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Candito A, Good DW, Palacio-Torralba J, Hammer S, Johnson O, McNeill SA, Reuben RL, Chen Y. Locating and sizing tumor nodules in human prostate using instrumented probing - computational framework and experimental validation. Comput Methods Biomech Biomed Engin 2023; 26:383-398. [PMID: 35446736 DOI: 10.1080/10255842.2022.2065200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Detection of tumor nodules is key to early cancer diagnosis. This study investigates the potential of using the mechanical data, acquired from probing the prostate for detecting the existence, and, more importantly, characterizing the size and depth, from the posterior surface, of the prostate cancer (PCa) nodules. A computational approach is developed to quantify the uncertainty of nodule detectability and is based on identifying stiffness anomalies in the profiles of point force measurements across transverse sections of the prostate. The capability of the proposed method was assessed firstly using a 'training' dataset of in silico models including PCa nodules with random size, depth and location, followed by a clinical feasibility study, involving experimental data from 13 ex vivo prostates from patients who had undergone radical prostatatectomy. Promising levels of sensitivity and specificity were obtained for detecting the PCa nodules in a total of 44 prostate sections. This study has shown that the proposed methods could be a useful complementary tool to exisiting diagnostic methods of PCa. The future study will involve implementing the proposed measurement and detection strategies in vivo, with the help of a miniturized medical device.
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Affiliation(s)
- Antonio Candito
- Institute of Mechanical, Process and Energy Engineering, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, UK
| | - Daniel W Good
- Edinburgh Urological Cancer Group, Division of Pathology Laboratories, Institute of Genetics and Molecular Medicine, University of Edinburgh, Western General Hospital, Edinburgh, UK.,Department of Urology, NHS Lothian, Western General Hospital, Edinburgh, UK
| | - Javier Palacio-Torralba
- Institute of Mechanical, Process and Energy Engineering, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, UK
| | - Steven Hammer
- Institute of Mechanical, Process and Energy Engineering, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, UK
| | - Olufemi Johnson
- Institute of Mechanical, Process and Energy Engineering, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, UK
| | - S Alan McNeill
- Edinburgh Urological Cancer Group, Division of Pathology Laboratories, Institute of Genetics and Molecular Medicine, University of Edinburgh, Western General Hospital, Edinburgh, UK.,Department of Urology, NHS Lothian, Western General Hospital, Edinburgh, UK
| | - Robert L Reuben
- Institute of Mechanical, Process and Energy Engineering, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, UK
| | - Yuhang Chen
- Institute of Mechanical, Process and Energy Engineering, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, UK
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Sun YK, Yu Y, Xu G, Wu J, Liu YY, Wang S, Dong L, Xiang LH, Xu HX. Added value of shear-wave elastography in the prediction of extracapsular extension and seminal vesicle invasion before radical prostatectomy. Asian J Androl 2023; 25:259-264. [PMID: 36153925 PMCID: PMC10069689 DOI: 10.4103/aja202256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The purpose of this study was to analyze the value of transrectal shear-wave elastography (SWE) in combination with multivariable tools for predicting adverse pathological features before radical prostatectomy (RP). Preoperative clinicopathological variables, multiparametric magnetic resonance imaging (mp-MRI) manifestations, and the maximum elastic value of the prostate (Emax) on SWE were retrospectively collected. The accuracy of SWE for predicting adverse pathological features was evaluated based on postoperative pathology, and parameters with statistical significance were selected. The diagnostic performance of various models, including preoperative clinicopathological variables (model 1), preoperative clinicopathological variables + mp-MRI (model 2), and preoperative clinicopathological variables + mp-MRI + SWE (model 3), was evaluated with area under the receiver operator characteristic curve (AUC) analysis. Emax was significantly higher in prostate cancer with extracapsular extension (ECE) or seminal vesicle invasion (SVI) with both P < 0.001. The optimal cutoff Emax values for ECE and SVI were 60.45 kPa and 81.55 kPa, respectively. Inclusion of mp-MRI and SWE improved discrimination by clinical models for ECE (model 2 vs model 1, P = 0.031; model 3 vs model 1, P = 0.002; model 3 vs model 2, P = 0.018) and SVI (model 2 vs model 1, P = 0.147; model 3 vs model 1, P = 0.037; model 3 vs model 2, P = 0.134). SWE is valuable for identifying patients at high risk of adverse pathology.
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Affiliation(s)
- Yi-Kang Sun
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai 200072, China.,Department of Ultrasound, Zhongshan Hospital, Institute of Ultrasound in Medicine and Engineering, Fudan University, Shanghai 200032, China
| | - Yang Yu
- Department of Urology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai 200072, China
| | - Guang Xu
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai 200072, China
| | - Jian Wu
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai 200072, China
| | - Yun-Yun Liu
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai 200072, China
| | - Shuai Wang
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai 200072, China
| | - Lin Dong
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai 200072, China
| | - Li-Hua Xiang
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai 200072, China
| | - Hui-Xiong Xu
- Department of Ultrasound, Zhongshan Hospital, Institute of Ultrasound in Medicine and Engineering, Fudan University, Shanghai 200032, China
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Francis C, Sato T, Okuyama T, Tanaka M. A cable driven robotic palpation system with contact force sensing based on cable tension observation. Int J Med Robot 2022; 18:e2435. [PMID: 35727607 PMCID: PMC9786714 DOI: 10.1002/rcs.2435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 06/14/2022] [Accepted: 06/16/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Prostate Cancer screening based on manual palpation is subjective. Robotic palpation systems can objectively acquire stiffness conditions of the prostate. METHODS A 2DoF cable driven robotic system for prostate palpation is proposed. An indirect method to estimate the contact force based on cable tension observation is presented. Kinematic models and a joint angle estimation method to determine the tip position of the probe are derived. Positioning accuracy was verified using an optical marker tracking system and by displacement measurement, respectively. The contact force estimation method was validated on silicone phantom samples. RESULTS A good consistence between the estimated and measured contact force was observed. The contact force was correlated with the elastic modulus of each silicone phantom. There was also a good agreement between the theoretical and the measured tip position. CONCLUSION In the proposed palpation system, the indirect contact force estimation method is viable and holds potential for the stiffness assessment of the prostate. The tip position vital for palpation can be determined through estimated joint angles.
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Affiliation(s)
- Chikweto Francis
- Department of Biomedical EngineeringGraduate School of Biomedical EngineeringTohoku UniversitySendaiJapan
| | - Taiga Sato
- Department of Biomedical EngineeringGraduate School of Biomedical EngineeringTohoku UniversitySendaiJapan
| | - Takeshi Okuyama
- Department of RoboticsGraduate School of EngineeringTohoku UniversitySendaiJapan
| | - Mami Tanaka
- Department of Biomedical EngineeringGraduate School of Biomedical EngineeringTohoku UniversitySendaiJapan
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4
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Liu Y, Zeng S, Xu R. Application of Multiple Ultrasonic Techniques in the Diagnosis of Prostate Cancer. Front Oncol 2022; 12:905087. [PMID: 35832558 PMCID: PMC9271763 DOI: 10.3389/fonc.2022.905087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 05/12/2022] [Indexed: 11/23/2022] Open
Abstract
Methods for diagnosing prostate cancer (PCa) are developing in the direction of imaging. Advanced ultrasound examination modes include micro-Doppler, computerized-transrectal ultrasound, elastography, contrast-enhanced ultrasound and microultrasound. When two or more of these modes are used in PCa diagnosis, the combined technique is called multiparameter ultrasound (mp-US). Mp-US provides complementary information to multiparameter magnetic resonance imaging (mp-MRI) for diagnosing PCa. At present, no study has attempted to combine the characteristics of different ultrasound modes with advanced classification systems similar to the PIRADS system in mpMRI for the diagnosis of PCa. As an imaging method, mp-US has great potential in the diagnosis of PCa.
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Affiliation(s)
- Yushan Liu
- Department of Ultrasound, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Shi Zeng
- Department of Ultrasound, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Ran Xu
- Department of Urology, The Second Xiangya Hospital of Central South University, Changsha, China
- *Correspondence: Ran Xu,
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Chikweto F, Okuyama T, Tanaka M. Development of a tendon driven robotic probe for prostate palpation. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:1330-1335. [PMID: 34891530 DOI: 10.1109/embc46164.2021.9630059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Palpation is a clinical diagnosis method utilized by physicians to acquire valuable information about the pathological condition of an organ using the sense of touch. This method, however, is subjective. The accuracy depends on the physician's experience and skill. Therefore, to make palpation objective and minimize variability in prostate cancer diagnosis among physicians, an automated palpation system is required. This paper describes the design and experimental evaluation of a 2 Degrees of Freedom (2DoF) tendon driven robotic palpation probe. The probe's palpation motion is controlled by actuating driving tendons using a cable-differential pulley transmission system and a return spring. A kinematic model of the robotic probe was derived. Furthermore, a tendon path length model was geometrically determined, and an optimization method for guide arc center placement to minimize change in tendon length was presented. Preliminary experimental and theoretical results were compared to determine the positioning accuracy. The difference between theoretical pitch angles [0°,80°] and measured values for the yaw angle range of [0°, 40°] was found to be in the range of 0.03° ~ 5.06°.Clinical Relevance- Diagnosis based on manual palpation is often subjective and palpation sensitivity depends on the physician's level of experience and skill. Therefore, an objective method for acquiring tactile information is relevant. Robotic palpation system provides objective and quantitative information for better understanding of the pathological and physiological changes in the tissue using mechanical properties as biomarkers.
