technologies state that they are currently exploring the use of Cellvizio for the lung. It posits that Cellvizio may be able to examine the lung in real time to see the impact of a Covid-19 infection for severe and long term Covid-19 patients. In particular viewing pulmonary fibrosis (a lung disease), lung tissue microstructure, lung inflammation, and olfactory slits. However, bronchoscopy usually can only reach fairly central airways. And Covid-19 affects peripheral lung that is more towards the rib cage surface.

What are the alternatives to the French Technology?

ZEISS CONVIVO In Vivo Pathology specifically designed for neurosurgery using Optiscan’s technology.

Optiscan’s InVivage -- for imaging cellular architecture, in clinical and research settings real-time, sub-cellular, with high-resolution images at 1000x real magnification.

Optiscan FIVE2 handheld confocal in vivo imaging for clinical, translational, preclinical and other research

Note that in April 2017 NDF Research stated:

We see Optiscan’s technology as representing a superior offering to that of Mauna Kea, who was a later arrival than Optiscan in the field.

Optiscan is well-placed to grow its live micro-imaging offering.

Optiscan has strong clinical relationships, with many top tier hospitals around the world having hosted clinical studies of the company’s devices over the years. This provides considerable credibility for Optiscan as it seeks the buy-in of Key Opinion Leaders for its current product suite.

Are there other applications of Optiscan’s technology?

Ex-vivo (outside the living body) --- Whilst Optiscan’s focus in on the living (human and animal) there is no reason why the technology cannot be used for post mortem tissue analysis. Perhaps the differentiation between Covid-19 and the influenza? I contend that the examination of cancers in a corpse may provide a useful base for an artificial intelligence (AI) database. As long as the tissue is preserved properly.

Botany?

The question arises whether Optiscan’s technology can also be used for the examination of plant cells which are microscopic in size (0.01 to 1.0 mm)? Whilst I am not advocating that Optiscan diverts it current endeavours into these other potential applications, we should be aware of the possible future uses of the technology. Moreover, this lateral thinking may assist in our appreciation of the great significance of the technology.