Matti Sievert

BACKGROUND Confocal laser endomicroscopy (CLE) enables real-time, in vivo tissue assessment during head and neck cancer surgery, where the balance between oncological safety and functional preservation is particularly delicate. Artificial intelligence (AI) can support CLE interpretation, yet clinical adoption remains limited, a gap attributed less to model performance than to a lack of interfaces that make AI outputs interpretable and trustworthy at the point of care. OBJECTIVE This study aimed to investigate how explanatory, user-centered interfaces can enable reliable human–AI collaboration for AI-assisted CLE across the surgical workflow. METHODS Following a user-centered design approach, a user journey map informed the development of three high-fidelity prototypes addressing intraoperative, pre-/postoperative, and educational use cases. A mixed-methods evaluation with five experienced surgeons from four institutions combined think-aloud exploration, the short User Experience Questionnaire (UEQ-S), and semi-structured interviews; qualitative data were analysed inductively through thematic analysis. RESULTS Explainability, conveyed through influential morphological features, class activation maps, and example-based case comparisons, anchored AI recommendations in surgeons’ established clinical reasoning and supported verification against their own judgement. Explicit communication of model uncertainty emerged as a distinct prerequisite for calibrated trust. Clarity, simplicity, and adaptive information density were identified as central design principles, while diverging preferences pointed to a need for configurable interaction modes. All three prototypes were rated as excellent on the UEQ-S (overall means 2.53–2.68). CONCLUSIONS Trustworthy integration of AI into CLE depends primarily on explanatory interfaces aligned with clinical reasoning and on transparent communication of uncertainty, rather than on model performance alone. Configurable, workflow-adaptive designs and case-based educational applications represent promising directions for clinical translation.

An initial application of Confocal laser microendoscopy (CLE) in basal cell carcinoma (BCC) was promising, yet data in this field are still limited. Tumor vasculature, which can be clearly visualized by CLE, differs significantly from that of normal tissue, but has not yet been systematically analyzed as a target of CLE in BCC. By systematically assessing vascular features, we aim to define diagnostic criteria that support a more standardized and objective use of CLE in BCC. CLE imaging was performed in nine patients with histologically confirmed facial BCC. Forty artifact-free vascular sequences (20 BCC, 20 healthy skin) were analyzed using five predefined criteria independently rated by three blinded reviewers. Diagnostic accuracy, sensitivity, specificity, and interrater agreement were calculated. Normal skin showed regular, well-defined, round vessels of uniform size, whereas BCC demonstrated heterogeneous, dilated, and elongated vessels with indistinct borders and variable flow. Mean sensitivity and specificity were 91.7 ± 4.7% and 86.7 ± 6.2%, respectively, with substantial interrater agreement (κ = 0.77). Vascular features in CLE sequences supported the differentiation between BCC and healthy skin. Incorporating vascular criteria into CLE-based scoring systems appears promising for a more standardized differentiation of BCC from healthy skin. Further studies with larger patient cohorts are warranted to validate these preliminary findings and assess their clinical applicability. Not applicable, as this study is a retrospective analysis.

Zusammenfassung Hintergrund Schilddrüsenknoten sind häufige Zufallsbefunde in der Sonographie. Die sonographische Früherkennung in der Sekundärprävention in Form eines Screenings scheint dabei keinen patientenrelevanten Nutzen zu haben. Ziel Darstellung der internationalen Evidenz zum Nutzen und Schaden von Sonographie in der Sekundärprävention von Schilddrüsenknoten. Methodik Narrative Übersicht (PubMed-Recherche, 2010–2025) zu Leitlinien (American Thyroid Association, ATA; American Association of Clinical Endocrinology, AACE/American College of Endocrinology, ACE; European Thyroid Association, ETA; United States Preventive Services Task Force, USPSTF; National Institute for Health and Care Excellence, NICE; deutschsprachige S3-Leitlinien), bevölkerungsbasierten Studien (SHIP, KORA, SEER) sowie systematischen Reviews und Metaanalysen. Ergebnisse Die Prävalenz von Schilddrüsenknoten ist hoch, der Anteil klinisch relevanter oder maligner Befunde gering. Die Mortalität des Schilddrüsenkarzinoms ist niedrig. Ein generelles Sonographie-Screening asymptomatischer Erwachsener erhöht die Inzidenz – überwiegend indolenter papillären Karzinome – ohne Mortalitätsreduktion. Das Risiko der Überdiagnostik und nachfolgenden Übertherapie ist substanziell. Internationale und nationale Leitlinien raten daher vom Screening zur Früherkennung des Schilddrüsenkarzinoms ab. Für die gezielte Abklärung bei klinischem Verdacht sind standardisierte Ultraschall-Risikoklassifikationen (z. B. European Thyroid Imaging Reporting and Data System, EU-TIRADS/American College of Radiology TIRADS, ACR TIRADS) essenziell. Schlussfolgerung Ein generelles Screening asymptomatischer Personen mittels Sonographie wird nicht empfohlen. Die Rate an Überdiagnostik ist hoch, der Nutzen hinsichtlich Morbiditäts- oder Mortalitätsreduktion nicht belegt.