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Iele A, Ricciardi A, Pecorella C, Cirillo A, Ficuciello F, Siciliano B, La Rocca R, Mirone V, Consales M, Cusano A. Miniaturized optical fiber probe for prostate cancer screening. BIOMEDICAL OPTICS EXPRESS 2021; 12:5691-5703. [PMID: 34692209 PMCID: PMC8515973 DOI: 10.1364/boe.430408] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/16/2021] [Accepted: 07/19/2021] [Indexed: 05/17/2023]
Abstract
Tissue elasticity is universally recognized as a diagnostic and prognostic biomarker for prostate cancer. As the first diagnostic test, the digital rectal examination is used since malignancy changes the prostate morphology and affects its mechanical properties. Currently, this examination is performed manually by the physician, with an unsatisfactory positive predictive value of 42%. A more objective and spatially selective technique is expected to provide a better prediction degree and understanding of the disease. To this aim, here we propose a miniaturized probe, based on optical fiber sensor technology, for mechanical characterization of the prostate with sub-millimeter resolution. Specifically, the optical system incorporates a customized Fiber Bragg Grating, judiciously integrated in a metallic cannula and moved by a robotic arm. The probe enables the local measurement of the force upon tissue indentation with a resolution of 0.97 mN. The system has been developed in such a way to be potentially used directly in vivo. Measurements performed on phantom tissues mimicking different stages of the prostatic carcinoma demonstrated the capability of our device to distinguish healthy from diseased zones of the prostate. The study on phantoms has been complemented with preliminary ex vivo experiments on real organs obtained from radical surgeries. Our findings lay the foundation for the development of advanced optical probes that, when integrated inside biopsy needle, are able to perform in vivo direct mechanical measurements with high sensitivity and spatial resolution, opening to new scenarios for early diagnosis and enhanced diagnostic accuracy of prostate cancer.
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Affiliation(s)
- Antonio Iele
- Optoelectronics Group, Engineering Department, University of Sannio, Benevento, I-82100, Italy
| | - Armando Ricciardi
- Optoelectronics Group, Engineering Department, University of Sannio, Benevento, I-82100, Italy
| | - Claudia Pecorella
- PRISMA Lab, Department of Electrical Engineering and Information Technology, University of Naples Federico II, Naples, I-80125, Italy
| | - Andrea Cirillo
- PRISMA Lab, Department of Electrical Engineering and Information Technology, University of Naples Federico II, Naples, I-80125, Italy
| | - Fanny Ficuciello
- PRISMA Lab, Department of Electrical Engineering and Information Technology, University of Naples Federico II, Naples, I-80125, Italy
| | - Bruno Siciliano
- PRISMA Lab, Department of Electrical Engineering and Information Technology, University of Naples Federico II, Naples, I-80125, Italy
| | - Roberto La Rocca
- Department of Neurosciences, Sciences of Reproduction and Odontostomatology, Urology Unit, University of Naples Federico II, Naples, I-80125, Italy
| | - Vincenzo Mirone
- Department of Neurosciences, Sciences of Reproduction and Odontostomatology, Urology Unit, University of Naples Federico II, Naples, I-80125, Italy
| | - Marco Consales
- Optoelectronics Group, Engineering Department, University of Sannio, Benevento, I-82100, Italy
| | - Andrea Cusano
- Optoelectronics Group, Engineering Department, University of Sannio, Benevento, I-82100, Italy
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7
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Candito A, Palacio-Torralba J, Jiménez-Aguilar E, Good DW, McNeill A, Reuben RL, Chen Y. Identification of tumor nodule in soft tissue: An inverse finite-element framework based on mechanical characterization. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2020; 36:e3369. [PMID: 32452138 DOI: 10.1002/cnm.3369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 04/01/2020] [Accepted: 05/16/2020] [Indexed: 06/11/2023]
Abstract
Identification and characterization of nodules in soft tissue, including their size, shape, and location, provide a basis for tumor identification. This study proposes an inverse finite-element (FE) based computational framework, for characterizing the size of examined tissue sample and detecting the presence of embedded tumor nodules using instrumented palpation, without a priori anatomical knowledge. The inverse analysis was applied to a model system, the human prostate, and was based on the reaction forces which can be obtained by trans-rectal mechanical probing and those from an equivalent FE model, which was optimized iteratively, by minimizing an error function between the two cases, toward the target solution. The tumor nodule can be identified through its influence on the stress state of the prostate. The effectiveness of the proposed method was further verified using a realistic prostate model reconstructed from magnetic resonance (MR) images. The results show the proposed framework to be capable of characterizing the key geometrical indices of the prostate and identifying the presence of cancerous nodules. Therefore, it has potential, when combined with instrumented palpation, for primary diagnosis of prostate cancer, and, potentially, solid tumors in other types of soft tissue.
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Affiliation(s)
- Antonio Candito
- Institute of Mechanical, Process and Energy Engineering, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, UK
| | - Javier Palacio-Torralba
- Institute of Mechanical, Process and Energy Engineering, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, UK
| | | | - Daniel W Good
- Edinburgh Urological Cancer Group, Division of Pathology Laboratories, Institute of Genetics and Molecular Medicine, Western General Hospital, The University of Edinburgh, Edinburgh, UK
- Department of Urology, NHS Lothian, Western General Hospital, Edinburgh, UK
| | - Alan McNeill
- Edinburgh Urological Cancer Group, Division of Pathology Laboratories, Institute of Genetics and Molecular Medicine, Western General Hospital, The University of Edinburgh, Edinburgh, UK
- Department of Urology, NHS Lothian, Western General Hospital, Edinburgh, UK
| | - Robert L Reuben
- Institute of Mechanical, Process and Energy Engineering, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, UK
| | - Yuhang Chen
- Institute of Mechanical, Process and Energy Engineering, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, UK
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8
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Estimation of the hyperelastic parameters of fresh human oropharyngeal soft tissues using indentation testing. J Mech Behav Biomed Mater 2020; 108:103798. [PMID: 32469719 DOI: 10.1016/j.jmbbm.2020.103798] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 03/31/2020] [Accepted: 04/12/2020] [Indexed: 01/15/2023]
Abstract
Patient-specific finite element (FE) modeling of the upper airway is an effective tool for accurate assessment of obstructive sleep apnea (OSA) syndrome. It is also useful for planning minimally invasive surgical procedures under severe OSA conditions. A major requirement of FE modeling is having reliable data characterizing the biomechanical properties of the upper airway tissues, particularly oropharyngeal soft tissue. While some data characterizing this tissue's linear elastic regime is available, reliable data characterizing its hyperelasticity is scarce. The aim of the current study is to estimate the hyperelastic mechanical properties of the oropharyngeal soft tissues, including the palatine tonsil, soft palate, uvula, and tongue base. Fresh tissue specimens of human oropharyngeal tissue were acquired from 13 OSA patients who underwent standard surgical procedures. Indentation testing was performed on the specimens to obtain their force-displacement data. To determine the specimens' hyperelastic parameters using these data, an inverse FE framework was utilized. In this work, the hyperelastic parameters corresponding to the commonly used Yeoh and 2nd order Ogden models were obtained. Both models captured the experimental force-displacement data of the tissue specimens reasonably accurately with mean errors of 11.65% or smaller. This study has provided estimates of the hyperelastic parameters of all upper airway soft tissues using fresh human tissue specimens for the first time.
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9
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Black RA, Houston G. 40th Anniversary Issue: Reflections on papers from the archive on "Biomechanics". Med Eng Phys 2020; 72:70-71. [PMID: 31554579 DOI: 10.1016/j.medengphy.2019.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Richard A Black
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, Scotland, UK.
| | - Gregor Houston
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, Scotland, UK
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10
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Johnson B, Campbell S, Campbell-Kyureghyan N. The differences in measured prostate material properties between probing and unconfined compression testing methods. Med Eng Phys 2020; 80:44-51. [PMID: 32381284 DOI: 10.1016/j.medengphy.2020.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 01/21/2020] [Accepted: 03/01/2020] [Indexed: 01/20/2023]
Abstract
Characterization of the mechanical properties of organs is important for determining their behavior under load and understanding and predicting their response. In order to appropriately understand behavior, including developing predictive models, the method used to measure the properties should match the application as different testing techniques can yield different results. One of the organs where little mechanical testing has been performed is the prostate. Therefore, the goal of this paper is to expand the knowledge of prostate gland mechanical behavior by using two different compressive testing methods under various loading rates. No differences were found between the elastic modulus measured using the compression and probing protocols for both human and porcine specimens. The elastic modulus ranged from 0.08 MPa at 1%/s to 0.24 MPa at 25%/s for human specimens and from 0.2 MPa at 1%/s to 0.4 MPa at 25%/s for porcine specimens. A strain rate dependency of the elastic modulus was observed for both testing methods. The dependency on strain rate started to saturate at higher rates and a material model was created to quantify this dependence as well as the stress-strain behavior. No strain rate dependency was observed for failure stress or failure strain. Overall, similar values of elastic modulus were found for both probing and compression protocols and the relationship developed between elastic modulus and strain rate could be implemented in models of the prostate gland to aid in understanding the response to dynamic loads.
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Affiliation(s)
- Blake Johnson
- Industrial and Manufacturing Engineering Department, College of Engineering and Applied Science, University of Wisconsin-Milwaukee, 3200N Cramer St., Milwaukee, WI 53211, United States
| | - Scott Campbell
- Structural Analysis Consulting Group, PO Box 170735, Milwaukee, WI 53217, United States
| | - Naira Campbell-Kyureghyan
- Industrial and Manufacturing Engineering Department, College of Engineering and Applied Science, University of Wisconsin-Milwaukee, 3200N Cramer St., Milwaukee, WI 53211, United States; Department of Mechanical Engineering, School of Science and Engineering, Merrimack College, 315 Turnpike St., N Andover, MA 01845, United States.
