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Hu J, Xing J, Shao P, Ma X, Li P, Liu P, Zhang R, Chen W, Lei W, Xu RX. Raman spectroscopy with an improved support vector machine for discrimination of thyroid and parathyroid tissues. JOURNAL OF BIOPHOTONICS 2024; 17:e202400084. [PMID: 38890800 DOI: 10.1002/jbio.202400084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 04/24/2024] [Accepted: 04/25/2024] [Indexed: 06/20/2024]
Abstract
The objective of this study was to discriminate thyroid and parathyroid tissues using Raman spectroscopy combined with an improved support vector machine (SVM) algorithm. In thyroid surgery, there is a risk of inadvertently removing the parathyroid glands. At present, there is a lack of research on using Raman spectroscopy to discriminate parathyroid and thyroid tissues. In this article, samples were obtained from 43 individuals with thyroid and parathyroid tissues for Raman spectroscopy analysis. This study employed partial least squares (PLS) to reduce dimensions of data, and three optimization algorithms are used to improve the classification accuracy of SVM algorithm model in spectral analysis. The results show that PLS-GA-SVM algorithm has higher diagnostic accuracy and better reliability. The sensitivity of this algorithm is 94.67% and the accuracy is 94.44%. It can be concluded that Raman spectroscopy combined with the PLS-GA-SVM diagnostic algorithm has significant potential for discriminating thyroid and parathyroid tissues.
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Affiliation(s)
- Jie Hu
- Department of Precision Machinery and Precision Instrumentation, University of Science and Technology of China, Hefei, China
| | - Jinyu Xing
- Department of Precision Machinery and Precision Instrumentation, University of Science and Technology of China, Hefei, China
- Institute of Advanced Technology, University of Science and Technology of China, Hefei, China
| | - Pengfei Shao
- Department of Precision Machinery and Precision Instrumentation, University of Science and Technology of China, Hefei, China
| | - Xiaopeng Ma
- First Affiliated Hospital, University of Science and Technology of China, Hefei, China
| | - Peikun Li
- General Surgery Department, Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Peng Liu
- Suzhou Institute for Advanced Research, University of Science and Technology of China, Suzhou, China
| | - Ru Zhang
- Department of Precision Machinery and Precision Instrumentation, University of Science and Technology of China, Hefei, China
| | - Wei Chen
- Department of Precision Machinery and Precision Instrumentation, University of Science and Technology of China, Hefei, China
| | - Wang Lei
- General Surgery Department, Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Ronald X Xu
- Department of Precision Machinery and Precision Instrumentation, University of Science and Technology of China, Hefei, China
- Suzhou Institute for Advanced Research, University of Science and Technology of China, Suzhou, China
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David S, Tavera H, Trang T, Dallaire F, Daoust F, Tremblay F, Richer L, Meterissian S, Leblond F. Macroscopic inelastic scattering imaging using a hyperspectral line-scanning system identifies invasive breast cancer in lumpectomy and mastectomy specimens. JOURNAL OF BIOMEDICAL OPTICS 2024; 29:065004. [PMID: 38846676 PMCID: PMC11155388 DOI: 10.1117/1.jbo.29.6.065004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 05/14/2024] [Accepted: 05/20/2024] [Indexed: 06/09/2024]
Abstract
Significance Of patients with early-stage breast cancer, 60% to 75% undergo breast-conserving surgery. Of those, 20% or more need a second surgery because of an incomplete tumor resection only discovered days after surgery. An intraoperative imaging technology allowing cancer detection on the margins of breast specimens could reduce re-excision procedure rates and improve patient survival. Aim We aimed to develop an experimental protocol using hyperspectral line-scanning Raman spectroscopy to image fresh breast specimens from cancer patients. Our objective was to determine whether macroscopic specimen images could be produced to distinguish invasive breast cancer from normal tissue structures. Approach A hyperspectral inelastic scattering imaging instrument was used to interrogate eight specimens from six patients undergoing breast cancer surgery. Machine learning models trained with a different system to distinguish cancer from normal breast structures were used to produce tissue maps with a field-of-view of 1 cm 2 classifying each pixel as either cancer, adipose, or other normal tissues. The predictive model results were compared with spatially correlated histology maps of the specimens. Results A total of eight specimens from six patients were imaged. Four of the hyperspectral images were associated with specimens containing cancer cells that were correctly identified by the new ex vivo pathology technique. The images associated with the remaining four specimens had no histologically detectable cancer cells, and this was also correctly predicted by the instrument. Conclusions We showed the potential of hyperspectral Raman imaging as an intraoperative breast cancer margin assessment technique that could help surgeons improve cosmesis and reduce the number of repeat procedures in breast cancer surgery.
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Affiliation(s)
- Sandryne David
- Polytechnique Montréal, Department of Engineering Physics, Montreal, Quebec, Canada
- Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), Montreal, Quebec, Canada
| | - Hugo Tavera
- Polytechnique Montréal, Department of Engineering Physics, Montreal, Quebec, Canada
- Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), Montreal, Quebec, Canada
| | - Tran Trang
- Polytechnique Montréal, Department of Engineering Physics, Montreal, Quebec, Canada
- Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), Montreal, Quebec, Canada
| | - Frédérick Dallaire
- Polytechnique Montréal, Department of Engineering Physics, Montreal, Quebec, Canada
- Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), Montreal, Quebec, Canada
| | - François Daoust
- Polytechnique Montréal, Department of Engineering Physics, Montreal, Quebec, Canada
- Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), Montreal, Quebec, Canada
| | - Francine Tremblay
- McGill University Health Center (MUHC), Department of Surgery, Montreal, Quebec, Canada
| | - Lara Richer
- McGill University Health Center (MUHC), Department of Pathology, Montreal, Quebec, Canada
| | - Sarkis Meterissian
- McGill University Health Center (MUHC), Department of Surgery, Montreal, Quebec, Canada
| | - Frédéric Leblond
- Polytechnique Montréal, Department of Engineering Physics, Montreal, Quebec, Canada
- Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), Montreal, Quebec, Canada
- Institut du cancer de Montréal, Montreal, Quebec, Canada
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Jin L, Dai N, Yang X. Preliminary study on the optical diagnosis of orbital rhabdomyosarcoma by Raman spectroscopy. Sci Rep 2024; 14:9735. [PMID: 38679641 PMCID: PMC11056361 DOI: 10.1038/s41598-024-60520-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 04/24/2024] [Indexed: 05/01/2024] Open
Abstract
To investigate the Raman spectral features of orbital rhabdomyosarcoma (ORMS) tissue and normal orbital tissue in vitro, and to explore the feasibility of Raman spectroscopy for the optical diagnosis of ORMS. 23 specimens of ORMS and 27 specimens of normal orbital tissue were obtained from resection surgery and measured in vitro using Raman spectroscopy coupled to a fiber optic probe. The important spectral differences between the tissue categories were exploited for tissue classification with the multivariate statistical techniques of principal component analysis (PCA) and linear discriminant analysis (LDA). Compared to normal tissue, the Raman peak intensities located at 1450 and 1655 cm-1 were significantly lower for ORMS (p < 0.05), while the peak intensities located at 721, 758, 1002, 1088, 1156, 1206, 1340, 1526 cm-1 were significantly higher (p < 0.05). Raman spectra differences between normal tissue and ORMS could be attributed to the changes in the relative amounts of biochemical components, such as nucleic acids, tryptophan, phenylalanine, carotenoid and lipids. The Raman spectroscopy technique together with PCA-LDA modeling provides a diagnostic accuracy of 90.0%, sensitivity of 91.3%, and specificity of 88.9% for ORMS identification. Significant differences in Raman peak intensities exist between normal orbital tissue and ORMS. This work demonstrated for the first time that the Raman spectroscopy associated with PCA-LDA diagnostic algorithms has promising potential for accurate, rapid and noninvasive optical diagnosis of ORMS at the molecular level.
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Affiliation(s)
- Ling Jin
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Nengli Dai
- Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Xiaobo Yang
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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Veluponnar D, de Boer LL, Dashtbozorg B, Jong LJS, Geldof F, Guimaraes MDS, Sterenborg HJCM, Vrancken-Peeters MJTFD, van Duijnhoven F, Ruers T. Margin assessment during breast conserving surgery using diffuse reflectance spectroscopy. JOURNAL OF BIOMEDICAL OPTICS 2024; 29:045006. [PMID: 38665316 PMCID: PMC11045169 DOI: 10.1117/1.jbo.29.4.045006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 04/03/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024]
Abstract
Significance During breast-conserving surgeries, it is essential to evaluate the resection margins (edges of breast specimen) to determine whether the tumor has been removed completely. In current surgical practice, there are no methods available to aid in accurate real-time margin evaluation. Aim In this study, we investigated the diagnostic accuracy of diffuse reflectance spectroscopy (DRS) combined with tissue classification models in discriminating tumorous tissue from healthy tissue up to 2 mm in depth on the actual resection margin of in vivo breast tissue. Approach We collected an extensive dataset of DRS measurements on ex vivo breast tissue and in vivo breast tissue, which we used to develop different classification models for tissue classification. Next, these models were used in vivo to evaluate the performance of DRS for tissue discrimination during breast conserving surgery. We investigated which training strategy yielded optimum results for the classification model with the highest performance. Results We achieved a Matthews correlation coefficient of 0.76, a sensitivity of 96.7% (95% CI 95.6% to 98.2%), a specificity of 90.6% (95% CI 86.3% to 97.9%) and an area under the curve of 0.98 by training the optimum model on a combination of ex vivo and in vivo DRS data. Conclusions DRS allows real-time margin assessment with a high sensitivity and specificity during breast-conserving surgeries.