Background: Due to their high prevalence the management of thyroid nodules requires a particularly systematic approach. If the diagnostics reveal a suspected or confirmed thyroid cancer, in most cases surgical treatment remains the primary treatment option. Objective: The aim of this work is to provide an overview of the guideline-based approach to thyroid nodules and carcinomas with a focus on diagnostics and surgical treatment. The essential differences in content between the previous and current guidelines are identified. Material and methods: Selection of the most practice-relevant recommendations of the guidelines on thyroid cancer published in 2025 and comparison of these with the recommendations of the guidelines on surgical treatment of malignant thyroid diseases published in 2012. Results: The new guidelines are significantly more comprehensive and detailed. The recommended diagnostic procedure is more precise and supplemented by examination techniques such as elastography. The surgical procedure keeps its role as the primary treatment approach. In accordance with the current study situation new options, such as the observational behavior for papillary microcarcinomas under defined conditions, are included. The recommendations on the diagnostics and treatment of undifferentiated thyroid cancer have been substantially expanded. Conclusion: The new guidelines provide a comprehensive overview of the diagnostics and treatment of thyroid cancer and expands on the previous guidelines with consideration of the current study situation.

Zusammenfassung Raumforderungen der Glandula parotidea sind selten und überwiegend gutartig. Ihre chirurgische Behandlung ist aufgrund der Nähe zum Nervus facialis herausfordernd. Besonders das pleomorphe Adenom und das Zystadenolymphom treten häufig auf. Das chirurgische Vorgehen richtet sich nach Lage, Größe und Verdachtsdiagnose der Raumforderung. Während früher radikale Operationstechniken bevorzugt wurden, steht heute die Reduktion der Operationsmorbidität durch weniger invasive Resektionsverfahren im Fokus. Hier bietet insbesondere die extrakapsuläre Dissektion funktionelle Vorteile gegenüber ausgedehnteren Resektionen bei vergleichbar niedrigen Rezidivraten. Komplikationen wie Fazialisparesen, Speichelfisteln und das Frey-Syndrom treten dadurch mit geringerer Inzidenz und Ausprägung auf, sind dann aber gut behandelbar, z. B. mit Botulinumtoxin. In speziellen Fällen – etwa bei gesichertem, bilateralem Zystadenolymphom – kann der chirurgischen Therapie ein konservatives Vorgehen im Sinne eines Wait-and-scan-Konzepts vorgezogen werden. Ziel bleibt stets die vollständige Resektion bei maximalem Funktionserhalt.

The aim of this study was to analyze thyroglossal duct cyst carcinoma (TDCC) in a single-center retrospective analysis, supplemented by a systematic literature review to inform treatment approaches. Patient records from a tertiary referral center were analyzed for individuals diagnosed with TDCC between 2002 and 2023. A systematic review followed the PRISMA guidelines, encompassing studies from Medline and PubMed. Patient data, including demographics, imaging results, and histological findings were extracted. The primary outcome assessed was tumor-free and recurrence-free survival, while additional variables included treatment regimens and follow-up data. The analysis identified a total of 484 TDCC cases, confirming papillary thyroid carcinoma (PTC) as the predominant type (94.2%), with synchronous thyroid gland carcinomas observed in 34.6%. The age range was 8 to 76 with median age of 40 years. Women were affected in 62%, men in 36%. The recurrence rate was 7.4%, with distant metastases observed in 1% of cases. The overall survival rate was 99.1%, regardless of the treatment regimen. Although rare, TDCC predominantly presents as PTC, with a favorable prognosis. Sistrunk’s procedure remains the primary surgical approach, but optimal management regarding therapies such as total thyroidectomy, neck dissection, or radioiodine ablation requires careful evaluation of risk factors like rare tumor types, suspicious lymph nodes, thyroid nodules, age, radiation exposure, and molecular patterns. Emphasizing more individualized treatment strategies, we propose an algorithm that can help to reduce invasiveness and overtreatment risks in selected cases.