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11
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Correas JM, Halpern EJ, Barr RG, Ghai S, Walz J, Bodard S, Dariane C, de la Rosette J. Advanced ultrasound in the diagnosis of prostate cancer. World J Urol 2020; 39:661-676. [PMID: 32306060 DOI: 10.1007/s00345-020-03193-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 03/30/2020] [Indexed: 12/17/2022] Open
Abstract
The diagnosis of prostate cancer (PCa) can be challenging due to the limited performance of current diagnostic tests, including PSA, digital rectal examination and transrectal conventional US. Multiparametric MRI has improved PCa diagnosis and is recommended prior to biopsy; however, mp-MRI does miss a substantial number of PCa. Advanced US modalities include transrectal prostate elastography and contrast-enhanced US, as well as improved B-mode, micro-US and micro-Doppler techniques. These techniques can be combined to define a novel US approach, multiparametric US (mp-US). Mp-US improves PCa diagnosis but is not sufficiently accurate to obviate the utility of mp-MRI. Mp-US using advanced techniques and mp-MRI provide complementary information which will become even more important in the era of focal therapy, where precise identification of PCa location is needed.
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Affiliation(s)
- Jean-Michel Correas
- Department of Adult Radiology, Paris University and Necker University Hospital, 149 rue de Sèvres, 75015, Paris Cedex 15, France.
| | - Ethan J Halpern
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Richard G Barr
- Department of Radiology, Northeastern Ohio Medical University, Rootstown, OH, USA
| | - Sangeet Ghai
- Department of Medical Imaging, Princess Margaret Cancer Centre and University of Toronto, Toronto, ON, Canada
| | - Jochen Walz
- Department of Urology, Institut Paoli-Calmettes Cancer Centre, Marseille, France
| | - Sylvain Bodard
- Department of Adult Radiology, Paris University and Necker University Hospital, 149 rue de Sèvres, 75015, Paris Cedex 15, France
| | - Charles Dariane
- Department of Urology, Paris University and European Hospital Georges Pompidou, Paris, France
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12
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A novel palpation-based method for tumor nodule quantification in soft tissue-computational framework and experimental validation. Med Biol Eng Comput 2020; 58:1369-1381. [PMID: 32279204 PMCID: PMC7211792 DOI: 10.1007/s11517-020-02168-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 03/21/2020] [Indexed: 12/02/2022]
Abstract
Variation in mechanical properties is a useful marker for cancer in soft tissue and has been used in clinical diagnosis for centuries. However, to develop such methods as instrumented palpation, there remain challenges in using the mechanical response during palpation to quantify tumor load. This study proposes a computational framework of identification and quantification of cancerous nodules in soft tissue without a priori knowledge of its geometry, size, and depth. The methodology, using prostate tissue as an exemplar, is based on instrumented palpation performed at positions with various indentation depths over the surface of the relevant structure (in this case, the prostate gland). The profile of force feedback results is then compared with the benchmark in silico models to estimate the size and depth of the cancerous nodule. The methodology is first demonstrated using computational models and then validated using tissue-mimicking gelatin phantoms, where the depth and volume of the tumor nodule is estimated with good accuracy. The proposed framework is capable of quantifying a tumor nodule in soft tissue without a priori information about its geometry, thus presenting great promise in clinical palpation diagnosis for a wide variety of solid tumors including breast and prostate cancer. This study proposes a computational framework of quantification of cancerous nodules in soft tissue. The methodology is based on instrumental palpation performed at positions with various indentation depths. The profile of force feedback results is then compared with the benchmark in silico models to estimate the size and depth of the cancerous nodule. ![]()
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13
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Quantifying tactile properties of liver tissue, silicone elastomers, and a 3D printed polymer for manufacturing realistic organ models. J Mech Behav Biomed Mater 2020; 104:103630. [DOI: 10.1016/j.jmbbm.2020.103630] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 01/07/2020] [Accepted: 01/08/2020] [Indexed: 01/17/2023]
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14
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A Mechatronic Platform for Computer Aided Detection of Nodules in Anatomopathological Analyses via Stiffness and Ultrasound Measurements. SENSORS 2019; 19:s19112512. [PMID: 31159334 PMCID: PMC6603638 DOI: 10.3390/s19112512] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 05/11/2019] [Accepted: 05/29/2019] [Indexed: 11/17/2022]
Abstract
This study presents a platform for ex-vivo detection of cancer nodules, addressing automation of medical diagnoses in surgery and associated histological analyses. The proposed approach takes advantage of the property of cancer to alter the mechanical and acoustical properties of tissues, because of changes in stiffness and density. A force sensor and an ultrasound probe were combined to detect such alterations during force-regulated indentations. To explore the specimens, regardless of their orientation and shape, a scanned area of the test sample was defined using shape recognition applying optical background subtraction to the images captured by a camera. The motorized platform was validated using seven phantom tissues, simulating the mechanical and acoustical properties of ex-vivo diseased tissues, including stiffer nodules that can be encountered in pathological conditions during histological analyses. Results demonstrated the platform’s ability to automatically explore and identify the inclusions in the phantom. Overall, the system was able to correctly identify up to 90.3% of the inclusions by means of stiffness in combination with ultrasound measurements, paving pathways towards robotic palpation during intraoperative examinations.
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15
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Kelly NP, Flood HD, Hoey DA, Kiely PA, Giri SK, Coffey JC, Walsh MT. Direct mechanical characterization of prostate tissue-a systematic review. Prostate 2019; 79:115-125. [PMID: 30225866 DOI: 10.1002/pros.23718] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 08/21/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Direct mechanical characterization of tissue is the application of engineering techniques to biological tissue to ascertain stiffness or elasticity, which can change in response to disease states. A number of papers have been published on the application of these techniques to prostate tissue with a range of results reported. There is a marked variability in the results depending on testing techniques and disease state of the prostate tissue. We aimed to clarify the utility of direct mechanical characterization of prostate tissue in identifying disease states. METHODS A systematic review of the published literature regarding direct mechanical characterization of prostate tissue was undertaking according to PRISMA guidelines. RESULTS A variety of testing methods have been used, including compression, indentation, and tensile testing, as well as some indirect testing techniques, such as shear-wave elastography. There is strong evidence of significant stiffness differences between cancerous and non-cancerous prostate tissue, as well as correlations with prostate cancer stage. There is a correlation with increasing prostate stiffness and increasing lower urinary tract symptoms in patients with benign prostate hyperplasia. There is a wide variation in the testing methods and protocols used in the literature making direct comparison between papers difficult. Most studies utilise ex-vivo or cadaveric tissue, while none incorporate in vivo testing. CONCLUSION Direct mechanical assessment of prostate tissue permits a better understanding of the pathological and physiological changes that are occurring within the tissue. Further work is needed to include prospective and in vivo data to aid medical device design and investigate non-surgical methods of managing prostate disease.
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Affiliation(s)
- Niall P Kelly
- Department of Urology, University Hospital Limerick, Limerick, Ireland
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
- BioScience BioEngineering Research (BioSciBER), Health Research Institute (HRI), Bernal Institute, School of Engineering, University of Limerick, Limerick, Ireland
| | - Hugh D Flood
- Department of Urology, University Hospital Limerick, Limerick, Ireland
| | - David A Hoey
- Trinity Centre for Bioengineering, Trinity Biomedical Sciences Institute, Department of Mechanical and Manufacturing Engineering, School of Engineering, Trinity College Dublin, Dublin, Ireland
- Advanced Materials and Bioengineering Research Centre, Trinity College Dublin & RCSI, Dublin, Ireland
| | - Patrick A Kiely
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
- BioScience BioEngineering Research (BioSciBER), Health Research Institute (HRI), Bernal Institute, School of Engineering, University of Limerick, Limerick, Ireland
| | - Subhasis K Giri
- Department of Urology, University Hospital Limerick, Limerick, Ireland
| | - J Calvin Coffey
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Michael T Walsh
- BioScience BioEngineering Research (BioSciBER), Health Research Institute (HRI), Bernal Institute, School of Engineering, University of Limerick, Limerick, Ireland
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Gerling GJ, Hauser SC, Soltis BR, Bowen AK, Fanta KD, Wang Y. A Standard Methodology to Characterize the Intrinsic Material Properties of Compliant Test Stimuli. IEEE TRANSACTIONS ON HAPTICS 2018; 11:498-508. [PMID: 29993841 PMCID: PMC6396288 DOI: 10.1109/toh.2018.2825396] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Understanding how we perceive differences in material compliance, or 'softness,' is a central topic in the field of haptics. The intrinsic elasticity of an object is the primary factor thought to influence our perceptual estimates. Therefore, most studies test and report the elasticity of their stimuli, typically as stiffness or modulus. However, many reported estimates are of very high magnitude for silicone-elastomers, which may be due to artifacts in characterization technique. This makes it very difficult to compare the perceptual results between the studies. The work herein defines a standardized and easy-to-implement way to characterize test stimuli. The procedure involves the unconstrained, uniaxial compression of a plate into cylindrical substrates 10 mm tall by 10 mm diameter. The resultant force-displacement data are straightforwardly converted into stress-strain data, from which a modulus is readily derived. This procedure was used to re-characterize stimuli from prior studies. The revised results from the validated method herein are 200-1,100 percent lower than modulus values either reported and/or approximated from stiffness. This is practically significant when differences of 10-15 percent are perceptually discriminable. The re-characterized estimates are useful in comparing prior studies and designing new studies. Furthermore, this characterization methodology may help more readily bridge studies on perception with those designing technology.