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Affiliation(s)
- Dinusha Veluponnar
- Netherlands Cancer Institute, Antoni van Leeuwenhoek, Department of Surgery, Image-Guided Surgery, Amsterdam, The Netherlands
- University of Twente, Department of Nanobiophysics, Faculty of Science and Technology, Enschede, The Netherlands
| | - Lisanne L. de Boer
- Netherlands Cancer Institute, Antoni van Leeuwenhoek, Department of Surgery, Image-Guided Surgery, Amsterdam, The Netherlands
| | - Behdad Dashtbozorg
- Netherlands Cancer Institute, Antoni van Leeuwenhoek, Department of Surgery, Image-Guided Surgery, Amsterdam, The Netherlands
| | - Lynn-Jade S. Jong
- Netherlands Cancer Institute, Antoni van Leeuwenhoek, Department of Surgery, Image-Guided Surgery, Amsterdam, The Netherlands
- University of Twente, Department of Nanobiophysics, Faculty of Science and Technology, Enschede, The Netherlands
| | - Freija Geldof
- Netherlands Cancer Institute, Antoni van Leeuwenhoek, Department of Surgery, Image-Guided Surgery, Amsterdam, The Netherlands
- University of Twente, Department of Nanobiophysics, Faculty of Science and Technology, Enschede, The Netherlands
| | - Marcos Da Silva Guimaraes
- Netherlands Cancer Institute, Antoni van Leeuwenhoek, Department of Pathology, Amsterdam, The Netherlands
| | - Henricus J. C. M. Sterenborg
- Amsterdam University Medical Center, Department of Biomedical Engineering and Physics, Amsterdam, The Netherlands
| | | | - Frederieke van Duijnhoven
- Netherlands Cancer Institute, Antoni van Leeuwenhoek, Department of Surgery, Image-Guided Surgery, Amsterdam, The Netherlands
| | - Theo Ruers
- Netherlands Cancer Institute, Antoni van Leeuwenhoek, Department of Surgery, Image-Guided Surgery, Amsterdam, The Netherlands
- University of Twente, Department of Nanobiophysics, Faculty of Science and Technology, Enschede, The Netherlands
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Rainu SK, Ramachandran RG, Parameswaran S, Krishnakumar S, Singh N. Advancements in Intraoperative Near-Infrared Fluorescence Imaging for Accurate Tumor Resection: A Promising Technique for Improved Surgical Outcomes and Patient Survival. ACS Biomater Sci Eng 2023; 9:5504-5526. [PMID: 37661342 DOI: 10.1021/acsbiomaterials.3c00828] [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: 09/05/2023]
Abstract
Clear surgical margins for solid tumor resection are essential for preventing cancer recurrence and improving overall patient survival. Complete resection of tumors is often limited by a surgeon's ability to accurately locate malignant tissues and differentiate them from healthy tissue. Therefore, techniques or imaging modalities are required that would ease the identification and resection of tumors by real-time intraoperative visualization of tumors. Although conventional imaging techniques such as positron emission tomography (PET), computed tomography (CT), magnetic resonance imaging (MRI), or radiography play an essential role in preoperative diagnostics, these cannot be utilized in intraoperative tumor detection due to their large size, high cost, long imaging time, and lack of cancer specificity. The inception of several imaging techniques has paved the way to intraoperative tumor margin detection with a high degree of sensitivity and specificity. Particularly, molecular imaging using near-infrared fluorescence (NIRF) based nanoprobes provides superior imaging quality due to high signal-to-noise ratio, deep penetration to tissues, and low autofluorescence, enabling accurate tumor resection and improved survival rates. In this review, we discuss the recent developments in imaging technologies, specifically focusing on NIRF nanoprobes that aid in highly specific intraoperative surgeries with real-time recognition of tumor margins.
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Affiliation(s)
- Simran Kaur Rainu
- Center for Biomedical Engineering, Indian Institute of Technology Delhi, Hauz Khas, New Delhi 110016, India
| | - Remya Girija Ramachandran
- L&T Ocular Pathology Department, Vision Research Foundation, Kamalnayan Bajaj Institute for Research in Vision and Ophthalmology, Chennai 600006, India
| | - Sowmya Parameswaran
- L&T Ocular Pathology Department, Vision Research Foundation, Kamalnayan Bajaj Institute for Research in Vision and Ophthalmology, Chennai 600006, India
| | - Subramanian Krishnakumar
- L&T Ocular Pathology Department, Vision Research Foundation, Kamalnayan Bajaj Institute for Research in Vision and Ophthalmology, Chennai 600006, India
| | - Neetu Singh
- Center for Biomedical Engineering, Indian Institute of Technology Delhi, Hauz Khas, New Delhi 110016, India
- Biomedical Engineering Unit, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
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Byrd BK, Wells WA, Strawbridge RR, Barth CW, Samkoe KS, Gibbs SL, Davis SC. Evaluating Receptor-Specific Fresh Specimen Staining for Tumor Margin Detection in Clinical Breast Specimens. Mol Imaging Biol 2023; 25:911-922. [PMID: 37351769 PMCID: PMC10598096 DOI: 10.1007/s11307-022-01771-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/22/2022] [Accepted: 09/06/2022] [Indexed: 06/24/2023]
Abstract
PURPOSE Reliable and rapid identification of tumor in the margins of breast specimens during breast-conserving surgery to reduce repeat surgery rates is an active area of investigation. Dual-stain difference imaging (DDSI) is one of many approaches under evaluation for this application. This technique aims to topically apply fluorescent stain pairs (one targeted to a receptor-of-interest and the other a spectrally distinct isotype), image both stains, and compute a normalized difference image between the two channels. Prior evaluation and optimization in a variety of preclinical models produced encouraging diagnostic performance. Herein, we report on a pilot clinical study which evaluated HER2-targeted DDSI on 11 human breast specimens. PROCEDURES Gross sections from 11 freshly excised mastectomy specimens were processed using a HER2-receptor-targeted DDSI protocol shortly after resection. After staining with the dual-probe protocol, specimens were imaged on a fluorescence scanner, followed by tissue fixation for hematoxylin and eosin and anti-HER2 immunohistochemical staining. Receiver operator characteristic curves and area under the curve (AUC) analysis were used to assess diagnostic performance of the resulting images. Performance values were also compared to expression level determined from IHC staining. RESULTS Eight of the 11 specimens presented with distinguishable invasive ductal carcinoma and/or were not affected by an imaging artifact. In these specimens, the DDSI technique provided an AUC = 0.90 ± 0.07 for tumor-to-adipose tissue and 0.81 ± 0.15 for tumor-to-glandular tissue, which was significantly higher than AUC values recovered from images of the targeted probe alone. DDSI values and diagnostic performance did not correlate with HER2 expression level, and tumors with low HER2 expression often produced high AUC, suggesting that even the low expression levels were enough to help distinguish tumor. CONCLUSIONS The results from this preliminary study of rapid receptor-specific staining in human specimens were consistent with prior preclinical results and demonstrated promising diagnostic potential.
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Affiliation(s)
- Brook K Byrd
- Thayer School of Engineering, Dartmouth College, Hanover, NH, 03755, USA
| | - Wendy A Wells
- Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, 03766, USA
| | | | - Connor W Barth
- Biomedical Engineering Department, Oregon Health & Science University, Portland, OR, 97201, USA
| | - Kimberley S Samkoe
- Thayer School of Engineering, Dartmouth College, Hanover, NH, 03755, USA
| | - Summer L Gibbs
- Biomedical Engineering Department, Oregon Health & Science University, Portland, OR, 97201, USA
| | - Scott C Davis
- Thayer School of Engineering, Dartmouth College, Hanover, NH, 03755, USA.
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7
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Veluponnar D, de Boer LL, Geldof F, Jong LJS, Da Silva Guimaraes M, Vrancken Peeters MJTFD, van Duijnhoven F, Ruers T, Dashtbozorg B. Toward Intraoperative Margin Assessment Using a Deep Learning-Based Approach for Automatic Tumor Segmentation in Breast Lumpectomy Ultrasound Images. Cancers (Basel) 2023; 15:cancers15061652. [PMID: 36980539 PMCID: PMC10046373 DOI: 10.3390/cancers15061652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/01/2023] [Accepted: 03/06/2023] [Indexed: 03/30/2023] Open
Abstract
There is an unmet clinical need for an accurate, rapid and reliable tool for margin assessment during breast-conserving surgeries. Ultrasound offers the potential for a rapid, reproducible, and non-invasive method to assess margins. However, it is challenged by certain drawbacks, including a low signal-to-noise ratio, artifacts, and the need for experience with the acquirement and interpretation of images. A possible solution might be computer-aided ultrasound evaluation. In this study, we have developed new ensemble approaches for automated breast tumor segmentation. The ensemble approaches to predict positive and close margins (distance from tumor to margin ≤ 2.0 mm) in the ultrasound images were based on 8 pre-trained deep neural networks. The best optimum ensemble approach for segmentation attained a median Dice score of 0.88 on our data set. Furthermore, utilizing the segmentation results we were able to achieve a sensitivity of 96% and a specificity of 76% for predicting a close margin when compared to histology results. The promising results demonstrate the capability of AI-based ultrasound imaging as an intraoperative surgical margin assessment tool during breast-conserving surgery.
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Affiliation(s)
- Dinusha Veluponnar
- Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
- Department of Nanobiophysics, Faculty of Science and Technology, University of Twente, Drienerlolaan 5, 7522 NB Enschede, The Netherlands
| | - Lisanne L de Boer
- Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Freija Geldof
- Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Lynn-Jade S Jong
- Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Marcos Da Silva Guimaraes
- Department of Pathology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | | | - Frederieke van Duijnhoven
- Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Theo Ruers
- Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
- Department of Nanobiophysics, Faculty of Science and Technology, University of Twente, Drienerlolaan 5, 7522 NB Enschede, The Netherlands
| | - Behdad Dashtbozorg
- Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
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Translational Potential of Fluorescence Polarization for Breast Cancer Cytopathology. Cancers (Basel) 2023; 15:cancers15051501. [PMID: 36900291 PMCID: PMC10000687 DOI: 10.3390/cancers15051501] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/24/2023] [Accepted: 02/26/2023] [Indexed: 03/06/2023] Open
Abstract
Breast cancer is the most common malignancy in women. The standard of care for diagnosis involves invasive core needle biopsy followed by time-consuming histopathological evaluation. A rapid, accurate, and minimally invasive method to diagnose breast cancer would be invaluable. Therefore, this clinical study investigated the fluorescence polarization (Fpol) of the cytological stain methylene blue (MB) for the quantitative detection of breast cancer in fine needle aspiration (FNA) specimens. Cancerous, benign, and normal cells were aspirated from excess breast tissues immediately following surgery. The cells were stained in aqueous MB solution (0.05 mg/mL) and imaged using multimodal confocal microscopy. The system provided MB Fpol and fluorescence emission images of the cells. Results from optical imaging were compared to clinical histopathology. In total, we imaged and analyzed 3808 cells from 44 breast FNAs. Fpol images displayed quantitative contrast between cancerous and noncancerous cells, whereas fluorescence emission images showed the morphological features comparable to cytology. Statistical analysis demonstrated that MB Fpol is significantly higher (p < 0.0001) in malignant vs. benign/normal cells. It also revealed a correlation between MB Fpol values and tumor grade. The results indicate that MB Fpol could provide a reliable, quantitative diagnostic marker for breast cancer at the cellular level.