Purpose Confocal laser endomicroscopy (CLE) enables a real time in-vivo optical biopsy of the upper aerodigestive tract. Previous studies demonstrated its potential in identifying malignant tissue, but none examined mucosa treated with radiotherapy. This study characterizes the appearance of irradiated mucosa using CLE. Methods We recorded 58 CLE sequences (860 s, 6,884 frames) in 10 patients previously treated with radiotherapy for upper aerodigestive tract tumors. A corresponding tissue biopsy (formalin-fixed, H&E stained) was taken as the reference standard for each sequence. We analyzed each sequence regarding differences from normal mucosa and characterized irradiated mucosa in CLE. Results Irradiated mucosa in CLE exhibits irregular tissue architecture. Radiation induces DNA damage, apoptosis, and tissue inflammation, leading to hyperkeratotic and fibrotic tissue. Consequently, CLE showed a wider range of cellular morphologic and tissue structural aberrancies, in comparison to normal, non-irradiated mucosa. In addition to regular honeycomb-like patterns, the tissue displayed uneven, blurry, and cell-rich areas. Irradiated mucosa appears more irregular and variable in CLE than radiation-naïve mucosa. Conclusion Irradiated mucosa can be differentiated from healthy tissue using CLE, but its higher baseline morphological variability may mimic malignancy. Further research is needed to clarify its impact on tumor detection and refine existing scoring systems.

Background/Objectives: Descending necrotising mediastinitis (DNM) is a severe, life-threatening infection that originates from the oropharyngeal or odontogenic regions and spreads to the mediastinum. It poses significant challenges due to its rapid progression and high morbidity. Methods: This monocentric, retrospective study analysed the records of 22 patients treated for DNM between 2008 and 2022. Diagnosis relied on characteristic clinical, radiological, and intraoperative findings linking oropharyngeal or cervical infections to mediastinitis. Contrast-enhanced computed tomography (CT) was used in all cases for diagnosis. Data collected included demographics, comorbidities, surgical interventions, time from diagnosis to surgery, re-operations, and complications. Microbiological analyses targeted aerobic and anaerobic pathogens. Results: The study included 22 patients (mean age 60 ± 9 years, 59% male) with DNM. The primary sources of infection were oropharyngeal (77%) and odontogenic (23%). Hypertension (86%), diabetes (68%), and cardiac arrhythmias (59%) were common comorbidities. Thoracotomy with mediastinal drainage and debridement was performed in 95% of patients, while 45% underwent cervicotomy and 82% required tracheostomy. The median intensive care unit (ICU) and hospital stays were 21 and 30 days, respectively. Delayed surgery (>24 h) significantly prolonged hospital stays (median: 62 vs. 28 days, p = 0.05). Re-operations were required in 82% of patients, with longer ICU stays observed in this group (median: 25 vs. 7 days, p = 0.003). Sepsis occurred in 55% and was associated with a higher tracheostomy rate (100% vs. 60%, p = 0.029). The mortality rate was 9%. Conclusions: Early recognition and prompt aggressive surgical intervention are paramount in managing DNM to mitigate complications and improve survival.

Confocal laser endomicroscopy (CLE) represents an emerging probe‐based intraoperative optical imaging modality, contingent on differential fluoroscein uptake, equipped to improve intraoperative identification of subclinical mucosal disease. In the analysis herein, we describe improved sensitivity, compared to narrow band imaging and small‐volume tissue biopsies, of CLE in the discrimination of occult disease based on cellular and subcellular morphology during endoscopic resection of early‐staged larynx cancers. Laryngoscope , 135:1767–1770, 2025