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17
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Xu C, Wang Y, Hauser SC, Gerling GJ. In the Tactile Discrimination of Compliance, Perceptual Cues in Addition to Contact Area Are Required. ACTA ACUST UNITED AC 2018; 62:1535-1539. [PMID: 31787831 DOI: 10.1177/1541931218621347] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In our ability to discriminate compliant, or 'soft,' objects, we rely upon information acquired from interactions at the finger pad. We have yet to resolve the most pertinent perceptual cues. However, doing so is vital for building effective, dynamic displays. By introducing psychophysical illusions through spheres of various size and elasticity, we investigate the utility of contact area cues, thought to be key in encoding compliance. For both active and passive touch, we determine finger pad-to-stimulus contact areas, using an ink-based procedure, as well as discrimination thresholds. The findings indicate that in passive touch, participants cannot discriminate certain small compliant versus large stiff spheres, which generate similar contact areas. In active touch, however, participants easily discriminate these spheres, though contact areas remain similar. Supplementary cues based on stimulus rate and/or proprioception seem vital. One cue that does differ for illusion cases is finger displacement given a volitionally applied force.
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18
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Correlation between stress drop and applied strain as a biomarker for tumor detection. J Mech Behav Biomed Mater 2018; 86:450-462. [PMID: 30054237 DOI: 10.1016/j.jmbbm.2018.07.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 07/04/2018] [Accepted: 07/15/2018] [Indexed: 11/23/2022]
Abstract
This is the first study to measure the viscoelastic behavior of tumor tissues using stepwise compression-relaxation testing, and investigate the measured (Δσ-ε) relation between stress drop (Δσ) and applied strain (ε) as a biomarker for tumor detection. Stepwise compression-relaxation testing was implemented via a 2D tactile sensor to measure stress drop at each applied strain of a sample. Pearson correlation analysis was conducted to quantify the measured Δσ-ε relation as slope of stress drop versus applied strain (m=Δσ/ε) and coefficient of determination (R2). The measured results on soft materials revealed no dependency of coefficient of determination on the testing parameters and dependency of slope on them. Three groups of tissues: five mouse breast tumor (BT) tissues ex vivo, two mouse pancreatic tumor (PT) tissues in vivo and six normal tissues, were measured by using different testing parameters. Coefficient of determination was found to show significant difference among the center, edge and outside sites of all the BT tissues, and no difference between the BT outside sites and the normal tissues. Coefficient of determination also revealed significant difference between before and after treatment of the PT tissues, and no difference between the PT tissues after treatment and the normal tissues. Moreover, coefficient of determination of the PT tissues before treatment was found to be significantly different from that of the BT center sites, but slope failed to capture their difference. Dummy tumors made of silicon rubbers were found to behave differently from the native tumors. By removing the need of fitting the time-dependent data with a viscoelastic model, this study offered a time-efficient solution to quantifying the viscosity for tumor detection.
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19
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Hauser SC, Gerling GJ, Hauser SC, Gerling GJ, Gerling GJ, Hauser SC. Force-Rate Cues Reduce Object Deformation Necessary to Discriminate Compliances Harder than the Skin. IEEE TRANSACTIONS ON HAPTICS 2018; 11:232-240. [PMID: 28641270 PMCID: PMC6020043 DOI: 10.1109/toh.2017.2715845] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Grasping and manipulating an object requires us to perceive its material compliance. Compliance is thought to be encoded by relationships of force, displacement, and contact area at the finger pad. Prior work suggests that objects must be sufficiently deformed to become discriminable, but the utility of time-dependent cues has not been fully explored. The studies herein find that the availability of force-rate cues improve compliance discriminability so as to require less deformation of stimulus and finger pad. In particular, we tested the impact of controlling force-rate and displacement-rate cues in passive touch psychophysical experiments. An ink-based method to mark the finger pad was used to measure contact area per stimulus, simultaneously with displacement and force. Compliances spanned a range harder and softer than the finger pad. The results indicated harder compliances were discriminable at lower peak forces when the stimulus control mode was displacement-rate (0.5 N) compared to force-rate (1.3 N). That is, when displacement-rate was controlled to be equal between the two compliances, the resultant force-rate psychophysical cues could be more readily discriminated. In extending prior studies, while some magnitude of finger pad deformation may be sufficient for discriminability, temporal cues tied to force afford more efficient judgments.
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20
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Bayat S, Azizi S, Daoud MI, Nir G, Imani F, Gerardo CD, Yan P, Tahmasebi A, Vignon F, Sojoudi S, Wilson S, Iczkowski KA, Lucia MS, Goldenberg L, Salcudean SE, Abolmaesumi P, Mousavi P. Investigation of Physical Phenomena Underlying Temporal-Enhanced Ultrasound as a New Diagnostic Imaging Technique: Theory and Simulations. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2018; 65:400-410. [PMID: 29505407 DOI: 10.1109/tuffc.2017.2785230] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Temporal-enhanced ultrasound (TeUS) is a novel noninvasive imaging paradigm that captures information from a temporal sequence of backscattered US radio frequency data obtained from a fixed tissue location. This technology has been shown to be effective for classification of various in vivo and ex vivo tissue types including prostate cancer from benign tissue. Our previous studies have indicated two primary phenomena that influence TeUS: 1) changes in tissue temperature due to acoustic absorption and 2) micro vibrations of tissue due to physiological vibration. In this paper, first, a theoretical formulation for TeUS is presented. Next, a series of simulations are carried out to investigate micro vibration as a source of tissue characterizing information in TeUS. The simulations include finite element modeling of micro vibration in synthetic phantoms, followed by US image generation during TeUS imaging. The simulations are performed on two media, a sparse array of scatterers and a medium with pathology mimicking scatterers that match nuclei distribution extracted from a prostate digital pathology data set. Statistical analysis of the simulated TeUS data shows its ability to accurately classify tissue types. Our experiments suggest that TeUS can capture the microstructural differences, including scatterer density, in tissues as they react to micro vibrations.
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21
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Clements MB, Schmidt KM, Canfield SE, Gilbert SM, Khandelwal SR, Koontz BF, Lallas CD, Liauw S, Nguyen PL, Showalter TN, Trabulsi EJ, Cathro HP, Schenkman NS, Krupski TL. Creation of a Novel Digital Rectal Examination Evaluation Instrument to Teach and Assess Prostate Examination Proficiency. JOURNAL OF SURGICAL EDUCATION 2018; 75:434-441. [PMID: 28923535 DOI: 10.1016/j.jsurg.2017.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 07/16/2017] [Accepted: 08/05/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To create a validated tool to measure digital rectal examination proficiency and aid with teaching of the examination. DESIGN The Digital Rectal Examination Clinical Tool was created using a modified Delphi method with 5 urologists and 5 radiation oncologists. The instrument was then validated in a population of preclinical medical students examining male urological teaching associates, and clinical trainees (third- and fourth-year medical students and urology resident physicians) examining prospectively enrolled subjects. Trainees completed paired examinations with an attending urologist, and responses were scored with reference to the attending responses. SETTING The instrument was validated at the University of Virginia in the urology clinic, endoscopic operating room, and main operating room settings. PARTICIPANTS We tested the instrument on consenting subjects consisting of male urologic teaching associates (n = 12), clinic patients (n = 4), and operating room patients (n = 64). The participants were undergraduate (n = 302) and graduate (n = 9) medical trainees. RESULTS In preclerkship trainees, improved scores in subjects without abnormal compared to those with abnormal findings demonstrated validity. In clinical trainees, scores on the Digital Rectal Examination Clinical Tool increased by 2% for each additional year of training, demonstrating construct validity. CONCLUSIONS We used an expert panel to create a novel instrument for measuring digital rectal examination proficiency and validated it with preclinical and clinical trainee cohorts at our institution.