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Wang J, Zhang G. Side‐viewing handheld confocal Raman probe coupled with an off‐axis parabolic mirror for superficial epithelial Raman measurements of luminal organs. TRANSLATIONAL BIOPHOTONICS 2022. [DOI: 10.1002/tbio.202200010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Jianfeng Wang
- Key Laboratory of Photoelectronic Imaging Technology and System of Ministry of Education of China, School of Optics and Photonics Beijing Institute of Technology Beijing China
- Institute of Engineering Medicine, Beijing Institute of Technology Beijing China
| | - Guling Zhang
- College of Science Minzu University of China Beijing China
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Dooley M, Paterson T, Dexter L, Matousek P, Dehghani H, Notingher I. Model-Based Optimization of Laser Excitation and Detection Improves Spectral Contrast in Noninvasive Diffuse Raman Spectroscopy. APPLIED SPECTROSCOPY 2022; 76:801-811. [PMID: 35081779 DOI: 10.1177/00037028211072900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Spatially offset Raman spectroscopy (SORS) is a powerful technique for subsurface molecular analysis of optically turbid samples. Numerical modeling of light propagation has been used to investigate opportunities for improving spectral contrast and signal to noise ratio when imaging regions of interest located 0-4.5 mm below the surface in polymer bulk material. Two- and three-dimensional modeling results demonstrate that when analyzing a certain region of interest (ROI) of finite lateral dimensions below the sample surface, offsetting both the laser source and detector in opposite directions from the central point of the ROI can increase the spectral contrast as compared to conventional SORS approach where the detector or the laser source is maintained at the central point (centered SORS). The outlined modeling results have been validated experimentally using a bulk polymer sample with a trans-stilbene ROI (cylinder) below the sample surface. The results show that modeling of the spatial configurations of laser excitation and detection points can be used to optimize the instrument configuration to achieve significant improvements (up to 2.25-fold) in performance over the conventional centered SORS. Such optimal solutions can then be implemented, for example, using robust fiber optic probes, moveable optics, or flexible spatial light modulator instruments for specific applications.
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Affiliation(s)
- Max Dooley
- School of Physics and Astronomy, 6123University of Nottingham, Nottingham, UK
| | - Thomas Paterson
- School of Physics and Astronomy, 6123University of Nottingham, Nottingham, UK
| | - Louise Dexter
- School of Physics and Astronomy, 6123University of Nottingham, Nottingham, UK
| | - Pavel Matousek
- Central Laser Facility, UK Research and Innovation (UKRI), STFC Rutherford Appleton Laboratory, Harwell Oxford, UK
| | - Hamid Dehghani
- School of Computer Sciences, 1724University of Birmingham, Birmingham, UK
| | - Ioan Notingher
- School of Physics and Astronomy, 6123University of Nottingham, Nottingham, UK
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11
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Raman-Guided Bronchoscopy: Feasibility and Detection Depth Studies Using Ex Vivo Lung Tissues and SERS Nanoparticle Tags. PHOTONICS 2022. [DOI: 10.3390/photonics9060429] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Image-guided and robotic bronchoscopy is currently under intense research and development for a broad range of clinical applications, especially for minimally invasive biopsy and surgery of peripheral pulmonary nodules or lesions that are frequently discovered by CT or MRI scans. Optical imaging and spectroscopic modalities at the near-infrared (NIR) window hold great promise for bronchoscopic navigation and guidance because of their high detection sensitivity and molecular/cellular specificity. However, light scattering and background interference are two major factors limiting the depth of tissue penetration of photons, and diseased lesions such as small tumors buried under the tissue surface often cannot be detected. Here we report the use of a miniaturized Raman device that is inserted into one of the bronchoscope channels for sensitive detection of “phantom” tumors using fresh pig lung tissues and surface-enhanced Raman scattering (SERS) nanoparticle tags. The ex vivo results demonstrate not only the feasibility of using Raman spectroscopy for endoscopic guidance, but also show that ultrabright SERS nanoparticles allow detection through a bronchial wall of 0.85 mm in thickness and a 5 mm-thick layer of lung tissue (approaching the fourth-generation airway). This work highlights the prospects and potential of Raman-guided bronchoscopy for minimally invasive imaging and detection of lung lesions.
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12
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Andreou C, Weissleder R, Kircher MF. Multiplexed imaging in oncology. Nat Biomed Eng 2022; 6:527-540. [PMID: 35624151 DOI: 10.1038/s41551-022-00891-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 09/06/2021] [Indexed: 01/24/2023]
Abstract
In oncology, technologies for clinical molecular imaging are used to diagnose patients, establish the efficacy of treatments and monitor the recurrence of disease. Multiplexed methods increase the number of disease-specific biomarkers that can be detected simultaneously, such as the overexpression of oncogenic proteins, aberrant metabolite uptake and anomalous blood perfusion. The quantitative localization of each biomarker could considerably increase the specificity and the accuracy of technologies for clinical molecular imaging to facilitate granular diagnoses, patient stratification and earlier assessments of the responses to administered therapeutics. In this Review, we discuss established techniques for multiplexed imaging and the most promising emerging multiplexing technologies applied to the imaging of isolated tissues and cells and to non-invasive whole-body imaging. We also highlight advances in radiology that have been made possible by multiplexed imaging.
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Affiliation(s)
- Chrysafis Andreou
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Center for Molecular Imaging and Nanotechnology (CMINT), Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Electrical and Computer Engineering, University of Cyprus, Nicosia, Cyprus
| | - Ralph Weissleder
- Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. .,Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. .,Department of Systems Biology, Harvard Medical School, Boston, MA, USA.
| | - Moritz F Kircher
- Molecular Pharmacology Program, Sloan Kettering Institute, New York, NY, USA.,Department of Imaging, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.,Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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13
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Emerging and future use of intra-surgical volumetric X-ray imaging and adjuvant tools for decision support in breast-conserving surgery. CURRENT OPINION IN BIOMEDICAL ENGINEERING 2022; 22. [DOI: 10.1016/j.cobme.2022.100382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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14
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Lauwerends LJ, Abbasi H, Bakker Schut TC, Van Driel PBAA, Hardillo JAU, Santos IP, Barroso EM, Koljenović S, Vahrmeijer AL, Baatenburg de Jong RJ, Puppels GJ, Keereweer S. The complementary value of intraoperative fluorescence imaging and Raman spectroscopy for cancer surgery: combining the incompatibles. Eur J Nucl Med Mol Imaging 2022; 49:2364-2376. [PMID: 35102436 PMCID: PMC9165240 DOI: 10.1007/s00259-022-05705-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 01/23/2022] [Indexed: 01/09/2023]
Abstract
A clear margin is an important prognostic factor for most solid tumours treated by surgery. Intraoperative fluorescence imaging using exogenous tumour-specific
fluorescent agents has shown particular benefit in improving complete resection of tumour tissue. However, signal processing for fluorescence imaging is complex, and fluorescence signal intensity does not always perfectly correlate with tumour location. Raman spectroscopy has the capacity to accurately differentiate between malignant and healthy tissue based on their molecular composition. In Raman spectroscopy, specificity is uniquely high, but signal intensity is weak and Raman measurements are mainly performed in a point-wise manner on microscopic tissue volumes, making whole-field assessment temporally unfeasible. In this review, we describe the state-of-the-art of both optical techniques, paying special attention to the combined intraoperative application of fluorescence imaging and Raman spectroscopy in current clinical research. We demonstrate how these techniques are complementary and address the technical challenges that have traditionally led them to be considered mutually exclusive for clinical implementation. Finally, we present a novel strategy that exploits the optimal characteristics of both modalities to facilitate resection with clear surgical margins.
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Affiliation(s)
- L J Lauwerends
- Department of Otorhinolaryngology, Head and Neck Surgery, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - H Abbasi
- Department of Otorhinolaryngology, Head and Neck Surgery, Erasmus MC Cancer Institute, Rotterdam, Netherlands.,Center for Optical Diagnostics and Therapy, Department of Dermatology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - T C Bakker Schut
- Center for Optical Diagnostics and Therapy, Department of Dermatology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - P B A A Van Driel
- Department of Orthopedic Surgery, Isala Hospital, Zwolle, Netherlands
| | - J A U Hardillo
- Department of Otorhinolaryngology, Head and Neck Surgery, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - I P Santos
- Molecular Physical-Chemistry R&D Unit, Department of Chemistry, University of Coimbra, Coimbra, Portugal
| | | | - S Koljenović
- Department of Pathology, Antwerp University Hospital/Antwerp University, Antwerp, Belgium
| | - A L Vahrmeijer
- Department of Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - R J Baatenburg de Jong
- Department of Otorhinolaryngology, Head and Neck Surgery, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - G J Puppels
- Center for Optical Diagnostics and Therapy, Department of Dermatology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - S Keereweer
- Department of Otorhinolaryngology, Head and Neck Surgery, Erasmus MC Cancer Institute, Rotterdam, Netherlands.
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15
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Li W, Li X. Development of intraoperative assessment of margins in breast conserving surgery: a narrative review. Gland Surg 2022; 11:258-269. [PMID: 35242687 PMCID: PMC8825505 DOI: 10.21037/gs-21-652] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 11/17/2021] [Indexed: 07/28/2023]
Abstract
OBJECTIVE We intend to provide an informative and up-to-date summary on the topic of intraoperative assessment of margins in breast conserving surgery (BCS). Conventional methods as well as cutting-edge technologies are analyzed for their advantages and limitations in the hope that clinicians can turn to this for reference. This review can also offer guidance for technicians in the future design of intraoperative margin assessment tools. BACKGROUND Achieving negative margins during BCS is one of the vital factors for preventing local recurrence. Conducting intraoperative margin assessment can ensure negative margins to a large extent and possibly relieve patients of the anguish of re-interventions. In recent years, innovative methods for margin assessment during BCS are advancing rapidly. And there is a lack of summary regarding the development of intraoperative margin assessment in BCS. METHODS A PubMed search with keywords "intraoperative margin assessment" and "breast conserving surgery" was conducted. Relevant publications were screened manually for its title, abstract and even full text to determine its true relevance. Publications on neo-adjuvant therapy and intraoperative radiotherapy were excluded. References from the searched articles and other supplementary articles were also looked into. CONCLUSIONS Conventional methods for margin assessment yields stable outcome but its use is limited because of the demand on pathology staff and the trade-off between time and precision. Conventional imaging techniques pass the workload to radiologists at the cost of a significantly low duration of time. Involving artificial intelligence for image-based assessment is a further improvement. However, conventional imaging is inherently flawed in that occult lesions can't show on the image and the showing ones are ambiguous and open to interpretation. Unconventional techniques which base their judgment on cellular composition are more reassuring. Nonetheless, unconventional techniques should be subjected to clinical trials before putting into practice. And studies regarding comparison between conventional methods and unconventional methods are also needed to evaluate their relative efficacy.
