This document describes contact endoscopy (CE), a non-invasive optical technique that uses a magnifying endoscope to provide real-time visualization and examination of the cellular architecture and vascular patterns of mucosal tissues. CE allows in vivo assessment of precancerous and cancerous lesions without biopsy. Several contact endoscope models from Karl Storz are described. The document outlines CE's applications in examining various head and neck tissues and its ability to detect abnormalities. The benefits of CE include its non-invasive nature, ability to examine large areas quickly, and provision of immediate results.

3.  Non Invasive Optical technique
 Real time visualisation
 In situ examination of
Pattern of vascularisation
Cellular architecture of the superficial
layers of the mucosa.

4.  Hamou, 1979
Cervical & Uterine epithelial cells.
 Andrea et al, 1990
Pathologies of larynx

5.  Magnified images -Hopkins’ rod-lens
endoscope placed on the surface of the dye
stained mucosal tissue.
 Allows assessment of precancerous and
cancerous lesions in vivo
 Has significant potential in the
histopathologic diagnosis of many suspicious
head and neck mucosal lesions without tissue
biopsy.

6. Karl Storz, Germany
 7215 AA
 7215 BA

7.  Diameters of scopes- 4mm 5.5 mm
 Length- 23 cm 18 cm
 Straight forward(O degree) & Forward-
Oblique telescopes(30 degree)
 Magnification- 1x 60x & 150x
 High intensity xenon light source
 Real time photographic & video
documentation

10. Zero degree contact microlaryngoscope
KarlStorz

11.  magnifying endoscope 0° placed in contact
against the mucosal surface,
Documented magnified cytological images (at
60x or 150x) are recorded
 Vascular patterns were studied without
staining as the stain prevents penetration of
light into submucosal plane where the blood
vessels lie.

12.  Staining of the superficial cells of the mucosa
with a contrast dye, 1% methylene blue

14.  homogeneousness of distribution of cells
 number of cells per field
 uniformity of nucleus
 staining, hyperchromatism, nuclear cytoplasmic
ratio,
 Nuclear & cellular pleomorphism, prominent
nucleoli, presence of mitotic figures
 pattern of distribution, branching & coiling of
blood vessels.
 rate of flow of RBCs inside the blood vessels seen
on CE of unstained lesion.

15.  Assess
Vocal cord
Nasal Mucosa
Nasopharynx
Oral Cavity
Oropharynx
Trachea

16.  For Oral Cavity & other accessible areas
can be used in outpatient dept
 Laryngeal Mucosa
passage of CE through a suspension
laryngoscope under Anaesthesia.

17.  Done under GA
 Transition from ciliated to squamous
epithelium can be observed.

18. Abnormality
 Metaplastic substitution of ciliated epithelium
by squamous in chronic smokers,GERD
patients.
 Chronic laryngitis- epithelial cells have larger
nuclei than normal & an increased
nuclear:cytoplasmic ratio.

19.  Keratosis detected easily- different stages of
keratinization can be seen.
 Leukoplakia- heterogeneity of cell populations
with nuclei of different colour,size & shape.

20.  Carcinoma- extreme heterogeneity of nuclear
size, shape & staining characteristics.
Enables assessment of transitional zone
between normal & abnormal mucosa
-a better evaluation of early stage disease.
 Laryngeal papillomata assessment &
management- Typical vascular loops in the
core of pappillomata.also koilocytes.

24. Normal-
 Squamous epithelium-anterior tip & inferior
border of Inferior turbinate, septum & nasal
vestibule.
 Ciliated epithelium- most of nasal cavity.
 Duct orifices of the gland –most prominent at
the anterior end of turbinate.
 Microvascular network

25. Useful in
Chronic rhinosinusitis
Allergic rhinitis
Nasal polyposis
Mucociliary diseases

26.  Chronic Rhinitis
Squamous epithelium covers most of inferior &
middle turbinate, anterior septum.
Area of keratosis predominate in the parts
exposed to turbulent air flow.
Overproduction of mucus.

27.  Allergic Rhintis
Papillae of glands larger than normal.
ciliated epithelium preserved.
 Nasal Polyps
Anterior surface covered by squamous
epithelium while rest ciliated cells.
Can detect metaplastic changes.

28.  Normal
Oral mucosa morphology varies from site to site
Masticatory mucosa covering hard palate &
gingiva is keratinised epithelium
Transition from keratinised epithelium in lip to
non keratinised epithelium of vestibule.

29.  Abnormality
Diagnosis of early cancer
Study of tumourmargins
Assessment of response to radiotherapy
& Chemotherapy

32.  Used in
Long term followup of patients treated for
Nasopharyngeal Carcinoma.

33.  Normally
Squamous epithelium in central & inferior part
of posterior wall.
Orifices of glandular duct throughout nose.

34. Abnormality
 Irregular vascular pattern-
atypical vessels,thrombosis,blood cell
aggregates & increased vascular fragility.
 Tissue fragile & bleed easily if probed firmly.
 Malignancy- anisokaryosis,heterochromasia &
hyperchromasia

35.  Non invasive, simple, quick, repeatable, in
vivo examination of cellular architecture and
vascular pattern of mucosa.

36.  Large and multiple areas examined quickly & in the
same sitting.
 Avoids tissue damage and changes in cells which
can occur due to biopsy and processing of tissue for
histopathological examination. Suspicious lesions
thus can be followed up serially.
 Can help in deciding precise site for taking biopsy
by identifying areas of cellular atypia which may
improve the yield of biopsy.

37.  Can help in deciding margins of resection
during tumour removal by differentiating
tumour.
 Results are known immediately.
 Can be employed both in out patient
department and operation theatre.

38.  Can be combined with other techniques like
autofluorescence (Compact Endoscopy).
 Video and still images can be stored and
reviewed as many time as necessary

39.  Inability to detect very early dysplasia
 differentiation of 'carcinoma in situ' from
'invasive carcinoma'.

40.  Accuracy & clinical applicability of contact
endoscopes will continue to improve by
- improvements in optical system, new cell
dyes, markers,fluorescent products,light
sources,image processing & better recording
techniques.
 Enable CE findings to be instrumental in
deciding the treatment modality both pre
operatively as well as during surgery.

41.  Combination of Autofluorescence & Contact
Endoscopy

42.  In autofluorescence endoscopy, an emission
spectrum fixed wavelength(375 to 440 nm), &
autofluorescence is measured in green spectrum
between 470 and 800 nm.
 Appearance & degree of autofluorescence depend
on structure of the examined tissue, mainly
content of fluorophores.

43.  Normal mucosa -bright green autofluorescence
*translucent elastic fibers in the lamina propria.
 Significant decrease in fluorescence intensity - in
areas with dysplastic & cancerous changes
 After visualization of the dysplastic or cancerous
hot spots by autofluorescence, contact endoscopy
was performed.

45.  Compact endoscopy
- useful method in the detection and
delineation of Precancerous
& Cancerous lesions.
-complementary tool supplementing
Microlaryngoscopy.