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Affiliation(s)
- Matthew B Clements
- Department of Urology, University of Virginia, Charlottesville, Virginia.
| | - Karen M Schmidt
- Department of Psychology, University of Virginia, Charlottesville, Virginia
| | | | - Scott M Gilbert
- Department of Urology, Moffitt Cancer Center, Tampa, Florida
| | - Shiv R Khandelwal
- Department of Radiation Oncology, University of Virginia, Charlottesville, Virginia
| | - Bridget F Koontz
- Department of Radiation Oncology, Duke Cancer Institute, Durham, North Carolina
| | - Costas D Lallas
- Department of Urology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Stanley Liauw
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, Illinois
| | - Paul L Nguyen
- Department of Radiation Oncology, Harvard Medical School, Boston, Massachusetts
| | - Timothy N Showalter
- Department of Radiation Oncology, University of Virginia, Charlottesville, Virginia
| | - Edouard J Trabulsi
- Department of Urology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Helen P Cathro
- Department of Pathology, University of Virginia, Charlottesville, Virginia
| | - Noah S Schenkman
- Department of Urology, University of Virginia, Charlottesville, Virginia
| | - Tracey L Krupski
- Department of Urology, University of Virginia, Charlottesville, Virginia
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22
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Palacio‐Torralba J, Good DW, Stewart GD, McNeill SA, Reuben RL, Chen Y. A novel method for rapid and quantitative mechanical assessment of soft tissue for diagnostic purposes: A computational study. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2018; 34:e2917. [PMID: 28753220 PMCID: PMC5836875 DOI: 10.1002/cnm.2917] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 06/23/2017] [Accepted: 07/20/2017] [Indexed: 05/07/2023]
Abstract
Biological tissues often experience drastic changes in their microstructure due to their pathophysiological conditions. Such microstructural changes could result in variations in mechanical properties, which can be used in diagnosing or monitoring a wide range of diseases, most notably cancer. This paves the avenue for non-invasive diagnosis by instrumented palpation although challenges remain in quantitatively assessing the amount of diseased tissue by means of mechanical characterization. This paper presents a framework for tissue diagnosis using a quantitative and efficient estimation of the fractions of cancerous and non-cancerous tissue without a priori knowledge of tissue microstructure. First, the sample is tested in a creep or stress relaxation experiment, and the behavior is characterized using a single term Prony series. A rule of mixtures, which relates tumor fraction to the apparent mechanical properties, is then obtained by minimizing the difference between strain energy of a heterogeneous system and an equivalent homogeneous one. Finally, the percentage of each tissue constituent is predicted by comparing the observed relaxation time with that calculated from the rule of mixtures. The proposed methodology is assessed using models reconstructed from histological samples and magnetic resonance imaging of prostate. Results show that estimation of cancerous tissue fraction can be obtained with a maximum error of 12% when samples of different sizes, geometries, and tumor fractions are presented. The proposed framework has the potential to be applied to a wide range of diseases such as rectal polyps, cirrhosis, or breast and prostate cancer whose current primary diagnosis remains qualitative.
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Affiliation(s)
- Javier Palacio‐Torralba
- Institute of Mechanical, Process, and Energy Engineering, School of Engineering and Physical SciencesHeriot‐Watt UniversityEdinburghEH14 4ASUK
| | - Daniel W. Good
- Edinburgh Urological Cancer Group, Division of Pathology Laboratories, Institute of Genetics and Molecular MedicineUniversity of EdinburghWestern General Hospital, Crewe Road SouthEdinburghEH4 2XUUK
| | - Grant D. Stewart
- Edinburgh Urological Cancer Group, Division of Pathology Laboratories, Institute of Genetics and Molecular MedicineUniversity of EdinburghWestern General Hospital, Crewe Road SouthEdinburghEH4 2XUUK
- Department of Urology, NHS LothianWestern General HospitalCrewe Road SouthEdinburghEH4 2XUUK
| | - S. Alan McNeill
- Edinburgh Urological Cancer Group, Division of Pathology Laboratories, Institute of Genetics and Molecular MedicineUniversity of EdinburghWestern General Hospital, Crewe Road SouthEdinburghEH4 2XUUK
- Department of Urology, NHS LothianWestern General HospitalCrewe Road SouthEdinburghEH4 2XUUK
| | - Robert L. Reuben
- Institute of Mechanical, Process, and Energy Engineering, School of Engineering and Physical SciencesHeriot‐Watt UniversityEdinburghEH14 4ASUK
| | - Yuhang Chen
- Institute of Mechanical, Process, and Energy Engineering, School of Engineering and Physical SciencesHeriot‐Watt UniversityEdinburghEH14 4ASUK
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23
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Hammer SJ, Good DW, Scanlan P, Palacio-Torralba J, Phipps S, Stewart GD, Shu W, Chen Y, McNeill SA, Reuben RL. Quantitative mechanical assessment of the whole prostate gland ex vivo using dynamic instrumented palpation. Proc Inst Mech Eng H 2017; 231:1081-1100. [PMID: 28965486 DOI: 10.1177/0954411917734257] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
An instrumented palpation sensor, designed for measuring the dynamic modulus of tissue in vivo, has been developed and trialled on ex vivo whole prostate glands. The sensor consists of a flexible membrane sensor/actuator with an embedded strain gauge and is actuated using a dynamically varying airflow at frequencies of 1 and 5 Hz. The device was calibrated using an indentation stiffness measurement rig and gelatine samples with a range of static modulus similar to that reported in the literature for prostate tissue. The glands were removed from patients with diagnosed prostate cancer scheduled for radical prostatectomy, and the stiffness was measured within 30 min of surgical removal. Each prostate was later examined histologically in a column immediately below each indentation point and graded into one of the four groups; normal, benign prostatic hyperplasia, cancerous and mixed cancer and benign prostatic hyperplasia. In total, 11 prostates were assessed using multiple point probing, and the complex modulus at 1 and 5 Hz was calculated on a point-by-point basis. The device yielded values of quasi-static modulus of 15 ± 0.5 kPa and dynamic modulus of 20 ± 0.5 kPa for whole prostates, and a sensitivity of up to 80% with slightly lower specificity was achieved on diagnosis of prostate cancer using a combination of mechanical measures. This assessment did not take into account some obvious factors such as edge effects, overlap and clinical significance of the cancer, all of which would improve performance. The device, as currently configured, is immediately deployable in vivo. A number of improvements are also identified which could improve the sensitivity and specificity in future embodiments of the probe.
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Affiliation(s)
- Steven J Hammer
- 1 Institute of Mechanical, Process and Energy Engineering, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, UK
| | - Daniel W Good
- 2 Department of Urology, Western General Hospital, Edinburgh, UK
- 3 Edinburgh Urological Cancer Group, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Paul Scanlan
- 1 Institute of Mechanical, Process and Energy Engineering, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, UK
| | - Javier Palacio-Torralba
- 1 Institute of Mechanical, Process and Energy Engineering, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, UK
| | - Simon Phipps
- 2 Department of Urology, Western General Hospital, Edinburgh, UK
- 3 Edinburgh Urological Cancer Group, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Grant D Stewart
- 3 Edinburgh Urological Cancer Group, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Will Shu
- 1 Institute of Mechanical, Process and Energy Engineering, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, UK
| | - Yuhang Chen
- 1 Institute of Mechanical, Process and Energy Engineering, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, UK
| | - S Alan McNeill
- 2 Department of Urology, Western General Hospital, Edinburgh, UK
- 3 Edinburgh Urological Cancer Group, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Robert L Reuben
- 1 Institute of Mechanical, Process and Energy Engineering, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, UK
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24
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Doyle AJ, King DM, Browne JE. A review of the recommendations governing quality assurance of ultrasound systems used for guidance in prostate brachytherapy. Phys Med 2017; 44:51-57. [PMID: 29254591 DOI: 10.1016/j.ejmp.2017.11.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 09/23/2017] [Accepted: 11/11/2017] [Indexed: 11/19/2022] Open
Abstract
Ultrasound guided brachytherapy for the treatment of prostate cancer has become a routine treatment option, due to many benefits including patient recovery and dose localisation [1]; however it is not clear whether the standards which govern the image quality for these systems are adequate. Upon review of the recommended standards for ultrasound systems used in prostate brachytherapy procedures, the recommended tests do not appear to be specific to the clinical application of ultrasound guided prostate brachytherapy. Rather they are generic and similar to those recommended for other clinical applications such as general abdominal scanning [2]. Furthermore, there is growing evidence that these tests should be specific to the clinical application [3,4] in order to gain meaningful data about the performance of the system for the application, and also to detect clinically relevant changes in quality control results. An additional problem is that there are no clinically relevant test phantom recommended for the quality assurance of ultrasound systems used in prostate brachytherapy. The image quality for this application of ultrasound needs to be monitored to ensure consistent levels of confidence in the procedure. This paper reviews the currently recommended test guidelines and test phantoms for ultrasound systems used in prostate brachytherapy from the different standard bodies and professional organisations. A critical analysis of those tests which are most reflective of the imaging and guidance tasks undertaken in an ultrasound guided prostate brachytherapy procedure will also be presented to inform the design of a TRUS quality assurance protocol.
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Affiliation(s)
- Andrea Jane Doyle
- School of Physics & Clinical & Optometric Sciences, Medical Ultrasound Physics and Technology Group, Centre of Industrial Engineering Optics, FOCAS Institute, Dublin Institute of Technology, Ireland.
| | | | - Jacinta E Browne
- School of Physics & Clinical & Optometric Sciences, Medical Ultrasound Physics and Technology Group, Centre of Industrial Engineering Optics, FOCAS Institute, Dublin Institute of Technology, Ireland.
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Palacio-Torralba J, Good DW, McNeill SA, Reuben RL, Chen Y. Histology-based homogenization analysis of soft tissue: application to prostate cancer. J R Soc Interface 2017; 14:rsif.2017.0088. [PMID: 28404869 PMCID: PMC5414912 DOI: 10.1098/rsif.2017.0088] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 03/16/2017] [Indexed: 12/21/2022] Open
Abstract
It is well known that the changes in tissue microstructure associated with certain pathophysiological conditions can influence its mechanical properties. Quantitatively relating the tissue microstructure to the macroscopic mechanical properties could lead to significant improvements in clinical diagnosis, especially when the mechanical properties of the tissue are used as diagnostic indices such as in digital rectal examination and elastography. In this study, a novel method of imposing periodic boundary conditions in non-periodic finite-element meshes is presented. This method is used to develop quantitative relationships between tissue microstructure and its apparent mechanical properties for benign and malignant tissue at various length scales. Finally, the inter-patient variation in the tissue properties is also investigated. Results show significant changes in the statistical distribution of the mechanical properties at different length scales. More importantly the loss of the normal differentiation of glandular structure of cancerous tissue has been demonstrated to lead to changes in mechanical properties and anisotropy. The proposed methodology is not limited to a particular tissue or material and the example used could help better understand how changes in the tissue microstructure caused by pathological conditions influence the mechanical properties, ultimately leading to more sensitive and accurate diagnostic technologies.