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Affiliation(s)
- Wanheng Li
- First Clinical Medical School, Southern Medical University, Guangzhou, China
| | - Xiru Li
- Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
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16
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Penders J, Nagelkerke A, Cunnane EM, Pedersen SV, Pence IJ, Coombes RC, Stevens MM. Single Particle Automated Raman Trapping Analysis of Breast Cancer Cell-Derived Extracellular Vesicles as Cancer Biomarkers. ACS NANO 2021; 15:18192-18205. [PMID: 34735133 PMCID: PMC9286313 DOI: 10.1021/acsnano.1c07075] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Extracellular vesicles (EVs) secreted by cancer cells provide an important insight into cancer biology and could be leveraged to enhance diagnostics and disease monitoring. This paper details a high-throughput label-free extracellular vesicle analysis approach to study fundamental EV biology, toward diagnosis and monitoring of cancer in a minimally invasive manner and with the elimination of interpreter bias. We present the next generation of our single particle automated Raman trapping analysis─SPARTA─system through the development of a dedicated standalone device optimized for single particle analysis of EVs. Our visualization approach, dubbed dimensional reduction analysis (DRA), presents a convenient and comprehensive method of comparing multiple EV spectra. We demonstrate that the dedicated SPARTA system can differentiate between cancer and noncancer EVs with a high degree of sensitivity and specificity (>95% for both). We further show that the predictive ability of our approach is consistent across multiple EV isolations from the same cell types. Detailed modeling reveals accurate classification between EVs derived from various closely related breast cancer subtypes, further supporting the utility of our SPARTA-based approach for detailed EV profiling.
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Affiliation(s)
- Jelle Penders
- Department
of Materials, Imperial College London, London SW7 2AZ, United Kingdom
- Department
of Bioengineering, Imperial College London, London SW7 2AZ, United Kingdom
- Institute
of Biomedical Engineering, Imperial College
London, London SW7 2AZ, United Kingdom
| | - Anika Nagelkerke
- Department
of Materials, Imperial College London, London SW7 2AZ, United Kingdom
- Department
of Bioengineering, Imperial College London, London SW7 2AZ, United Kingdom
- Institute
of Biomedical Engineering, Imperial College
London, London SW7 2AZ, United Kingdom
| | - Eoghan M. Cunnane
- Department
of Materials, Imperial College London, London SW7 2AZ, United Kingdom
- Department
of Bioengineering, Imperial College London, London SW7 2AZ, United Kingdom
- Institute
of Biomedical Engineering, Imperial College
London, London SW7 2AZ, United Kingdom
| | - Simon V. Pedersen
- Department
of Materials, Imperial College London, London SW7 2AZ, United Kingdom
- Department
of Bioengineering, Imperial College London, London SW7 2AZ, United Kingdom
- Institute
of Biomedical Engineering, Imperial College
London, London SW7 2AZ, United Kingdom
| | - Isaac J. Pence
- Department
of Materials, Imperial College London, London SW7 2AZ, United Kingdom
- Department
of Bioengineering, Imperial College London, London SW7 2AZ, United Kingdom
- Institute
of Biomedical Engineering, Imperial College
London, London SW7 2AZ, United Kingdom
| | - R. Charles Coombes
- Department
of Surgery and Cancer, Hammersmith Hospital, Imperial College, London W120HS, United Kingdom
| | - Molly M. Stevens
- Department
of Materials, Imperial College London, London SW7 2AZ, United Kingdom
- Department
of Bioengineering, Imperial College London, London SW7 2AZ, United Kingdom
- Institute
of Biomedical Engineering, Imperial College
London, London SW7 2AZ, United Kingdom
- E-mail:
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17
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Pence IJ, Evans CL. Translational biophotonics with Raman imaging: clinical applications and beyond. Analyst 2021; 146:6379-6393. [PMID: 34596653 PMCID: PMC8543123 DOI: 10.1039/d1an00954k] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 08/30/2021] [Indexed: 01/25/2023]
Abstract
Clinical medicine continues to seek novel rapid non-invasive tools capable of providing greater insight into disease progression and management. Raman scattering based technologies constitute a set of tools under continuing development to address outstanding challenges spanning diagnostic medicine, surgical guidance, therapeutic monitoring, and histopathology. Here we review the mechanisms and clinical applications of Raman scattering, specifically focusing on high-speed imaging methods that can provide spatial context for translational biomedical applications.
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Affiliation(s)
- Isaac J Pence
- Wellman Center for Photomedicine, Harvard Medical School, Massachusetts General Hospital, 149 13th Street, Charlestown, Massachusetts 02129, USA.
| | - Conor L Evans
- Wellman Center for Photomedicine, Harvard Medical School, Massachusetts General Hospital, 149 13th Street, Charlestown, Massachusetts 02129, USA.
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18
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A New Look into Cancer-A Review on the Contribution of Vibrational Spectroscopy on Early Diagnosis and Surgery Guidance. Cancers (Basel) 2021; 13:cancers13215336. [PMID: 34771500 PMCID: PMC8582426 DOI: 10.3390/cancers13215336] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/14/2021] [Accepted: 10/18/2021] [Indexed: 02/05/2023] Open
Abstract
Simple Summary Cancer is a leading cause of death worldwide, with the detection of the disease in its early stages, as well as a correct assessment of the tumour margins, being paramount for a successful recovery. While breast cancer is one of most common types of cancer, head and neck cancer is one of the types of cancer with a lower prognosis and poor aesthetic results. Vibrational spectroscopy detects molecular vibrations, being sensitive to different sample compositions, even when the difference was slight. The use of spectroscopy in biomedicine has been extensively explored, since it allows a broader assessment of the biochemical fingerprint of several diseases. This literature review covers the most recent advances in breast and head and neck cancer early diagnosis and intraoperative margin assessment, through Raman and Fourier transform infrared spectroscopies. The rising field of spectral histopathology was also approached. The authors aimed at expounding in a more concise and simple way the challenges faced by clinicians and how vibrational spectroscopy has evolved to respond to those needs for the two types of cancer with the highest potential for improvement regarding an early diagnosis, surgical margin assessment and histopathology. Abstract In 2020, approximately 10 million people died of cancer, rendering this disease the second leading cause of death worldwide. Detecting cancer in its early stages is paramount for patients’ prognosis and survival. Hence, the scientific and medical communities are engaged in improving both therapeutic strategies and diagnostic methodologies, beyond prevention. Optical vibrational spectroscopy has been shown to be an ideal diagnostic method for early cancer diagnosis and surgical margins assessment, as a complement to histopathological analysis. Being highly sensitive, non-invasive and capable of real-time molecular imaging, Raman and Fourier transform infrared (FTIR) spectroscopies give information on the biochemical profile of the tissue under analysis, detecting the metabolic differences between healthy and cancerous portions of the same sample. This constitutes tremendous progress in the field, since the cancer-prompted morphological alterations often occur after the biochemical imbalances in the oncogenic process. Therefore, the early cancer-associated metabolic changes are unnoticed by the histopathologist. Additionally, Raman and FTIR spectroscopies significantly reduce the subjectivity linked to cancer diagnosis. This review focuses on breast and head and neck cancers, their clinical needs and the progress made to date using vibrational spectroscopy as a diagnostic technique prior to surgical intervention and intraoperative margin assessment.
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19
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Alfonso-Garcia A, Bec J, Weyers B, Marsden M, Zhou X, Li C, Marcu L. Mesoscopic fluorescence lifetime imaging: Fundamental principles, clinical applications and future directions. JOURNAL OF BIOPHOTONICS 2021; 14:e202000472. [PMID: 33710785 PMCID: PMC8579869 DOI: 10.1002/jbio.202000472] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 03/03/2021] [Accepted: 03/05/2021] [Indexed: 05/16/2023]
Abstract
Fluorescence lifetime imaging (FLIm) is an optical spectroscopic imaging technique capable of real-time assessments of tissue properties in clinical settings. Label-free FLIm is sensitive to changes in tissue structure and biochemistry resulting from pathological conditions, thus providing optical contrast to identify and monitor the progression of disease. Technical and methodological advances over the last two decades have enabled the development of FLIm instrumentation for real-time, in situ, mesoscopic imaging compatible with standard clinical workflows. Herein, we review the fundamental working principles of mesoscopic FLIm, discuss the technical characteristics of current clinical FLIm instrumentation, highlight the most commonly used analytical methods to interpret fluorescence lifetime data and discuss the recent applications of FLIm in surgical oncology and cardiovascular diagnostics. Finally, we conclude with an outlook on the future directions of clinical FLIm.
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Affiliation(s)
- Alba Alfonso-Garcia
- Department of Biomedical Engineering, University of California, Davis, Davis, California
| | - Julien Bec
- Department of Biomedical Engineering, University of California, Davis, Davis, California
| | - Brent Weyers
- Department of Biomedical Engineering, University of California, Davis, Davis, California
| | - Mark Marsden
- Department of Biomedical Engineering, University of California, Davis, Davis, California
| | - Xiangnan Zhou
- Department of Biomedical Engineering, University of California, Davis, Davis, California
| | - Cai Li
- Department of Biomedical Engineering, University of California, Davis, Davis, California
| | - Laura Marcu
- Department of Biomedical Engineering, University of California, Davis, Davis, California
- Department Neurological Surgery, University of California, Davis, California
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20
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Fales AM, Strobbia P, Vo-Dinh T, Ilev IK, Pfefer TJ. 3D-printed phantoms for characterizing SERS nanoparticle detectability in turbid media. Analyst 2021; 145:6045-6053. [PMID: 32766656 DOI: 10.1039/d0an01295e] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Recent advances in plasmonic nanoparticle synthesis have enabled extremely high per-particle surface-enhanced Raman scattering (SERS) efficiencies. This has led to the development of SERS tags for in vivo applications (e.g. tumor targeting and detection), providing high sensitivity and fingerprint-like molecular specificity. While the SERS enhancement factor is a major contributor to SERS tag performance, in practice the throughput and excitation-collection geometry of the optical system can significantly impact detectability. Test methods to objectively quantify SERS particle performance under realistic conditions are necessary to facilitate clinical translation. Towards this goal, we have developed 3D-printed phantoms with tunable, biologically-relevant optical properties. Phantoms were designed to include 1 mm-diameter channels at different depths, which can be filled with SERS tag solutions. The effects of channel depth and particle concentration on the detectability of three different SERS tags were evaluated using 785 nm laser excitation at the maximum permissible exposure for skin. Two of these tags were commercially available, featuring gold nanorods as the SERS particle, while the third tag was prepared in-house using silver-coated gold nanostars. Our findings revealed that the measured SERS intensity of tags in solution is not always a reliable predictor of detectability when applied in a turbid medium such as tissue. The phantoms developed in this work can be used to assess the suitability of specific SERS tags and instruments for their intended clinical applications and provide a means of optimizing new SERS device-tag combination products.
