Deep Learning-Based Framework for In Vivo Identification of Glioblastoma Tumor using Hyperspectral Images of Human Brain

Identification of Melanoma From Hyperspectral Pathology Image Using 3D Convolutional Networks

Skin biopsy histopathological analysis is one of the primary methods used for pathologists to assess the presence and deterioration of melanoma in clinical. A comprehensive and reliable pathological analysis is the result of correctly segmented melanoma and its interaction with benign tissues, and therefore providing accurate therapy. In this study, we applied the deep convolution network on the hyperspectral pathology images to perform the segmentation of melanoma. To make the best use of spectral properties of three dimensional hyperspectral data, we proposed a 3D fully convolutional network named Hyper-net to segment melanoma from hyperspectral pathology images. In order to enhance the sensitivity of the model, we made a specific modification to the loss function with caution of false negative in diagnosis. The performance of Hyper-net surpassed the 2D model with the accuracy over 92%. The false negative rate decreased by nearly 66% using Hyper-net with the modified loss function. These findings demonstrated the ability of the Hyper-net for assisting pathologists in diagnosis of melanoma based on hyperspectral pathology images.

Comprehensive review of surgical microscopes: technology development and medical applications

SIGNIFICANCE

Surgical microscopes provide adjustable magnification, bright illumination, and clear visualization of the surgical field and have been increasingly used in operating rooms. State-of-the-art surgical microscopes are integrated with various imaging modalities, such as optical coherence tomography (OCT), fluorescence imaging, and augmented reality (AR) for image-guided surgery.

AIM

This comprehensive review is based on the literature of over 500 papers that cover the technology development and applications of surgical microscopy over the past century. The aim of this review is threefold: (i) providing a comprehensive technical overview of surgical microscopes, (ii) providing critical references for microscope selection and system development, and (iii) providing an overview of various medical applications.

APPROACH

More than 500 references were collected and reviewed. A timeline of important milestones during the evolution of surgical microscope is provided in this study. An in-depth technical overview of the optical system, mechanical system, illumination, visualization, and integration with advanced imaging modalities is provided. Various medical applications of surgical microscopes in neurosurgery and spine surgery, ophthalmic surgery, ear-nose-throat (ENT) surgery, endodontics, and plastic and reconstructive surgery are described.

RESULTS

Surgical microscopy has been significantly advanced in the technical aspects of high-end optics, bright and shadow-free illumination, stable and flexible mechanical design, and versatile visualization. New imaging modalities, such as hyperspectral imaging, OCT, fluorescence imaging, photoacoustic microscopy, and laser speckle contrast imaging, are being integrated with surgical microscopes. Advanced visualization and AR are being added to surgical microscopes as new features that are changing clinical practices in the operating room.

CONCLUSIONS

The combination of new imaging technologies and surgical microscopy will enable surgeons to perform challenging procedures and improve surgical outcomes. With advanced visualization and improved ergonomics, the surgical microscope has become a powerful tool in neurosurgery, spinal, ENT, ophthalmic, plastic and reconstructive surgeries.

Deep learning for brain disorders: from data processing to disease treatment

In order to reach precision medicine and improve patients' quality of life, machine learning is increasingly used in medicine. Brain disorders are often complex and heterogeneous, and several modalities such as demographic, clinical, imaging, genetics and environmental data have been studied to improve their understanding. Deep learning, a subpart of machine learning, provides complex algorithms that can learn from such various data. It has become state of the art in numerous fields, including computer vision and natural language processing, and is also growingly applied in medicine. In this article, we review the use of deep learning for brain disorders. More specifically, we identify the main applications, the concerned disorders and the types of architectures and data used. Finally, we provide guidelines to bridge the gap between research studies and clinical routine.