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Affiliation(s)
- Javier Palacio-Torralba
- Institute of Mechanical, Process and Energy Engineering, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh EH14 4AS, UK
| | - Daniel W Good
- Edinburgh Urological Cancer Group, Division of Pathology Laboratories, Institute of Genetics and Molecular Medicine, University of Edinburgh, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK.,Department of Urology, NHS Lothian, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK
| | - S Alan McNeill
- Edinburgh Urological Cancer Group, Division of Pathology Laboratories, Institute of Genetics and Molecular Medicine, University of Edinburgh, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK.,Department of Urology, NHS Lothian, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK
| | - Robert L Reuben
- Institute of Mechanical, Process and Energy Engineering, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh EH14 4AS, UK
| | - Yuhang Chen
- Institute of Mechanical, Process and Energy Engineering, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh EH14 4AS, UK
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26
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Rodriguez-Teja M, Breit C, Clarke M, Talar K, Wang K, Mohammad MA, Pickwell S, Etchandy G, Stasiuk GJ, Sturge J. How to Study Basement Membrane Stiffness as a Biophysical Trigger in Prostate Cancer and Other Age-related Pathologies or Metabolic Diseases. J Vis Exp 2016. [PMID: 27684203 PMCID: PMC5092048 DOI: 10.3791/54230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Here we describe a protocol that can be used to study the biophysical microenvironment related to increased thickness and stiffness of the basement membrane (BM) during age-related pathologies and metabolic disorders (e.g. cancer, diabetes, microvascular disease, retinopathy, nephropathy and neuropathy). The premise of the model is non-enzymatic crosslinking of reconstituted BM (rBM) matrix by treatment with glycolaldehyde (GLA) to promote advanced glycation endproduct (AGE) generation via the Maillard reaction. Examples of laboratory techniques that can be used to confirm AGE generation, non-enzymatic crosslinking and increased stiffness in GLA treated rBM are outlined. These include preparation of native rBM (treated with phosphate-buffered saline, PBS) and stiff rBM (treated with GLA) for determination of: its AGE content by photometric analysis and immunofluorescent microscopy, its non-enzymatic crosslinking by sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS PAGE) as well as confocal microscopy, and its increased stiffness using rheometry. The procedure described here can be used to increase the rigidity (elastic moduli, E) of rBM up to 3.2-fold, consistent with measurements made in healthy versus diseased human prostate tissue. To recreate the biophysical microenvironment associated with the aging and diseased prostate gland three prostate cell types were introduced on to native rBM and stiff rBM: RWPE-1, prostate epithelial cells (PECs) derived from a normal prostate gland; BPH-1, PECs derived from a prostate gland affected by benign prostatic hyperplasia (BPH); and PC3, metastatic cells derived from a secondary bone tumor originating from prostate cancer. Multiple parameters can be measured, including the size, shape and invasive characteristics of the 3D glandular acini formed by RWPE-1 and BPH-1 on native versus stiff rBM, and average cell length, migratory velocity and persistence of cell movement of 3D spheroids formed by PC3 cells under the same conditions. Cell signaling pathways and the subcellular localization of proteins can also be assessed.
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Affiliation(s)
| | - Claudia Breit
- Department of Mechanistic Cell Biology, Max Planck Institute of Molecular Physiology
| | - Mitchell Clarke
- School of Biological, Biomedical & Environmental Sciences, University of Hull
| | - Kamil Talar
- School of Biological, Biomedical & Environmental Sciences, University of Hull
| | - Kai Wang
- School of Biological, Biomedical & Environmental Sciences, University of Hull
| | - Mohammad A Mohammad
- School of Biological, Biomedical & Environmental Sciences, University of Hull
| | - Sage Pickwell
- School of Biological, Biomedical & Environmental Sciences, University of Hull
| | - Guillermina Etchandy
- Departamento de Genética, Facultad de Medicina, Universidad de la República (UDELAR)
| | - Graeme J Stasiuk
- School of Biological, Biomedical & Environmental Sciences, University of Hull
| | - Justin Sturge
- School of Biological, Biomedical & Environmental Sciences, University of Hull;
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27
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Delaine-Smith RM, Burney S, Balkwill FR, Knight MM. Experimental validation of a flat punch indentation methodology calibrated against unconfined compression tests for determination of soft tissue biomechanics. J Mech Behav Biomed Mater 2016; 60:401-415. [PMID: 26974584 DOI: 10.1016/j.jmbbm.2016.02.019] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 02/03/2016] [Accepted: 02/10/2016] [Indexed: 11/18/2022]
Abstract
Mechanical characterisation of soft biological tissues using standard compression or tensile testing presents a significant challenge due to specimen geometrical irregularities, difficulties in cutting intact and appropriately sized test samples, and issues with slippage or damage at the grips. Indentation can overcome these problems but requires fitting a model to the resulting load-displacement data in order to calculate moduli. Despite the widespread use of this technique, few studies experimentally validate their chosen model or compensate for boundary effects. In this study, viscoelastic hydrogels of different concentrations and dimensions were used to calibrate an indentation technique performed at large specimen-strain deformation (20%) and analysed with a range of routinely used mathematical models. A rigid, flat-ended cylindrical indenter was applied to each specimen from which 'indentation moduli' and relaxation properties were calculated and compared against values obtained from unconfined compression. Only one indentation model showed good agreement (<10% difference) with all moduli values obtained from compression. A sample thickness to indenter diameter ratio ≥1:1 and sample diameter to indenter diameter ratio ≥4:1 was necessary to achieve the greatest accuracy. However, it is not always possible to use biological samples within these limits, therefore we developed a series of correction factors. The approach was validated using human diseased omentum and bovine articular cartilage resulting in mechanical properties closely matching compression values. We therefore present a widely useable indentation analysis method to allow more accurate calculation of material mechanics which is important in the study of soft tissue development, ageing, health and disease.
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Affiliation(s)
- R M Delaine-Smith
- School of Engineering and Materials Science, Institute of Bioengineering, Queen Mary University of London, Mile End, London E1 4NS, UK; Centre for Cancer and Inflammation, Barts Cancer Institute, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK.
| | - S Burney
- School of Engineering and Materials Science, Institute of Bioengineering, Queen Mary University of London, Mile End, London E1 4NS, UK
| | - F R Balkwill
- Centre for Cancer and Inflammation, Barts Cancer Institute, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - M M Knight
- School of Engineering and Materials Science, Institute of Bioengineering, Queen Mary University of London, Mile End, London E1 4NS, UK
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Hauser SC, Gerling GJ. Measuring tactile cues at the fingerpad for object compliances harder and softer than the skin. IEEE HAPTICS SYMPOSIUM : [PROCEEDINGS]. IEEE HAPTICS SYMPOSIUM 2016; 2016:247-252. [PMID: 27331072 DOI: 10.1109/haptics.2016.7463185] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Distinguishing an object's compliance, into percepts of "softness" and "hardness," is crucial to our ability to grasp and manipulate it. Biomechanical cues at the skin's surface such as contact area and force rate have been thought to help encode compliance. However, no one has directly measured contact area with compliant materials, and few studies have considered compliances softer than the fingerpad. Herein, we developed a novel method to precisely measure the area in contact between compliant stimuli and the fingerpad, at given levels of force and displacement. To determine the method's robustness, we conducted psychophysical and biomechanical experiments with human subjects. The results indicate that cues including contact area at stimulus peak force of 3 Newtons, force rate over stimulus movement and at peak force, displacement and/or time to reach peak force may help in discriminating compliances while the directional spread of contact area is less important. Between softer and harder compliances, some cues were slightly more evident, though not yet definitively. Based upon the method's utility, the next step is to conduct broader experiments to distill the mixture of cues that encode compliance. The importance of such work lies in building haptic displays, for example, to render virtual tissues.
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Affiliation(s)
- Steven C Hauser
- Graduate student in Biomedical Engineering at the University of Virginia, VA 22904 USA
| | - Gregory J Gerling
- Associate professor in Systems and Information Engineering at the University of Virginia, Charlottesville, VA 22904 USA
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30
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Koh J, Jung DC, Oh YT, Yoo MG, Noh S, Han KH, Rha KH, Choi YD, Hong SJ. Additional Targeted Biopsy in Clinically Suspected Prostate Cancer: Prospective Randomized Comparison between Contrast-Enhanced Ultrasound and Sonoelastography Guidance. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:2836-2841. [PMID: 26298036 DOI: 10.1016/j.ultrasmedbio.2015.06.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 06/24/2015] [Accepted: 06/30/2015] [Indexed: 06/04/2023]
Abstract
Our aim was to improve the detection of prostate cancer by evaluating whether contrast-enhanced ultrasound (CEUS) or sonoelastography (SE) is more helpful in guiding targeted biopsy (TB) performed before systematic biopsy (SB). A total of 52 patients suspected of having prostate cancer were prospectively included and randomly assigned to either the CEUS or SE group. Different, independent radiologists performed TB and twelve-core SB. Within each group, cancer detection rates based on core number were compared between SB and TB. We evaluated the effect of TB on core-based cancer detection rates between the CEUS and SE groups. Cancer detection was higher in overall TB cores 16.4% (28/171) than SB cores 11.4% (71/624) in both groups. In the SE group, TB cores revealed higher cancer detection than did SB cores from 4.49% (14/312) to 12.86% (9/70) (p = 0.01). Compared with CEUS, SE may improve detection rates when considering additional TB guidance methods.