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Affiliation(s)
- Andrew M Fales
- Division of Biomedical Physics, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland 20993, USA.
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21
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Assessment of breast cancer surgical margins with multimodal optical microscopy: A feasibility clinical study. PLoS One 2021; 16:e0245334. [PMID: 33571221 PMCID: PMC7877783 DOI: 10.1371/journal.pone.0245334] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 12/28/2020] [Indexed: 11/18/2022] Open
Abstract
Providing surgical margin information during breast cancer surgery is crucial for the success of the procedure. The margin is defined as the distance from the tumor to the cut surface of the resection specimen. The consensus among surgeons and radiation oncologists is that there should be no tumor left within 1 to maximum 2 mm from the surface of the surgical specimen. If a positive margin remains, there is substantial risk for tumor recurrence, which may also result in potentially reduced cosmesis and eventual need for mastectomy. In this paper we report a novel multimodal optical imaging instrument based on combined high-resolution confocal microscopy-optical coherence tomography imaging for assessing the presence of potential positive margins on surgical specimens. Since rapid specimen analysis is critical during surgery, this instrument also includes a fluorescence imaging channel to enable rapid identification of the areas of the specimen that have potential positive margins. This is possible by specimen incubation with a cancer specific agent prior to imaging. In this study we used a quenched contrast agent, which is activated by cancer specific enzymes, such as urokinase plasminogen activators (uPA). Using this agent or a similar one, one may limit the use of high-resolution optical imaging to only fluorescence-highlighted areas for visualizing tissue morphology at the sub-cellular scale and confirming or ruling out cancer presence. Preliminary evaluation of this technology was performed on 20 surgical specimens and testing of the optical imaging findings was performed against histopathology. The combination of the three imaging modes allowed for high correlation between optical image analysis and histological ground-truth. The initial results are encouraging, showing instrument capability to assess margins on clinical specimens with a positive predictive value of 1.0 and a negative predictive value of 0.83.
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22
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Nicolson F, Kircher MF, Stone N, Matousek P. Spatially offset Raman spectroscopy for biomedical applications. Chem Soc Rev 2021; 50:556-568. [PMID: 33169761 PMCID: PMC8323810 DOI: 10.1039/d0cs00855a] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Indexed: 12/24/2022]
Abstract
In recent years, Raman spectroscopy has undergone major advancements in its ability to probe deeply through turbid media such as biological tissues. This progress has been facilitated by the advent of a range of specialist techniques based around spatially offset Raman spectroscopy (SORS) to enable non-invasive probing of living tissue through depths of up to 5 cm. This represents an improvement in depth penetration of up to two orders of magnitude compared to what can be achieved with conventional Raman methods. In combination with the inherently high molecular specificity of Raman spectroscopy, this has therefore opened up entirely new prospects for a range of new analytical applications across multiple fields including medical diagnosis and disease monitoring. This article discusses SORS and related variants of deep Raman spectroscopy such as transmission Raman spectroscopy (TRS), micro-SORS and surface enhanced spatially offset Raman spectroscopy (SESORS), and reviews the progress made in this field during the past 5 years including advances in non-invasive cancer diagnosis, monitoring of neurotransmitters, and assessment of bone disease.
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Affiliation(s)
- Fay Nicolson
- Department of Imaging, Dana-Farber Cancer Institute & Harvard Medical SchoolBostonMA 02215USA
| | - Moritz F. Kircher
- Department of Imaging, Dana-Farber Cancer Institute & Harvard Medical SchoolBostonMA 02215USA
- Department of Radiology, Brigham & Women's Hospital & Harvard Medical SchoolBostonMA 022115USA
| | - Nick Stone
- School of Physics and Astronomy, University of ExeterExeterEX4 4QLUK
- Royal Devon and Exeter NHS Foundation TrustBarrack RoadExeterDevonEX2 5DWUK
| | - Pavel Matousek
- Central Laser Facility, Research Complex at Harwell, STFC Rutherford Appleton Laboratory, UKRIHarwellOxfordOX11 0QXUK
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23
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Balasundaram G, Krafft C, Zhang R, Dev K, Bi R, Moothanchery M, Popp J, Olivo M. Biophotonic technologies for assessment of breast tumor surgical margins-A review. JOURNAL OF BIOPHOTONICS 2021; 14:e202000280. [PMID: 32951321 DOI: 10.1002/jbio.202000280] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 09/15/2020] [Accepted: 09/18/2020] [Indexed: 06/11/2023]
Abstract
Breast conserving surgery (BCS) offering similar surgical outcomes as mastectomy while retaining breast cosmesis is becoming increasingly popular for the management of early stage breast cancers. However, its association with reoperation rates of 20% to 40% following incomplete tumor removal warrants the need for a fast and accurate intraoperative surgical margin assessment tool that offers cellular, structural and molecular information of the whole specimen surface to a clinically relevant depth. Biophotonic technologies are evolving to qualify as such an intraoperative tool for clinical assessment of breast cancer surgical margins at the microscopic and macroscopic scale. Herein, we review the current research in the application of biophotonic technologies such as photoacoustic imaging, Raman spectroscopy, multimodal multiphoton imaging, diffuse optical imaging and fluorescence imaging using medically approved dyes for breast cancer detection and/or tumor subtype differentiation toward intraoperative assessment of surgical margins in BCS specimens, and possible challenges in their route to clinical translation.
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Affiliation(s)
- Ghayathri Balasundaram
- Singapore Bioimaging Consortium, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | | | - Ruochong Zhang
- Singapore Bioimaging Consortium, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Kapil Dev
- Singapore Bioimaging Consortium, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Renzhe Bi
- Singapore Bioimaging Consortium, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Mohesh Moothanchery
- Singapore Bioimaging Consortium, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Jürgen Popp
- Leibniz Institute of Photonic Technology, Jena, Germany
- Institute of Physical Chemistry and Abbe Center of Photonics, University Jena, Jena, Germany
| | - Malini Olivo
- Singapore Bioimaging Consortium, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
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24
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Balasundaram G, Goh Y, Moothanchery M, Attia A, Lim HQ, Burton NC, Qiu Y, Putti TC, Chan CW, Hartmann M, Quek ST, Olivo M. Optoacoustic characterization of breast conserving surgery specimens - A pilot study. PHOTOACOUSTICS 2020; 19:100164. [PMID: 32420026 PMCID: PMC7215246 DOI: 10.1016/j.pacs.2020.100164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 01/22/2020] [Accepted: 01/28/2020] [Indexed: 05/04/2023]
Abstract
In this pilot study, we tested an ultrasound-guided optoacoustic tomography (US-OT) two-dimensional (2D) array scanner to understand the optoacoustic patterns of excised breastconserving surgery (BCS) specimens. We imaged 14 BCS specimens containing malignant tumors at eight wavelengths spanning 700-1100 nm. Spectral unmixing across multiple wavelengths allowed for visualizing major intrinsic chromophores in the breast tissue including hemoglobin and lipid up to a depth of 7 mm. We identified less/no lipid signals within the tumor and intense deoxy-hemoglobin (Hb) signals on the rim of the tumor as unique characteristics of malignant tumors in comparison to no tumor region. We also observed continuous broad lipid signals as features of negative margins and compromised lipid signals interrupted by vasculature as features of positive margins. These differentiating patterns can form the basis of US-OT to be explored as an alternate, fast and efficient intraoperative method for evaluation of tumor resection margins.
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Affiliation(s)
| | - Yonggeng Goh
- Department of Diagnostic Imaging, National University Hospital, Singapore
| | - Mohesh Moothanchery
- Laboratory of Bio-Optical Imaging, Singapore Bioimaging Consortium, Singapore
| | - Amalina Attia
- Laboratory of Bio-Optical Imaging, Singapore Bioimaging Consortium, Singapore
| | - Hann Qian Lim
- Laboratory of Bio-Optical Imaging, Singapore Bioimaging Consortium, Singapore
| | | | - Yi Qiu
- iThera Medical GmbH, Germany
| | | | - Ching Wan Chan
- Department of Breast Surgery, National University Hospital, Singapore
| | - Mikael Hartmann
- Department of Breast Surgery, National University Hospital, Singapore
| | - Swee Tian Quek
- Department of Diagnostic Imaging, National University Hospital, Singapore
| | - Malini Olivo
- Laboratory of Bio-Optical Imaging, Singapore Bioimaging Consortium, Singapore
- Corresponding author at: Singapore Bioimaging Consortium (SBIC). A⁎STAR Research Entities, 11 Biopolis Way, #02-02 Helios, 138667, Singapore.
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25
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Wen X, Ou YC, Bogatcheva G, Thomas G, Mahadevan-Jansen A, Singh B, Lin EC, Bardhan R. Probing metabolic alterations in breast cancer in response to molecular inhibitors with Raman spectroscopy and validated with mass spectrometry. Chem Sci 2020; 11:9863-9874. [PMID: 34094246 PMCID: PMC8162119 DOI: 10.1039/d0sc02221g] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 08/19/2020] [Indexed: 01/07/2023] Open
Abstract
Rapid and accurate response to targeted therapies is critical to differentiate tumors that are resistant to treatment early in the regimen. In this work, we demonstrate a rapid, noninvasive, and label-free approach to evaluate treatment response to molecular inhibitors in breast cancer (BC) cells with Raman spectroscopy (RS). Metabolic reprogramming in BC was probed with RS and multivariate analysis was applied to classify the cells into responsive or nonresponsive groups as a function of drug dosage, drug type, and cell type. Metabolites identified with RS were then validated with mass spectrometry (MS). We treated triple-negative BC cells with Trametinib, an inhibitor of the extracellular-signal-regulated kinase (ERK) pathway. Changes measured with both RS and MS corresponding to membrane phospholipids, amino acids, lipids and fatty acids indicated that these BC cells were responsive to treatment. Comparatively, minimal metabolic changes were observed post-treatment with Alpelisib, an inhibitor of the mammalian target of rapamycin (mTOR) pathway, indicating treatment resistance. These findings were corroborated with cell viability assay and immunoblotting. We also showed estrogen receptor-positive MCF-7 cells were nonresponsive to Trametinib with minimal metabolic and viability changes. Our findings support that oncometabolites identified with RS will ultimately enable rapid drug screening in patients ensuring patients receive the most effective treatment at the earliest time point.
