Intraoperative Label-free Detection of Cholesteatoma Using Autofluorescence: A Feasibility Study

Abstract

Objective: To evaluate the ability to distinguish cholesteatoma from surrounding tissues using autofluorescence intraoperatively.

Study design: Prospective cohort study.

Setting: Tertiary referral center.

Patients: Patients with cholesteatoma undergoing middle ear surgery.

Intervention: Autofluorescence imaging with 470 nm excitation light.

Main outcome measure: Compare cholesteatoma autofluorescence with surrounding mucosa, bone, and granulation tissue.

Results: A total of 6 patients undergoing cholesteatoma surgery were prospectively enrolled in the study for imaging. A custom-designed endoscopic and macroscopic imaging set-up utilizing 470 nm excitation was used to image the surgical field in real-time. Intraoperatively, autofluorescence imaging allowed delineation of cholesteatoma from surrounding bone, granulation tissue, and mucosa, even when cholesteatoma identification was difficult with white light alone. The 470 nm excitation was able to target endogenous fluorophores, specifically flavin adenine dinucleotide (FAD) and keratin, which are present within cholesteatoma, but not present in mucosa and granulation tissue.

Conclusion: This study demonstrates the feasibility of autofluorescence-guided identification of cholesteatoma intraoperatively. The results support its potential as an adjunctive tool to surgeons for cholesteatoma identification.

Keywords: Autofluorescence; Cholesteatoma; Mastoidectomy; Middle ear surgery.