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Affiliation(s)
- Jieun Koh
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Dae Chul Jung
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea.
| | - Young Taik Oh
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Moon Gyu Yoo
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Songmi Noh
- Department of Pathology, Cha Medical College, Gang-Nam Cha Hospital, Seoul, Korea
| | - Kyung Hwa Han
- Avison Biomedical Research Center, Department of Radiology; Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Koon-Ho Rha
- Department of Urology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young Deuk Choi
- Department of Urology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Joon Hong
- Department of Urology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Kawano S, Kojima M, Higuchi Y, Sugimoto M, Ikeda K, Sakuyama N, Takahashi S, Hayashi R, Ochiai A, Saito N. Assessment of elasticity of colorectal cancer tissue, clinical utility, pathological and phenotypical relevance. Cancer Sci 2015; 106:1232-9. [PMID: 26083008 PMCID: PMC4582994 DOI: 10.1111/cas.12720] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 05/29/2015] [Accepted: 06/06/2015] [Indexed: 12/21/2022] Open
Abstract
Generally, cancer tissue is palpated as a hard mass. However, the elastic nature of cancer tissue is not well understood. The aim of the present study was to evaluate the clinical utility of measuring the elastic modulus (EM) in colorectal cancer tissue. Using a tactile sensor, we measured the EM of 106 surgically resected colorectal cancer tissues. Data on the EM were compared with clinicopathological findings, including stromal features represented by Azan staining and the α-SMA positive area ratio of the tumor area. Finally, a cDNA microarray profile of the tumors with high EM were compared with the findings of tumors with low EM. A higher EM in tumors was associated with pathological T, N, and M-stage tumors (P < 0.001, P = 0.001 and P = 0.011, respectively). Patients with high EM tumors had shorter disease-free survival than had patients with low EM. The EM showed strongly positive correlation with the Azan staining positive area ratio (r = 0.908) and the α-SMA positive area ratio (r = 0.921). Finally, the cDNA microarray data of the tumors with high EM revealed a distinct gene expression profile compared with data from those tumors with low EM. The assessment of the elasticity of colorectal cancer tissue may allow a more accurate clinical stage and prognosis estimation. The distinct phenotypical features of the high EM tumors and their strong association with stromal features suggest the existence of a biological mechanism involved in this phenomenon that may contribute to future therapy.
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Affiliation(s)
- Shingo Kawano
- Department of Colorectal and Pelvic Surgery, National Cancer Center Hospital East, Chiba, Japan.,Advanced Clinical Research of Cancer, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Motohiro Kojima
- Division of Pathology, Research Center for Innovative Oncology, National Cancer Center Hospital East, Chiba, Japan
| | - Yoichi Higuchi
- Division of Pathology, Research Center for Innovative Oncology, National Cancer Center Hospital East, Chiba, Japan
| | - Motokazu Sugimoto
- Department of Hepatobiliary-Pancreatic Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Koji Ikeda
- Department of Colorectal and Pelvic Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Naoki Sakuyama
- Department of Colorectal and Pelvic Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Shinichiro Takahashi
- Department of Hepatobiliary-Pancreatic Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Ryuichi Hayashi
- Advanced Clinical Research of Cancer, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Department of Head and Neck Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Atsushi Ochiai
- Division of Pathology, Research Center for Innovative Oncology, National Cancer Center Hospital East, Chiba, Japan
| | - Norio Saito
- Department of Colorectal and Pelvic Surgery, National Cancer Center Hospital East, Chiba, Japan
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Rodriguez-Teja M, Gronau JH, Breit C, Zhang YZ, Minamidate A, Caley MP, McCarthy A, Cox TR, Erler JT, Gaughan L, Darby S, Robson C, Mauri F, Waxman J, Sturge J. AGE-modified basement membrane cooperates with Endo180 to promote epithelial cell invasiveness and decrease prostate cancer survival. J Pathol 2014; 235:581-92. [PMID: 25408555 DOI: 10.1002/path.4485] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 11/05/2014] [Accepted: 11/08/2014] [Indexed: 11/10/2022]
Abstract
Biomechanical strain imposed by age-related thickening of the basal lamina and augmented tissue stiffness in the prostate gland coincides with increased cancer risk. Here we hypothesized that the structural alterations in the basal lamina associated with age can induce mechanotransduction pathways in prostate epithelial cells (PECs) to promote invasiveness and cancer progression. To demonstrate this, we developed a 3D model of PEC acini in which thickening and stiffening of basal lamina matrix was induced by advanced glycation end-product (AGE)-dependent non-enzymatic crosslinking of its major components, collagen IV and laminin. We used this model to demonstrate that antibody targeted blockade of CTLD2, the second of eight C-type lectin-like domains in Endo180 (CD280, CLEC13E, KIAA0709, MRC2, TEM9, uPARAP) that can recognize glycosylated collagens, reversed actinomyosin-based contractility [myosin-light chain-2 (MLC2) phosphorylation], loss of cell polarity, loss of cell-cell junctions, luminal infiltration and basal invasion induced by AGE-modified basal lamina matrix in PEC acini. Our in vitro results were concordant with luminal occlusion of acini in the prostate glands of adult Endo180(Δ) (Ex2-6/) (Δ) (Ex2-6) mice, with constitutively exposed CTLD2 and decreased survival of men with early (non-invasive) prostate cancer with high epithelial Endo180 expression and levels of AGE. These findings indicate that AGE-dependent modification of the basal lamina induces invasive behaviour in non-transformed PECs via a molecular mechanism linked to cancer progression. This study provides a rationale for targeting CTLD2 in Endo180 in prostate cancer and other pathologies in which increased basal lamina thickness and tissue stiffness are driving factors. © 2014 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of Pathological Society of Great Britain and Ireland.
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Affiliation(s)
- Mercedes Rodriguez-Teja
- Department of Surgery and Cancer, Imperial College London, UK; Departamento de Genética, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
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Good DW, Khan A, Hammer S, Scanlan P, Shu W, Phipps S, Parson SH, Stewart GD, Reuben R, McNeill SA. Tissue quality assessment using a novel direct elasticity assessment device (the E-finger): a cadaveric study of prostatectomy dissection. PLoS One 2014; 9:e112872. [PMID: 25384014 PMCID: PMC4226612 DOI: 10.1371/journal.pone.0112872] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 10/15/2014] [Indexed: 11/18/2022] Open
Abstract
Introduction Minimally invasive radical prostatectomy (RP) (robotic and laparoscopic), have brought improvements in the outcomes of RP due to improved views and increased degrees of freedom of surgical devices. Robotic and laparoscopic surgeries do not incorporate haptic feedback, which may result in complications secondary to inadequate tissue dissection (causing positive surgical margins, rhabdosphincter damage, etc). We developed a micro-engineered device (6 mm2 sized) [E-finger]) capable of quantitative elasticity assessment, with amplitude ratio, mean ratio and phase lag representing this. The aim was to assess the utility of the device in differentiating peri-prostatic tissue types in order to guide prostate dissection. Material and Methods Two embalmed and 2 fresh frozen cadavers were used in the study. Baseline elasticity values were assessed in bladder, prostate and rhabdosphincter of pre-dissected embalmed cadavers using the micro-engineered device. A measurement grid was created to span from the bladder, across the prostate and onto the rhabdosphincter of fresh frozen cadavers to enable a systematic quantitative elasticity assessment of the entire area by 2 independent assessors. Tissue was sectioned along each row of elasticity measurement points, and stained with haematoxylin and eosin (H&E). Image analysis was performed with Image Pro Premier to determine the histology at each measurement point. Results Statistically significant differences in elasticity were identified between bladder, prostate and sphincter in both embalmed and fresh frozen cadavers (p = <0.001). Intra-class correlation (ICC) reliability tests showed good reliability (average ICC = 0.851). Sensitivity and specificity for tissue identification was 77% and 70% respectively to a resolution of 6 mm2. Conclusions This cadaveric study has evaluated the ability of our elasticity assessment device to differentiate bladder, prostate and rhabdosphincter to a resolution of 6 mm2. The results provide useful data for which to continue to examine the use of elasticity assessment devices for tissue quality assessment with the aim of giving haptic feedback to surgeons performing complex surgery.