Scaling-Based Two-Step Reconstruction in Full Polarization-Compressed Hyperspectral Imaging

Polarized hyperspectral images can reflect the rich physicochemical characteristics of targets. Meanwhile, the contained plentiful information also brings great challenges to signal processing. Although compressive sensing theory provides a good idea for image processing, the simplified compression imaging system has difficulty in reconstructing full polarization information. Focused on this problem, we propose a two-step reconstruction method to handle polarization characteristics of different scales progressively. This paper uses a quarter-wave plate and a liquid crystal tunable filter to achieve full polarization compression and hyperspectral imaging. According to their numerical features, the Stokes parameters and their modulation coefficients are simultaneously scaled. The first Stokes parameter is reconstructed in the first step based on compressive sensing. Then, the last three Stokes parameters with similar order of magnitude are reconstructed in the second step based on previous results. The simulation results show that the two-step reconstruction method improves the reconstruction accuracy by 7.6 dB for the parameters that failed to be reconstructed by the non-optimized method, and reduces the reconstruction time by 8.25 h without losing the high accuracy obtained by the current optimization method. This feature scaling method provides a reference for the fast and high-quality reconstruction of physical quantities with obvious numerical differences.

Hyperspectral Imaging for Glioblastoma Surgery: Improving Tumor Identification Using a Deep Spectral-Spatial Approach

The primary treatment for malignant brain tumors is surgical resection. While gross total resection improves the prognosis, a supratotal resection may result in neurological deficits. On the other hand, accurate intraoperative identification of the tumor boundaries may be very difficult, resulting in subtotal resections. Histological examination of biopsies can be used repeatedly to help achieve gross total resection but this is not practically feasible due to the turn-around time of the tissue analysis. Therefore, intraoperative techniques to recognize tissue types are investigated to expedite the clinical workflow for tumor resection and improve outcome by aiding in the identification and removal of the malignant lesion. Hyperspectral imaging (HSI) is an optical imaging technique with the power of extracting additional information from the imaged tissue. Because HSI images cannot be visually assessed by human observers, we instead exploit artificial intelligence techniques and leverage a Convolutional Neural Network (CNN) to investigate the potential of HSI in twelve in vivo specimens. The proposed framework consists of a 3D-2D hybrid CNN-based approach to create a joint extraction of spectral and spatial information from hyperspectral images. A comparison study was conducted exploiting a 2D CNN, a 1D DNN and two conventional classification methods (SVM, and the SVM classifier combined with the 3D-2D hybrid CNN) to validate the proposed network. An overall accuracy of 80% was found when tumor, healthy tissue and blood vessels were classified, clearly outperforming the state-of-the-art approaches. These results can serve as a basis for brain tumor classification using HSI, and may open future avenues for image-guided neurosurgical applications.

Deep Learning in Selected Cancers' Image Analysis-A Survey

Deep learning algorithms have become the first choice as an approach to medical image analysis, face recognition, and emotion recognition. In this survey, several deep-learning-based approaches applied to breast cancer, cervical cancer, brain tumor, colon and lung cancers are studied and reviewed. Deep learning has been applied in almost all of the imaging modalities used for cervical and breast cancers and MRIs for the brain tumor. The result of the review process indicated that deep learning methods have achieved state-of-the-art in tumor detection, segmentation, feature extraction and classification. As presented in this paper, the deep learning approaches were used in three different modes that include training from scratch, transfer learning through freezing some layers of the deep learning network and modifying the architecture to reduce the number of parameters existing in the network. Moreover, the application of deep learning to imaging devices for the detection of various cancer cases has been studied by researchers affiliated to academic and medical institutes in economically developed countries; while, the study has not had much attention in Africa despite the dramatic soar of cancer risks in the continent.

Survival prediction of glioblastoma patients-are we there yet? A systematic review of prognostic modeling for glioblastoma and its clinical potential

Glioblastoma is associated with a poor prognosis. Even though survival statistics are well-described at the population level, it remains challenging to predict the prognosis of an individual patient despite the increasing number of prognostic models. The aim of this study is to systematically review the literature on prognostic modeling in glioblastoma patients. A systematic literature search was performed to identify all relevant studies that developed a prognostic model for predicting overall survival in glioblastoma patients following the PRISMA guidelines. Participants, type of input, algorithm type, validation, and testing procedures were reviewed per prognostic model. Among 595 citations, 27 studies were included for qualitative review. The included studies developed and evaluated a total of 59 models, of which only seven were externally validated in a different patient cohort. The predictive performance among these studies varied widely according to the AUC (0.58-0.98), accuracy (0.69-0.98), and C-index (0.66-0.70). Three studies deployed their model as an online prediction tool, all of which were based on a statistical algorithm. The increasing performance of survival prediction models will aid personalized clinical decision-making in glioblastoma patients. The scientific realm is gravitating towards the use of machine learning models developed on high-dimensional data, often with promising results. However, none of these models has been implemented into clinical care. To facilitate the clinical implementation of high-performing survival prediction models, future efforts should focus on harmonizing data acquisition methods, improving model interpretability, and externally validating these models in multicentered, prospective fashion.

