Fluorescence Spectroscopy for Real-Time Intraoperative Detection of Middle Ear Cholesteatoma

ObjectiveTo evaluate the potential of autofluorescence spectroscopy as a real-time intraoperative tool for cholesteatoma detection and differentiation from surrounding non-cholesteatoma middle-ear tissues. Study DesignProspective ex vivo study. SettingBesancon University Hospital, France (tertiary care center). MethodsAutofluorescence spectral scans were obtained from middle ear biopsies following 405-nm laser excitation. Histopathologic analysis confirmed tissue classification. Spectral data were analyzed using principal component analysis and classified using a quadratic discriminant analysis model. ResultsIn a cohort of 23 patients (36 tissue samples, 3,787 fluorescence spectra), the classification model achieved an accuracy of 94.5%, with a sensitivity of 94.7% and a specificity of 94.2%. All biopsies were correctly classified as cholesteatoma or non-cholesteatoma. ConclusionAutofluorescence spectroscopy demonstrated high diagnostic accuracy for cholesteatoma detection. The simplicity and real-time applicability of the method suggest its potential for intraoperative integration, aiming to enhance surgical precision and reduce recurrence rates. Future in vivo validation will be necessary to assess its feasibility in clinical practice.