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Affiliation(s)
- Xiaona Wen
- Department of Chemical and Biomolecular Engineering, Vanderbilt University Nashville TN 37235 USA
| | - Yu-Chuan Ou
- Department of Chemical and Biomolecular Engineering, Vanderbilt University Nashville TN 37235 USA
| | - Galina Bogatcheva
- Department of Medicine, Vanderbilt University Medical Center Nashville TN 37232 USA
| | - Giju Thomas
- Vanderbilt Biophotonics Center, Vanderbilt University Nashville TN 37232 USA
| | | | - Bhuminder Singh
- Department of Medicine, Vanderbilt University Medical Center Nashville TN 37232 USA
| | - Eugene C Lin
- Department of Chemistry and Biochemistry, National Chung Cheng University Chiayi 62106 Taiwan
| | - Rizia Bardhan
- Department of Chemical and Biological Engineering, Iowa State University Ames IA 50012 USA
- Nanovaccine Institute, Iowa State University Ames IA 50012 USA
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26
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Zaffino P, Moccia S, De Momi E, Spadea MF. A Review on Advances in Intra-operative Imaging for Surgery and Therapy: Imagining the Operating Room of the Future. Ann Biomed Eng 2020; 48:2171-2191. [PMID: 32601951 DOI: 10.1007/s10439-020-02553-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 06/17/2020] [Indexed: 12/19/2022]
Abstract
With the advent of Minimally Invasive Surgery (MIS), intra-operative imaging has become crucial for surgery and therapy guidance, allowing to partially compensate for the lack of information typical of MIS. This paper reviews the advancements in both classical (i.e. ultrasounds, X-ray, optical coherence tomography and magnetic resonance imaging) and more recent (i.e. multispectral, photoacoustic and Raman imaging) intra-operative imaging modalities. Each imaging modality was analyzed, focusing on benefits and disadvantages in terms of compatibility with the operating room, costs, acquisition time and image characteristics. Tables are included to summarize this information. New generation of hybrid surgical room and algorithms for real time/in room image processing were also investigated. Each imaging modality has its own (site- and procedure-specific) peculiarities in terms of spatial and temporal resolution, field of view and contrasted tissues. Besides the benefits that each technique offers for guidance, considerations about operators and patient risk, costs, and extra time required for surgical procedures have to be considered. The current trend is to equip surgical rooms with multimodal imaging systems, so as to integrate multiple information for real-time data extraction and computer-assisted processing. The future of surgery is to enhance surgeons eye to minimize intra- and after-surgery adverse events and provide surgeons with all possible support to objectify and optimize the care-delivery process.
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Affiliation(s)
- Paolo Zaffino
- Department of Experimental and Clinical Medicine, Universitá della Magna Graecia, Catanzaro, Italy
| | - Sara Moccia
- Department of Information Engineering (DII), Universitá Politecnica delle Marche, via Brecce Bianche, 12, 60131, Ancona, AN, Italy.
| | - Elena De Momi
- Department of Electronics, Information and Bioengineering (DEIB), Politecnico di Milano, Piazza Leonardo da Vinci, 32, 20133, Milano, MI, Italy
| | - Maria Francesca Spadea
- Department of Experimental and Clinical Medicine, Universitá della Magna Graecia, Catanzaro, Italy
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Song SW, Cho Y, Bae CH, Park CR, Kim HM. In situ real-time identification of packaged chemicals using a dual-offset optical probe. ANALYTICAL METHODS : ADVANCING METHODS AND APPLICATIONS 2020; 12:3032-3037. [PMID: 32930163 DOI: 10.1039/d0ay00612b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
In situ real-time and nondestructive identification of packaged chemicals is essential for applications such as homeland security and terrorism prevention. Although various Raman spectroscopic methods such as spatially offset Raman spectroscopy (SORS) and time-resolved Raman spectroscopy have been investigated for real-time detection, the background interference originating from packaging materials limits the accuracy of the analysis. In principle, the Raman background from the packaging cannot be removed completely. To overcome this limitation, we developed a SORS-based dual-offset optical probe (DOOP) system that offers real-time prediction of 20 chemicals concealed in various containers by completely removing the background signal. The DOOP system selectively acquires the Raman photons generated from both the outer packaging and the inner contents, whose intensities are dependent on the penetration depth of the laser. The Raman spectra obtained at two remote offsets are automatically subtracted after normalization. We demonstrate that the DOOP method provides the pure component spectra by completely removing background interference from three plastic containers for a total of 20 samples in three different containers. In addition, an artificial neural network (ANN) was applied to evaluate the accuracy of the real-time chemical identification system; our system led to drastic improvements of the ANN prediction accuracy.
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Affiliation(s)
- Si Won Song
- Department of Chemistry, Kookmin University, 77, Jeongneung-ro, Seongbuk-gu, Seoul, 02707, Republic of Korea.
| | - Youngho Cho
- Department of Chemistry, Kookmin University, 77, Jeongneung-ro, Seongbuk-gu, Seoul, 02707, Republic of Korea.
- Sensor System Research Center, Korea Institute of Science and Technology (KIST), 5 Hwarang-ro 14-gil, Seongbuk-gu, Seoul, 02792, Republic of Korea
| | - Chang Hyun Bae
- Department of Chemistry, Kookmin University, 77, Jeongneung-ro, Seongbuk-gu, Seoul, 02707, Republic of Korea.
| | - Chan Ryang Park
- Department of Chemistry, Kookmin University, 77, Jeongneung-ro, Seongbuk-gu, Seoul, 02707, Republic of Korea.
| | - Hyung Min Kim
- Department of Chemistry, Kookmin University, 77, Jeongneung-ro, Seongbuk-gu, Seoul, 02707, Republic of Korea.
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Pradipta AR, Tanei T, Morimoto K, Shimazu K, Noguchi S, Tanaka K. Emerging Technologies for Real-Time Intraoperative Margin Assessment in Future Breast-Conserving Surgery. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2020; 7:1901519. [PMID: 32382473 PMCID: PMC7201251 DOI: 10.1002/advs.201901519] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 01/16/2020] [Accepted: 02/14/2020] [Indexed: 05/23/2023]
Abstract
Clean surgical margins in breast-conserving surgery (BCS) are essential for preventing recurrence. Intraoperative pathologic diagnostic methods, such as frozen section analysis and imprint cytology, have been recognized as crucial tools in BCS. However, the complexity and time-consuming nature of these pathologic procedures still inhibit their broader applicability worldwide. To address this situation, two issues should be considered: 1) the development of nonpathologic intraoperative diagnosis methods that have better sensitivity, specificity, speed, and cost; and 2) the promotion of new imaging algorithms to standardize data for analyzing positive margins, as represented by artificial intelligence (AI), without the need for judgment by well-trained pathologists. Researchers have attempted to develop new methods or techniques; several have recently emerged for real-time intraoperative management of breast margins in live tissues. These methods include conventional imaging, spectroscopy, tomography, magnetic resonance imaging, microscopy, fluorescent probes, and multimodal imaging techniques. This work summarizes the traditional pathologic and newly developed techniques and discusses the advantages and disadvantages of each method. Taking into consideration the recent advances in analyzing pathologic data from breast cancer tissue with AI, the combined use of new technologies with AI algorithms is proposed, and future directions for real-time intraoperative margin assessment in BCS are discussed.
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Affiliation(s)
- Ambara R. Pradipta
- Biofunctional Synthetic Chemistry LaboratoryRIKEN Cluster for Pioneering Research2‐1 HirosawaWakoSaitama351‐0198Japan
- School of Materials and Chemical TechnologyDepartment of Chemical Science and EngineeringTokyo Institute of Technology2‐12‐1 Ookayama, Meguro‐kuTokyo152‐8552Japan
| | - Tomonori Tanei
- Department of Breast and Endocrine SurgeryGraduate School of MedicineOsaka University2‐2‐E10 Yamadaoka, SuitaOsaka565‐0871Japan
| | - Koji Morimoto
- Biofunctional Synthetic Chemistry LaboratoryRIKEN Cluster for Pioneering Research2‐1 HirosawaWakoSaitama351‐0198Japan
| | - Kenzo Shimazu
- Department of Breast and Endocrine SurgeryGraduate School of MedicineOsaka University2‐2‐E10 Yamadaoka, SuitaOsaka565‐0871Japan
| | - Shinzaburo Noguchi
- Department of Breast and Endocrine SurgeryGraduate School of MedicineOsaka University2‐2‐E10 Yamadaoka, SuitaOsaka565‐0871Japan
| | - Katsunori Tanaka
- Biofunctional Synthetic Chemistry LaboratoryRIKEN Cluster for Pioneering Research2‐1 HirosawaWakoSaitama351‐0198Japan
- School of Materials and Chemical TechnologyDepartment of Chemical Science and EngineeringTokyo Institute of Technology2‐12‐1 Ookayama, Meguro‐kuTokyo152‐8552Japan
- Biofunctional Chemistry LaboratoryA. Butlerov Institute of ChemistryKazan Federal University18 Kremlyovskaya StreetKazan420008Russia
- GlycoTargeting Research LaboratoryRIKEN Baton Zone Program2‐1 HirosawaWakoSaitama351‐0198Japan
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Schwarz J, Schmidt H. Technology for Intraoperative Margin Assessment in Breast Cancer. Ann Surg Oncol 2020; 27:2278-2287. [PMID: 32350717 DOI: 10.1245/s10434-020-08483-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND As breast-conserving surgery (BCS) has become standard for treatment of breast cancer, the need for new technology to improve intraoperative margin assessment (IMA) has become clear. Close or positive margins during BCS lead to additional surgeries, treatment delay, additional stress for patients, and healthcare cost. Academia and industry have developed a diverse field of new technologies to allow surgeons to assess margins in the operating room. These technologies aim to reduce current rates of positive margins on final pathology. METHODS We selected recently developed IMA technologies, some of which have undergone large clinical trials and others that are still in early stage development. Technologies were categorized based on underlying methodology to differentiate malignant and normal tissue: spectroscopy, electrical properties, optical imaging and molecular imaging. Additionally, this review details clinical investigations, relevant statistical analysis as well as strengths and weaknesses of the various technologies. CONCLUSION Numerous technical innovations are being implemented to diminish rates of positive margins at breast tumor resection. Close collaboration among cross-disciplinary teams to further develop many of these technologies as well as completion of larger scale clinical studies are required to define an optimal approach. Development with an eye toward prioritizing sensitivity/specificity as well as healthcare cost containment has the potential to make a significant impact on this ongoing clinical need in breast cancer surgery.