A Robust Dynamic Classifier Selection Approach for Hyperspectral Images with Imprecise Label Information

Supervised hyperspectral image (HSI) classification relies on accurate label information. However, it is not always possible to collect perfectly accurate labels for training samples. This motivates the development of classifiers that are sufficiently robust to some reasonable amounts of errors in data labels. Despite the growing importance of this aspect, it has not been sufficiently studied in the literature yet. In this paper, we analyze the effect of erroneous sample labels on probability distributions of the principal components of HSIs, and provide in this way a statistical analysis of the resulting uncertainty in classifiers. Building on the theory of imprecise probabilities, we develop a novel robust dynamic classifier selection (R-DCS) model for data classification with erroneous labels. Particularly, spectral and spatial features are extracted from HSIs to construct two individual classifiers for the dynamic selection, respectively. The proposed R-DCS model is based on the robustness of the classifiers’ predictions: the extent to which a classifier can be altered without changing its prediction. We provide three possible selection strategies for the proposed model with different computational complexities and apply them on three benchmark data sets. Experimental results demonstrate that the proposed model outperforms the individual classifiers it selects from and is more robust to errors in labels compared to widely adopted approaches.

Classification of Hyperspectral In Vivo Brain Tissue Based on Linear Unmixing

Hyperspectral imaging is a multidimensional optical technique with the potential of providing fast and accurate tissue classification. The main challenge is the adequate processing of the multidimensional information usually linked to long processing times and significant computational costs, which require expensive hardware. In this study, we address the problem of tissue classification for intraoperative hyperspectral images of in vivo brain tissue. For this goal, two methodologies are introduced that rely on a blind linear unmixing (BLU) scheme for practical tissue classification. Both methodologies identify the characteristic end-members related to the studied tissue classes by BLU from a training dataset and classify the pixels by a minimum distance approach. The proposed methodologies are compared with a machine learning method based on a supervised support vector machine (SVM) classifier. The methodologies based on BLU achieve speedup factors of ~459× and ~429× compared to the SVM scheme, while keeping constant and even slightly improving the classification performance.

Intraoperative Assessment of Gastric Sleeve Oxygenation Using Hyperspectral Imaging in Esophageal Resection: A Feasibility Study

Introduction

Sufficient tissue oxygenation is essential for anastomotic healing in visceral surgery. Hyperspectral imaging (HSI) is a noncontact, noninvasive technique for clinical assessment of tissue oxygenation in real time.

Methods

In this case series, HSI was used in 4 patients who were admitted for either esophageal cancer or cardiac carcinoma (AEG type I or II). Thoraco-abdominal surgical esophageal resection was performed after staging and neoadjuvant therapy. Intraoperative oxygenation of superficial (StO₂) and underlying tissue (NIR perfusion index) of the gastric sleeve were studied intrathoracic by means of the TIVITA® Tissue HSI camera. This was performed prior to esophagogastric anastomosis. The postoperative course, especially in view of surgical complications, was recorded.

Results

Assessment of StO₂ and NIR perfusion index was performed in 4 regions of interest per gastric sleeve, aboral and oral of the clinically determined resection line. It allowed the fast quantification of gastric oxygenation prior gastroesophageal anastomosis. Median StO₂ aboral of the determined resection line was 69%, while median StO₂ in the oral part of the gastric sleeve was found at 53%. In contrast, the median NIR perfusion index was similar aboral (80) and oral (82) of the resection line. In none of the 4 studied patients, an anastomotic failure appeared.