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Affiliation(s)
- Daniel W. Good
- Edinburgh Urological Cancer Group, University of Edinburgh, Western General Hospital, Edinburgh, EH2 4XU, United Kingdom
- Department of Urology, Western General Hospital, NHS Lothian, Edinburgh, United Kingdom
- * E-mail:
| | - Ashfaq Khan
- Department of Anatomy, University of Edinburgh, Edinburgh, United Kingdom
| | - Steven Hammer
- School of Engineering and Physical Sciences, Heriot Watt University, Edinburgh, United Kingdom
| | - Paul Scanlan
- School of Engineering and Physical Sciences, Heriot Watt University, Edinburgh, United Kingdom
| | - Wenmiao Shu
- School of Engineering and Physical Sciences, Heriot Watt University, Edinburgh, United Kingdom
| | - Simon Phipps
- Edinburgh Urological Cancer Group, University of Edinburgh, Western General Hospital, Edinburgh, EH2 4XU, United Kingdom
- Department of Urology, Western General Hospital, NHS Lothian, Edinburgh, United Kingdom
| | - Simon H. Parson
- Department of Anatomy, University of Edinburgh, Edinburgh, United Kingdom
| | - Grant D. Stewart
- Edinburgh Urological Cancer Group, University of Edinburgh, Western General Hospital, Edinburgh, EH2 4XU, United Kingdom
- Department of Urology, Western General Hospital, NHS Lothian, Edinburgh, United Kingdom
| | - Robert Reuben
- School of Engineering and Physical Sciences, Heriot Watt University, Edinburgh, United Kingdom
| | - S. Alan McNeill
- Edinburgh Urological Cancer Group, University of Edinburgh, Western General Hospital, Edinburgh, EH2 4XU, United Kingdom
- Department of Urology, Western General Hospital, NHS Lothian, Edinburgh, United Kingdom
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Palacio-Torralba J, Hammer S, Good DW, Alan McNeill S, Stewart GD, Reuben RL, Chen Y. Quantitative diagnostics of soft tissue through viscoelastic characterization using time-based instrumented palpation. J Mech Behav Biomed Mater 2014; 41:149-60. [PMID: 25460411 DOI: 10.1016/j.jmbbm.2014.09.027] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 09/18/2014] [Accepted: 09/23/2014] [Indexed: 10/24/2022]
Abstract
Although palpation has been successfully employed for centuries to assess soft tissue quality, it is a subjective test, and is therefore qualitative and depends on the experience of the practitioner. To reproduce what the medical practitioner feels needs more than a simple quasi-static stiffness measurement. This paper assesses the capacity of dynamic mechanical palpation to measure the changes in viscoelastic properties that soft tissue can exhibit under certain pathological conditions. A diagnostic framework is proposed to measure elastic and viscous behaviors simultaneously using a reduced set of viscoelastic parameters, giving a reliable index for quantitative assessment of tissue quality. The approach is illustrated on prostate models reconstructed from prostate MRI scans. The examples show that the change in viscoelastic time constant between healthy and cancerous tissue is a key index for quantitative diagnostics using point probing. The method is not limited to any particular tissue or material and is therefore useful for tissue where defining a unique time constant is not trivial. The proposed framework of quantitative assessment could become a useful tool in clinical diagnostics for soft tissue.
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Affiliation(s)
- Javier Palacio-Torralba
- Institute of Mechanical, Process and Energy Engineering, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh EH14 4AS, UK
| | - Steven Hammer
- Institute of Mechanical, Process and Energy Engineering, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh EH14 4AS, UK
| | - Daniel W Good
- Edinburgh Urological Cancer Group, Division of Pathology Laboratories, Institute of Genetics and Molecular Medicine, University of Edinburgh, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK
| | - S Alan McNeill
- Edinburgh Urological Cancer Group, Division of Pathology Laboratories, Institute of Genetics and Molecular Medicine, University of Edinburgh, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK; Department of Urology, NHS Lothian, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK
| | - Grant D Stewart
- Edinburgh Urological Cancer Group, Division of Pathology Laboratories, Institute of Genetics and Molecular Medicine, University of Edinburgh, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK; Department of Urology, NHS Lothian, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK
| | - Robert L Reuben
- Institute of Mechanical, Process and Energy Engineering, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh EH14 4AS, UK
| | - Yuhang Chen
- Institute of Mechanical, Process and Energy Engineering, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh EH14 4AS, UK.
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Ahn B, Lee H, Kim Y, Kim J. Robotic system with sweeping palpation and needle biopsy for prostate cancer diagnosis. Int J Med Robot 2013; 10:356-67. [DOI: 10.1002/rcs.1543] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Revised: 08/29/2013] [Accepted: 09/07/2013] [Indexed: 01/02/2023]
Affiliation(s)
- Bummo Ahn
- Wellness Technology R&D Group; Korea Institute of Industrial Technology; 143 Hanggaul-ro, Sangnok-gu Ansan-si Gyeonggi-do 426-910 Korea
| | - Hyosang Lee
- School of Mechanical, Aerospace & Systems Engineering, Department of Mechanical Engineering; Korea Advanced Institute of Science and Technology; 373-1 Guseong-dong Daejeon 305-701 Korea
| | - Yeongjin Kim
- The Robotics, Automation, and Medical Systems (RAMS) laboratory; University of Maryland; College Park MD 20742 USA
| | - Jung Kim
- School of Mechanical, Aerospace & Systems Engineering, Department of Mechanical Engineering; Korea Advanced Institute of Science and Technology; 373-1 Guseong-dong Daejeon 305-701 Korea
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Good DW, Stewart GD, Hammer S, Scanlan P, Shu W, Phipps S, Reuben R, McNeill AS. Elasticity as a biomarker for prostate cancer: a systematic review. BJU Int 2013; 113:523-34. [DOI: 10.1111/bju.12236] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Daniel W. Good
- Edinburgh Urological Cancer Group; University of Edinburgh; Edinburgh UK
- Department of Urology; Western General Hospital; Edinburgh UK
| | - Grant D. Stewart
- Edinburgh Urological Cancer Group; University of Edinburgh; Edinburgh UK
- Department of Urology; Western General Hospital; Edinburgh UK
| | - Steven Hammer
- School of Engineering and Physical Sciences; Heriot-Watt University; Edinburgh UK
| | - Paul Scanlan
- School of Engineering and Physical Sciences; Heriot-Watt University; Edinburgh UK
| | - Wenmiao Shu
- School of Engineering and Physical Sciences; Heriot-Watt University; Edinburgh UK
| | - Simon Phipps
- Edinburgh Urological Cancer Group; University of Edinburgh; Edinburgh UK
- Department of Urology; Western General Hospital; Edinburgh UK
| | - Robert Reuben
- School of Engineering and Physical Sciences; Heriot-Watt University; Edinburgh UK
| | - Alan S. McNeill
- Edinburgh Urological Cancer Group; University of Edinburgh; Edinburgh UK
- Department of Urology; Western General Hospital; Edinburgh UK
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Xu W, Hu X, Pan W. Tissue engineering concept in the research of the tumor biology. Technol Cancer Res Treat 2013; 13:149-59. [PMID: 23862747 DOI: 10.7785/tcrt.2012.500363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Tumor is a heterogeneous complex, which lives in a three-dimensional environment flush with biopathophysiological and biomechanical signals. This signaling abundant extracellular milieu co-evolving from cell-cell and cell-host interaction guides the development and the generation of the tumor. There has been a recent surge of interest in studying the tumor biology that more closely mirror what happens in living organisms, especially in cancer research. Incorporating cancer cells in the 3D mimicking environment instead of monolayers is reasonable for maintaining in vivo cancer behaviors in spatial and temporal context. However, 3D culture for cancer still presents a challenge for researchers in this field. Tissue engineering, originally aiming at designing the artificial organs, provided a feasible approach to recreate such complex mechanical and biochemical interplay. Aside from reproducing bionic environment, tissue engineering has been routinely introduced into cancer study to build three dimensional structures not only to develop molecular therapeutics, but also to screen for toxic effects of drugs or radiotherapy sensitivity. In this article, we focused on the recent advances of the well-defined tissue-engineering biomaterials in the application in tumor biology. We also discussed the fabrications of the scaffolds from different materials, which might contribute to future cancer research.
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Affiliation(s)
- Wen Xu
- Gastroenterology Department, The Second Affiliated Hospital of Zhejiang University, School of Medicine, #88 Jiefang Road, Hangzhou, Zhejiang, 310009 China.
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A quantitative comparison of soft tissue compressive viscoelastic model accuracy. J Mech Behav Biomed Mater 2013; 20:126-36. [DOI: 10.1016/j.jmbbm.2013.01.007] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Revised: 12/23/2012] [Accepted: 01/10/2013] [Indexed: 11/22/2022]
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Local property characterization of prostate glands using inhomogeneous modeling based on tumor volume and location analysis. Med Biol Eng Comput 2012; 51:197-205. [DOI: 10.1007/s11517-012-0984-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Accepted: 10/29/2012] [Indexed: 10/27/2022]
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Abstract
BACKGROUND All health care practitioners should be facile in the digital rectal exam (DRE) as it provides prostate, rectal and neurological information. The purpose of this study was first to justify our hypothesis that tissue elasticity is indicative of carcinomatous changes. Second, we employed urological surgeons to evaluate our prostate simulator in three ways: (1) authenticate that the elasticity of the simulated prostates accurately represents the range of normal prostate stiffness, (2) determine the range of nodule size reasonably palpable by DRE and (3) discern what degree of elasticity difference within the same prostate suggests malignancy. METHODS Institutional Review Board-approved materials characterization, human-subjects experiments, histopathology and chart abstraction of clinical history were performed. Material characterization of 21 ex-vivo prostatectomy specimens was evaluated using a custom-built, portable spherical indentation device while a novel prostate simulator was employed to measure human-subject perception of prostatic state. RESULTS From the materials characterization, the measurements of the 21 gross prostates and 40 cross-sections yielded 306 data points. Within the same prostate, cancer was always stiffer. Of the seven cases with an abnormal DRE, the DRE accurately identified adenocarcinoma in 85%. From the human-subjects experiments, the simulated prostates evaluated by urologists ranged in stiffness from 8.9 to 91 kPa, mimicking the range found on ex vivo analysis of 4.6-236.7 kPa. The urological surgeons determined the upper limit of stiffness palpated as realistic for a healthy prostate was 59.63 kPa while the lower limit of stiffness was 27.1 kPa. Nodule size less than 7.5 mm was felt to be too small to reasonably palpate. CONCLUSIONS We found it is not the absolute elasticity of the nodule, but rather the relationship of the nodule with the background prostate elasticity that constitutes the critical tactile feedback. Prostate simulator training may lead to greater familiarity with pertinent diagnostic cues and diagnosis of prostate cancer.
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