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Affiliation(s)
- Julia Schwarz
- Dubin Breast Center, Tisch Cancer Institute, New York, USA.,Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Breast Surgical Oncology, The Mount Sinai Hospital, New York, NY, USA
| | - Hank Schmidt
- Dubin Breast Center, Tisch Cancer Institute, New York, USA. .,Icahn School of Medicine at Mount Sinai, New York, NY, USA. .,Breast Surgical Oncology, The Mount Sinai Hospital, New York, NY, USA.
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Hubbard TJE, Shore A, Stone N. Raman spectroscopy for rapid intra-operative margin analysis of surgically excised tumour specimens. Analyst 2020; 144:6479-6496. [PMID: 31616885 DOI: 10.1039/c9an01163c] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Raman spectroscopy, a form of vibrational spectroscopy, has the ability to provide sensitive and specific biochemical analysis of tissue. This review article provides an in-depth analysis of the suitability of different Raman spectroscopy techniques in providing intra-operative margin analysis in a range of solid tumour pathologies. Surgical excision remains the primary treatment of a number of solid organ cancers. Incomplete excision of a tumour and positive margins on histopathological analysis is associated with a worse prognosis, the need for adjuvant therapies with significant side effects and a resulting financial burden. The provision of intra-operative margin analysis of surgically excised tumour specimens would be beneficial for a number of pathologies, as there are no widely adopted and accurate methods of margin analysis, beyond histopathology. The limitations of Raman spectroscopic studies to date are discussed and future work necessary to enable translation to clinical use is identified. We conclude that, although there remain a number of challenges in translating current techniques into a clinically effective tool, studies so far demonstrate that Raman Spectroscopy has the attributes to successfully perform highly accurate intra-operative margin analysis in a clinically relevant environment.
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Mondal SB, O'Brien CM, Bishop K, Fields RC, Margenthaler JA, Achilefu S. Repurposing Molecular Imaging and Sensing for Cancer Image-Guided Surgery. J Nucl Med 2020; 61:1113-1122. [PMID: 32303598 DOI: 10.2967/jnumed.118.220426] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 03/05/2020] [Indexed: 12/25/2022] Open
Abstract
Gone are the days when medical imaging was used primarily to visualize anatomic structures. The emergence of molecular imaging (MI), championed by radiolabeled 18F-FDG PET, has expanded the information content derived from imaging to include pathophysiologic and molecular processes. Cancer imaging, in particular, has leveraged advances in MI agents and technology to improve the accuracy of tumor detection, interrogate tumor heterogeneity, monitor treatment response, focus surgical resection, and enable image-guided biopsy. Surgeons are actively latching on to the incredible opportunities provided by medical imaging for preoperative planning, intraoperative guidance, and postoperative monitoring. From label-free techniques to enabling cancer-selective imaging agents, image-guided surgery provides surgical oncologists and interventional radiologists both macroscopic and microscopic views of cancer in the operating room. This review highlights the current state of MI and sensing approaches available for surgical guidance. Salient features of nuclear, optical, and multimodal approaches will be discussed, including their strengths, limitations, and clinical applications. To address the increasing complexity and diversity of methods available today, this review provides a framework to identify a contrast mechanism, suitable modality, and device. Emerging low-cost, portable, and user-friendly imaging systems make the case for adopting some of these technologies as the global standard of care in surgical practice.
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Affiliation(s)
- Suman B Mondal
- Department of Radiology, Washington University, St. Louis, Missouri
| | | | - Kevin Bishop
- Department of Radiology, Washington University, St. Louis, Missouri
| | - Ryan C Fields
- Department of Surgery and Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
| | - Julie A Margenthaler
- Department of Surgery and Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
| | - Samuel Achilefu
- Department of Radiology, Washington University, St. Louis, Missouri .,Department of Biomedical Engineering, Washington University, St. Louis, Missouri; and.,Department of Biochemistry and Molecular Biophysics, Washington University, St. Louis, Missouri
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Unger J, Hebisch C, Phipps JE, Lagarto JL, Kim H, Darrow MA, Bold RJ, Marcu L. Real-time diagnosis and visualization of tumor margins in excised breast specimens using fluorescence lifetime imaging and machine learning. BIOMEDICAL OPTICS EXPRESS 2020; 11:1216-1230. [PMID: 32206404 PMCID: PMC7075618 DOI: 10.1364/boe.381358] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 01/14/2020] [Accepted: 01/14/2020] [Indexed: 05/03/2023]
Abstract
Tumor-free surgical margins are critical in breast-conserving surgery. In up to 38% of the cases, however, patients undergo a second surgery since malignant cells are found at the margins of the excised resection specimen. Thus, advanced imaging tools are needed to ensure clear margins at the time of surgery. The objective of this study was to evaluate a random forest classifier that makes use of parameters derived from point-scanning label-free fluorescence lifetime imaging (FLIm) measurements of breast specimens as a means to diagnose tumor at the resection margins and to enable an intuitive visualization of a probabilistic classifier on tissue specimen. FLIm data from fresh lumpectomy and mastectomy specimens from 18 patients were used in this study. The supervised training was based on a previously developed registration technique between autofluorescence imaging data and cross-sectional histology slides. A pathologist's histology annotations provide the ground truth to distinguish between adipose, fibrous, and tumor tissue. Current results demonstrate the ability of this approach to classify the tumor with 89% sensitivity and 93% specificity and to rapidly (∼ 20 frames per second) overlay the probabilistic classifier overlaid on excised breast specimens using an intuitive color scheme. Furthermore, we show an iterative imaging refinement that allows surgeons to switch between rapid scans with a customized, low spatial resolution to quickly cover the specimen and slower scans with enhanced resolution (400 μm per point measurement) in suspicious regions where more details are required. In summary, this technique provides high diagnostic prediction accuracy, rapid acquisition, adaptive resolution, nondestructive probing, and facile interpretation of images, thus holding potential for clinical breast imaging based on label-free FLIm.
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Affiliation(s)
- Jakob Unger
- Department of Biomedical Engineering, University of California Davis, California, CA 95616, USA
- Corresponding authors
| | - Christoph Hebisch
- Department of Biomedical Engineering, University of California Davis, California, CA 95616, USA
| | - Jennifer E. Phipps
- Department of Biomedical Engineering, University of California Davis, California, CA 95616, USA
| | - João L. Lagarto
- Department of Biomedical Engineering, University of California Davis, California, CA 95616, USA
| | - Hanna Kim
- Department of Otolaryngology, University of California Davis, California, CA 95817, USA
| | - Morgan A. Darrow
- Department of Pathology and Laboratory Medicine, University of California Davis, California, CA 95817, USA
| | - Richard J. Bold
- Department of Surgery, University of California Davis, California, CA 95817, USA
| | - Laura Marcu
- Department of Biomedical Engineering, University of California Davis, California, CA 95616, USA
- Corresponding authors
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33
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Automated gigapixel circumferential surface microscopy of the prostate. Sci Rep 2020; 10:131. [PMID: 31924809 PMCID: PMC6954271 DOI: 10.1038/s41598-019-56939-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 12/19/2019] [Indexed: 11/10/2022] Open
Abstract
Positive surgical margins, or cancer cells found at the boundary of an excised tumor mass, are a significant problem in the management of many cancers resulting in worsened patient outcomes. The problem is exacerbated in organ sites such as the prostate, where unnecessarily wide local excisions can result in significant deterioration of post-operative quality of life due to collateral damage to neighboring structures. Yet, at the same time, incomplete tumor removal results in worsened prognosis and need for additional interventions. Here, we report the design and development of a rapid and completely automated system for intraoperative gigapixel ex vivo microscopy of the circumferential surgical prostate margin within intra-operative timeframes, called the Automated Prostate Positioning System (APPS). The APPS leverages the rotational geometry of the prostate and high speed structured illumination microscopy (SIM) to generate continuous gigapixel panoramas of the fresh intact prostate circumference, including areas of the prostate adjacent to the neurovascular bundles, the rectum, and the bladder wall. Our previous work using SIM and a manual prostate handling method demonstrated the promise of the imaging technique for accurate detection of positive surgical margins. Our work here advances the technology toward clinical adoption, by demonstrating 10% greater tissue surface coverage fraction, 1.6× faster imaging throughput, and reduced number of required operator steps, compared to our prior approach. The APPS may be operated by a single person in the operating room suite within intraoperative time limits, while simultaneously delivering nearly two orders of magnitude higher tissue surface coverage than destructive and labor-intensive frozen section analysis techniques.
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34
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Fahmy HM, Ismail AM, El-Feky AS, Abu Serea ES, Elshemey WM. Plasma membrane proteins: A new probe for the characterization of breast cancer. Life Sci 2019; 234:116777. [PMID: 31465734 DOI: 10.1016/j.lfs.2019.116777] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/08/2019] [Accepted: 08/15/2019] [Indexed: 12/20/2022]
Abstract
This work aimed to characterize normal, benign and malignant excised breast tissues through the analysis of the FTIR spectra of their plasma membrane proteins. Tissue characterization parameters such as peak position, peak intensity, area under the peak, relative peak intensity and relative area under peak were evaluated mainly for protein spectral peaks; 1150 cm-1, Amide I, Amide II, Amide III, and Amide A. The sensitivity, specificity and diagnostic accuracy for each parameter were obtained and Receiver Operating Characteristic (ROC) Curves were plotted. Results showed significant spectral differences between normal and benign tissues compared to malignant tissues at 1536 and 1645 cm-1. The three tissues could be distinguished at 2900 cm-1, where the malignant peak uniquely split into two separate peaks. ROC curves showed that the Amide A peak position yielded a higher accuracy compared to all other investigated characterization parameters. The deconvolution of Amide I revealed the conformational changes in plasma proteins characterizing the transformation to malignancy (a decrease in the percentage of alpha helix accompanied by an increase in the percentage of beta sheets). The use of the present structure-based analysis in conjunction with histopathological examination of excised breast tissues would offer an enhanced characterization that might reduce possible personal diagnostic mistakes.