Discussion/Conclusion

This report suggests that HSI is a feasible technique for intraoperative assessment of tissue oxygenation before gastroesophageal anastomosis and might reduce the incidence of anastomotic failure in the gastrointestinal tract.

Current applications of artificial intelligence for intraoperative decision support in surgery

Research into medical artificial intelligence (AI) has made significant advances in recent years, including surgical applications. This scoping review investigated AI-based decision support systems targeted at the intraoperative phase of surgery and found a wide range of technological approaches applied across several surgical specialties. Within the twenty-one (n = 21) included papers, three main categories of motivations were identified for developing such technologies: (1) augmenting the information available to surgeons, (2) accelerating intraoperative pathology, and (3) recommending surgical steps. While many of the proposals hold promise for improving patient outcomes, important methodological shortcomings were observed in most of the reviewed papers that made it difficult to assess the clinical significance of the reported performance statistics. Despite limitations, the current state of this field suggests that a number of opportunities exist for future researchers and clinicians to work on AI for surgical decision support with exciting implications for improving surgical care.

In Vivo Cancer Detection in Animal Model Using Hyperspectral Image Classification with Wavelet Feature Extraction

Hyperspectral imaging (HSI) is a promising optical imaging technique for cancer detection. However, quantitative methods need to be developed in order to utilize the rich spectral information and subtle spectral variation in such images. In this study, we explore the feasibility of using wavelet-based features from in vivo hyperspectral images for head and neck cancer detection. Hyperspectral reflectance data were collected from 12 mice bearing head and neck cancer. Catenation of 5-level wavelet decomposition outputs of hyperspectral images was used as a feature for tumor discrimination. A support vector machine (SVM) was utilized as the classifier. Seven types of mother wavelets were tested to select the one with the best performance. Classifications with raw reflectance spectra, 1-level wavelet decomposition output, and 2-level wavelet decomposition output, as well as the proposed feature were carried out for comparison. Our results show that the proposed wavelet-based feature yields better classification accuracy, and that using different type and order of mother wavelet achieves different classification results. The wavelet-based classification method provides a new approach for HSI detection of head and neck cancer in the animal model.

A Customized VGG19 Network with Concatenation of Deep and Handcrafted Features for Brain Tumor Detection

Brain tumor (BT) is one of the brain abnormalities which arises due to various reasons. The unrecognized and untreated BT will increase the morbidity and mortality rates. The clinical level assessment of BT is normally performed using the bio-imaging technique, and MRI-assisted brain screening is one of the universal techniques. The proposed work aims to develop a deep learning architecture (DLA) to support the automated detection of BT using two-dimensional MRI slices. This work proposes the following DLAs to detect the BT: (i) implementing the pre-trained DLAs, such as AlexNet, VGG16, VGG19, ResNet50 and ResNet101 with the deep-features-based SoftMax classifier; (ii) pre-trained DLAs with deep-features-based classification using decision tree (DT), k nearest neighbor (KNN), SVM-linear and SVM-RBF; and (iii) a customized VGG19 network with serially-fused deep-features and handcrafted-features to improve the BT detection accuracy. The experimental investigation was separately executed using Flair, T2 and T1C modality MRI slices, and a ten-fold cross validation was implemented to substantiate the performance of proposed DLA. The results of this work confirm that the VGG19 with SVM-RBF helped to attain better classification accuracy with Flair (>99%), T2 (>98%), T1C (>97%) and clinical images (>98%).

Emerging MRI Techniques to Redefine Treatment Response in Patients With Glioblastoma

Glioblastoma is the most common and most malignant primary brain tumor. Despite aggressive multimodal treatment, its prognosis remains poor. Even with continuous developments in MRI, which has provided us with newer insights into the diagnosis and understanding of tumor biology, response assessment in the posttherapy setting remains challenging. We believe that the integration of additional information from advanced neuroimaging techniques can further improve the diagnostic accuracy of conventional MRI. In this article, we review the utility of advanced neuroimaging techniques such as diffusion-weighted imaging, diffusion tensor imaging, perfusion-weighted imaging, proton magnetic resonance spectroscopy, and chemical exchange saturation transfer in characterizing and evaluating treatment response in patients with glioblastoma. We will also discuss the existing challenges and limitations of using these techniques in clinical settings and possible solutions to avoiding pitfalls in study design, data acquisition, and analysis for future studies. LEVEL OF EVIDENCE: 2 TECHNICAL EFFICACY STAGE: 3 J. Magn. Reson. Imaging 2020;52:978-997.

Deep learning applied to hyperspectral endoscopy for online spectral classification

Hyperspectral imaging (HSI) is being explored in endoscopy as a tool to extract biochemical information that may improve contrast for early cancer detection in the gastrointestinal tract. Motion artefacts during medical endoscopy have traditionally limited HSI application, however, recent developments in the field have led to real-time HSI deployments. Unfortunately, traditional HSI analysis methods remain unable to rapidly process the volume of hyperspectral data in order to provide real-time feedback to the operator. Here, a convolutional neural network (CNN) is proposed to enable online classification of data obtained during HSI endoscopy. A five-layered CNN was trained and fine-tuned on a dataset of 300 hyperspectral endoscopy images acquired from a planar Macbeth ColorChecker chart and was able to distinguish between its 18 constituent colors with an average accuracy of 94.3% achieved at 8.8 fps. Performance was then tested on a set of images simulating an endoscopy environment, consisting of color charts warped inside a rigid tube mimicking a lumen. The algorithm proved robust to such variations, with classification accuracies over 90% being obtained despite the variations, with an average drop in accuracy of 2.4% being registered at the points of longest working distance and most inclination. For further validation of the color-based classification system, ex vivo videos of a methylene blue dyed pig esophagus and images of different disease stages in the human esophagus were analyzed, showing spatially distinct color classifications. These results suggest that the CNN has potential to provide color-based classification during real-time HSI in endoscopy.

Tumor detection of the thyroid and salivary glands using hyperspectral imaging and deep learning

The performance of hyperspectral imaging (HSI) for tumor detection is investigated in ex-vivo specimens from the thyroid (N = 200) and salivary glands (N = 16) from 82 patients. Tissues were imaged with HSI in broadband reflectance and autofluorescence modes. For comparison, the tissues were imaged with two fluorescent dyes. Additionally, HSI was used to synthesize three-band RGB multiplex images to represent the human-eye response and Gaussian RGBs, which are referred to as HSI-synthesized RGB images. Using histological ground truths, deep learning algorithms were developed for tumor detection. For the classification of thyroid tumors, HSI-synthesized RGB images achieved the best performance with an AUC score of 0.90. In salivary glands, HSI had the best performance with 0.92 AUC score. This study demonstrates that HSI could aid surgeons and pathologists in detecting tumors of the thyroid and salivary glands.

Brain Tumor Analysis Empowered with Deep Learning: A Review, Taxonomy, and Future Challenges

Deep Learning (DL) algorithms enabled computational models consist of multiple processing layers that represent data with multiple levels of abstraction. In recent years, usage of deep learning is rapidly proliferating in almost every domain, especially in medical image processing, medical image analysis, and bioinformatics. Consequently, deep learning has dramatically changed and improved the means of recognition, prediction, and diagnosis effectively in numerous areas of healthcare such as pathology, brain tumor, lung cancer, abdomen, cardiac, and retina. Considering the wide range of applications of deep learning, the objective of this article is to review major deep learning concepts pertinent to brain tumor analysis (e.g., segmentation, classification, prediction, evaluation.). A review conducted by summarizing a large number of scientific contributions to the field (i.e., deep learning in brain tumor analysis) is presented in this study. A coherent taxonomy of research landscape from the literature has also been mapped, and the major aspects of this emerging field have been discussed and analyzed. A critical discussion section to show the limitations of deep learning techniques has been included at the end to elaborate open research challenges and directions for future work in this emergent area.

Augmented reality visualization of hyperspectral imaging classifications for image-guided brain tumor phantom resection

Wearable augmented reality (AR) is an emerging technology with enormous potential for use in the medical field, from training and procedure simulations to image-guided surgery. Medical AR seeks to enable surgeons to see tissue segmentations in real time. With the objective of achieving real-time guidance, the emphasis on speed produces the need for a fast method for imaging and classification. Hyperspectral imaging (HSI) is a non-contact, optical imaging modality that rapidly acquires hundreds of images of tissue at different wavelengths, which can be used to generate spectral data of the tissue. Combining HSI information and machine-learning algorithms allows for effective tissue classification. In this paper, we constructed a brain tissue phantom with porcine blood, yellow-dyed gelatin, and colorless gelatin to represent blood vessels, tumor, and normal brain tissue, respectively. Using a segmentation algorithm, hundreds of hyperspectral images were compiled to classify each of the pixels. Three segmentation labels were generated from the data, each with a different type of tissue. Our system virtually superimposes the HSI channels and segmentation labels of a brain tumor phantom onto the real scene using the HoloLens AR headset. The user can manipulate and interact with the segmentation labels and HSI channels by repositioning, rotating, changing visibility, and switching between them. All actions can be performed through either hand or voice controls. This creates a convenient and multifaceted visualization of brain tissue in real time with minimal user restrictions. We demonstrate the feasibility of a fast and practical HIS-AR technique for potential use of image-guided brain surgery.

O’Shanahan A, Carrera D, Bisshopp S, Sosa C, Marquez M, Camacho R, Plaza MDLL, Morera J, M. Callico G. Most Relevant Spectral Bands Identification for Brain Cancer Detection Using Hyperspectral Imaging

Hyperspectral imaging (HSI) is a non-ionizing and non-contact imaging technique capable of obtaining more information than conventional RGB (red green blue) imaging. In the medical field, HSI has commonly been investigated due to its great potential for diagnostic and surgical guidance purposes. However, the large amount of information provided by HSI normally contains redundant or non-relevant information, and it is extremely important to identify the most relevant wavelengths for a certain application in order to improve the accuracy of the predictions and reduce the execution time of the classification algorithm. Additionally, some wavelengths can contain noise and removing such bands can improve the classification stage. The work presented in this paper aims to identify such relevant spectral ranges in the visual-and-near-infrared (VNIR) region for an accurate detection of brain cancer using in vivo hyperspectral images. A methodology based on optimization algorithms has been proposed for this task, identifying the relevant wavelengths to achieve the best accuracy in the classification results obtained by a supervised classifier (support vector machines), and employing the lowest possible number of spectral bands. The results demonstrate that the proposed methodology based on the genetic algorithm optimization slightly improves the accuracy of the tumor identification in ~5%, using only 48 bands, with respect to the reference results obtained with 128 bands, offering the possibility of developing customized acquisition sensors that could provide real-time HS imaging. The most relevant spectral ranges found comprise between 440.5-465.96 nm, 498.71-509.62 nm, 556.91-575.1 nm, 593.29-615.12 nm, 636.94-666.05 nm, 698.79-731.53 nm and 884.32-902.51 nm.

Hyperspectral Imaging of Head and Neck Squamous Cell Carcinoma for Cancer Margin Detection in Surgical Specimens from 102 Patients Using Deep Learning

Surgical resection of head and neck (H and N) squamous cell carcinoma (SCC) may yield inadequate surgical cancer margins in 10 to 20% of cases. This study investigates the performance of label-free, reflectance-based hyperspectral imaging (HSI) and autofluorescence imaging for SCC detection at the cancer margin in excised tissue specimens from 102 patients and uses fluorescent dyes for comparison. Fresh surgical specimens (n = 293) were collected during H and N SCC resections (n = 102). The tissue specimens were imaged with reflectance-based HSI and autofluorescence imaging and afterwards with two fluorescent dyes for comparison. A histopathological ground truth was made. Deep learning tools were developed to detect SCC with new patient samples (inter-patient) and machine learning for intra-patient tissue samples. Area under the curve (AUC) of the receiver-operator characteristic was used as the main evaluation metric. Additionally, the performance was estimated in mm increments circumferentially from the tumor-normal margin. In intra-patient experiments, HSI classified conventional SCC with an AUC of 0.82 up to 3 mm from the cancer margin, which was more accurate than proflavin dye and autofluorescence (both p < 0.05). Intra-patient autofluorescence imaging detected human papilloma virus positive (HPV+) SCC with an AUC of 0.99 at 3 mm and greater accuracy than proflavin dye (p < 0.05). The inter-patient results showed that reflectance-based HSI and autofluorescence imaging outperformed proflavin dye and standard red, green, and blue (RGB) images (p < 0.05). In new patients, HSI detected conventional SCC in the larynx, oropharynx, and nasal cavity with 0.85-0.95 AUC score, and autofluorescence imaging detected HPV+ SCC in tonsillar tissue with 0.91 AUC score. This study demonstrates that label-free, reflectance-based HSI and autofluorescence imaging methods can accurately detect the cancer margin in ex-vivo specimens within minutes. This non-ionizing optical imaging modality could aid surgeons and reduce inadequate surgical margins during SCC resections.

Hyperspectral imaging for head and neck cancer detection: specular glare and variance of the tumor margin in surgical specimens

Head and neck squamous cell carcinoma (SCC) is primarily managed by surgical cancer resection. Recurrence rates after surgery can be as high as 55%, if residual cancer is present. Hyperspectral imaging (HSI) is evaluated for detection of SCC in ex-vivo surgical specimens. Several machine learning methods are investigated, including convolutional neural networks (CNNs) and a spectral-spatial classification framework based on support vector machines. Quantitative results demonstrate that additional data preprocessing and unsupervised segmentation can improve CNN results to achieve optimal performance. The methods are trained in two paradigms, with and without specular glare. Classifying regions that include specular glare degrade the overall results, but the combination of the CNN probability maps and unsupervised segmentation using a majority voting method produces an area under the curve value of 0.81 [0.80, 0.83]. As the wavelengths of light used in HSI can penetrate different depths into biological tissue, cancer margins may change with depth and create uncertainty in the ground truth. Through serial histological sectioning, the variance in the cancer margin with depth is investigated and paired with qualitative classification heat maps using the methods proposed for the testing group of SCC patients. The results determined that the validity of the top section alone as the ground truth may be limited to 1 to 2 mm. The study of specular glare and margin variation provided better understanding of the potential of HSI for the use in the operating room.

Artificial Intelligence in the Management of Glioma: Era of Personalized Medicine

Purpose: Artificial intelligence (AI) has accelerated novel discoveries across multiple disciplines including medicine. Clinical medicine suffers from a lack of AI-based applications, potentially due to lack of awareness of AI methodology. Future collaboration between computer scientists and clinicians is critical to maximize the benefits of transformative technology in this field for patients. To illustrate, we describe AI-based advances in the diagnosis and management of gliomas, the most common primary central nervous system (CNS) malignancy.

Methods: Presented is a succinct description of foundational concepts of AI approaches and their relevance to clinical medicine, geared toward clinicians without computer science backgrounds. We also review novel AI approaches in the diagnosis and management of glioma.

Results: Novel AI approaches in gliomas have been developed to predict the grading and genomics from imaging, automate the diagnosis from histopathology, and provide insight into prognosis.

Conclusion: Novel AI approaches offer acceptable performance in gliomas. Further investigation is necessary to improve the methodology and determine the full clinical utility of these novel approaches.

In-Vivo and Ex-Vivo Tissue Analysis through Hyperspectral Imaging Techniques: Revealing the Invisible Features of Cancer

In contrast to conventional optical imaging modalities, hyperspectral imaging (HSI) is able to capture much more information from a certain scene, both within and beyond the visual spectral range (from 400 to 700 nm). This imaging modality is based on the principle that each material provides different responses to light reflection, absorption, and scattering across the electromagnetic spectrum. Due to these properties, it is possible to differentiate and identify the different materials/substances presented in a certain scene by their spectral signature. Over the last two decades, HSI has demonstrated potential to become a powerful tool to study and identify several diseases in the medical field, being a non-contact, non-ionizing, and a label-free imaging modality. In this review, the use of HSI as an imaging tool for the analysis and detection of cancer is presented. The basic concepts related to this technology are detailed. The most relevant, state-of-the-art studies that can be found in the literature using HSI for cancer analysis are presented and summarized, both in-vivo and ex-vivo. Lastly, we discuss the current limitations of this technology in the field of cancer detection, together with some insights into possible future steps in the improvement of this technology.