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Affiliation(s)
- Heba M Fahmy
- Biophysics Department, Faculty of Science, Cairo University, 12613 Giza, Egypt.
| | - Alaa M Ismail
- Biophysics Department, Faculty of Science, Cairo University, 12613 Giza, Egypt
| | - Amena S El-Feky
- Biophysics Department, Faculty of Science, Cairo University, 12613 Giza, Egypt
| | - Esraa S Abu Serea
- Chemistry and Biochemistry Department, Faculty of Science, Cairo University, 12613 Giza, Egypt
| | - Wael M Elshemey
- Biophysics Department, Faculty of Science, Cairo University, 12613 Giza, Egypt; Department of Physics, Faculty of Science, Islamic University in Madinah, kSA
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35
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Summers PE, Vingiani A, Di Pietro S, Martellosio A, Espin-Lopez PF, Di Meo S, Pasian M, Ghitti M, Mangiacotti M, Sacchi R, Veronesi P, Bozzi M, Mazzanti A, Perregrini L, Svelto F, Preda L, Bellomi M, Renne G. Towards mm-wave spectroscopy for dielectric characterization of breast surgical margins. Breast 2019; 45:64-69. [PMID: 30884340 DOI: 10.1016/j.breast.2019.02.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 01/17/2019] [Accepted: 02/19/2019] [Indexed: 10/27/2022] Open
Abstract
PURPOSE The evaluation of the surgical margin in breast conservative surgery is a matter of general interest as such treatments are subject to the critical issue of margin status as positive surgical margins can undermine the effectiveness of the procedure. The relatively unexplored ability of millimeter-wave (mm-wave) spectroscopy to provide insight into the dielectric properties of breast tissues was investigated as a precursor to their possible use in assessment of surgical margins. METHODS We assessed the ability of a mm-wave system with a roughly hemispherical sensitive volume of ∼3 mm radius to distinguish malignant breast lesions in prospectively and consecutively collected tumoral and non-tumoral ex-vivo breast tissue samples from 91 patients. We characterized the dielectric properties of 346 sites in these samples, encompassing malignant, fibrocystic disease and normal breast tissues. An expert pathologist subsequently evaluated all measurement sites. RESULTS At multivariate analysis, mm-wave dielectric properties were significantly correlated to histologic diagnosis and fat content. Further, using 5-fold cross-validation in a Bayesian logistic mixed model that considered the patient as a random effect, the mm-wave dielectric properties of neoplastic tissues were significantly different from normal breast tissues, but not from fibrocystic tissue. CONCLUSION Reliable discrimination of malignant from normal, fat-rich breast tissue to a depth compatible with surgical margin assessment requirements was achieved with mm-wave spectroscopy.
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Affiliation(s)
- Paul E Summers
- Division of Radiology, IEO, European Institute of Oncology IRCCS, Milan, Italy.
| | - Andrea Vingiani
- Division of Pathology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | | | - Andrea Martellosio
- Division of Radiology, IEO, European Institute of Oncology IRCCS, Milan, Italy; Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Pedro F Espin-Lopez
- Division of Radiology, IEO, European Institute of Oncology IRCCS, Milan, Italy; Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Simona Di Meo
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Marco Pasian
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Michele Ghitti
- Applied Statistics Unit, Department of Earth and Environmental Sciences, University of Pavia, Pavia, Italy
| | - Marco Mangiacotti
- Applied Statistics Unit, Department of Earth and Environmental Sciences, University of Pavia, Pavia, Italy
| | - Roberto Sacchi
- Applied Statistics Unit, Department of Earth and Environmental Sciences, University of Pavia, Pavia, Italy
| | - Paolo Veronesi
- Division of Senology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Maurizio Bozzi
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Andrea Mazzanti
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Luca Perregrini
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Francesco Svelto
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Lorenzo Preda
- Division of Radiology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Massimo Bellomi
- Division of Radiology, IEO, European Institute of Oncology IRCCS, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Giuseppe Renne
- Division of Pathology, IEO, European Institute of Oncology IRCCS, Milan, Italy
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McEvoy MP, Landercasper J, Naik HR, Feldman S. Update of the American Society of Breast Surgeons Toolbox to address the lumpectomy reoperation epidemic. Gland Surg 2018; 7:536-553. [PMID: 30687627 DOI: 10.21037/gs.2018.11.03] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
In 2015, the American Society of Breast Surgeons (ASBrS) convened a multidisciplinary consensus conference, the Collaborative Attempt to Lower Lumpectomy Reoperation Rates (CALLER). The CALLER conference endorsed a "toolbox" of multiple processes of care for which there was evidence that they were associated with fewer reoperations. We present an update of the toolbox taking into consideration the latest advances in decreasing re excision rates. In this review, we performed a comprehensive review of the literature from 2015-2018 using search terms for each tool. The original ten tools were updated with the latest evidence from the literature and our strength of recommendation. We added an additional section looking at new tools and techniques that may provide more accurate intraoperative assessment of margins. The updates on the CALLER Toolbox for lumpectomy will help guide surgeons to various resources to aid in the removal of breast cancer, while being aware of cosmesis and decreasing re excision rates.
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Affiliation(s)
- Maureen P McEvoy
- Montefiore Medical Center, Montefiore Einstein Center for Cancer Care, Bronx, NY, USA
| | - Jeffrey Landercasper
- Gundersen Health System, Norma J. Vinger Center for Breast Cancer, La Crosse, WI, USA
| | - Himani R Naik
- Gundersen Health System, Norma J. Vinger Center for Breast Cancer, La Crosse, WI, USA
| | - Sheldon Feldman
- Montefiore Medical Center, Montefiore Einstein Center for Cancer Care, Bronx, NY, USA
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Allen WM, Foo KY, Zilkens R, Kennedy KM, Fang Q, Chin L, Dessauvagie BF, Latham B, Saunders CM, Kennedy BF. Clinical feasibility of optical coherence micro-elastography for imaging tumor margins in breast-conserving surgery. BIOMEDICAL OPTICS EXPRESS 2018; 9:6331-6349. [PMID: 31065432 PMCID: PMC6491020 DOI: 10.1364/boe.9.006331] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 10/26/2018] [Accepted: 11/08/2018] [Indexed: 05/08/2023]
Abstract
It has been demonstrated that optical coherence micro-elastography (OCME) provides additional contrast of tumor compared to optical coherence tomography (OCT) alone. Previous studies, however, have predominantly been performed on mastectomy specimens. Such specimens typically differ substantially in composition and geometry from the more clinically relevant wide-local excision (WLE) specimens excised during breast-conserving surgery. As a result, it remains unclear if the mechanical contrast observed is maintained in WLE specimens. In this manuscript, we begin to address this issue by performing a feasibility study of OCME on 17 freshly excised, intact WLE specimens. In addition, we present two developments required to sustain the progression of OCME towards intraoperative deployment. First, to enable the rapid visualization of en face images required for intraoperative assessment, we describe an automated segmentation algorithm to fuse en face micro-elastograms with OCT images to provide dual contrast images. Secondly, to validate contrast in micro-elastograms, we present a method that enables co-registration of en face images with histology of WLE specimens, sectioned in the orthogonal plane, without any modification to the standard clinical workflow. We present a summary of the observations across the 17 specimens imaged in addition to representative micro-elastograms and OCT images demonstrating contrast in a number of tumor margins, including those involved by invasive ductal carcinoma, mucinous carcinoma, and solid-papillary carcinoma. The results presented here demonstrate the potential of OCME for imaging tumor margins.
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Affiliation(s)
- Wes M. Allen
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, Western Australia, 6009, Australia
- Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6009, Australia
| | - Ken Y. Foo
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, Western Australia, 6009, Australia
- Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6009, Australia
| | - Renate Zilkens
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, Western Australia, 6009, Australia
- Division of Surgery, Medical School, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6009, Australia
| | - Kelsey M. Kennedy
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, Western Australia, 6009, Australia
- Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6009, Australia
- Current address: Department of Biomedical Engineering, Columbia University, 622 W 168th St, New York, NY 10025, USA
| | - Qi Fang
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, Western Australia, 6009, Australia
- Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6009, Australia
| | - Lixin Chin
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, Western Australia, 6009, Australia
- Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6009, Australia
| | - Benjamin F. Dessauvagie
- PathWest, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, Western Australia, 6150, Australia
- Division of Pathology and Laboratory Medicine, Medical School, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6009, Australia
| | - Bruce Latham
- PathWest, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, Western Australia, 6150, Australia
| | - Christobel M. Saunders
- Division of Surgery, Medical School, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6009, Australia
- Breast Centre, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, Western Australia, 6150, Australia
- Breast Clinic, Royal Perth Hospital, 197 Wellington Street, Perth, Western Australia, 6000, Australia
| | - Brendan F. Kennedy
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, Western Australia, 6009, Australia
- Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6009, Australia
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38
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Maloney BW, McClatchy DM, Pogue BW, Paulsen KD, Wells WA, Barth RJ. Review of methods for intraoperative margin detection for breast conserving surgery. JOURNAL OF BIOMEDICAL OPTICS 2018; 23:1-19. [PMID: 30369108 PMCID: PMC6210801 DOI: 10.1117/1.jbo.23.10.100901] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 10/03/2018] [Indexed: 05/18/2023]
Abstract
Breast conserving surgery (BCS) is an effective treatment for early-stage cancers as long as the margins of the resected tissue are free of disease according to consensus guidelines for patient management. However, 15% to 35% of patients undergo a second surgery since malignant cells are found close to or at the margins of the original resection specimen. This review highlights imaging approaches being investigated to reduce the rate of positive margins, and they are reviewed with the assumption that a new system would need high sensitivity near 95% and specificity near 85%. The problem appears to be twofold. The first is for complete, fast surface scanning for cellular, structural, and/or molecular features of cancer, in a lumpectomy volume, which is variable in size, but can be large, irregular, and amorphous. A second is for full, volumetric imaging of the specimen at high spatial resolution, to better guide internal radiologic decision-making about the spiculations and duct tracks, which may inform that surfaces are involved. These two demands are not easily solved by a single tool. Optical methods that scan large surfaces quickly are needed with cellular/molecular sensitivity to solve the first problem, but volumetric imaging with high spatial resolution for soft tissues is largely outside of the optical realm and requires x-ray, micro-CT, or magnetic resonance imaging if they can be achieved efficiently. In summary, it appears that a combination of systems into hybrid platforms may be the optimal solution for these two very different problems. This concept must be cost-effective, image specimens within minutes and be coupled to decision-making tools that help a surgeon without adding to the procedure. The potential for optical systems to be involved in this problem is emerging and clinical trials are underway in several of these technologies to see if they could reduce positive margin rates in BCS.
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Affiliation(s)
- Benjamin W. Maloney
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire, United States
| | - David M. McClatchy
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire, United States
| | - Brian W. Pogue
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire, United States
- Geisel School of Medicine, Department of Surgery, Hanover, New Hampshire, United States
- Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, United States
| | - Keith D. Paulsen
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire, United States
- Geisel School of Medicine, Department of Surgery, Hanover, New Hampshire, United States
- Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, United States
| | - Wendy A. Wells
- Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, United States
- Geisel School of Medicine, Department of Pathology and Laboratory Medicine, Hanover, New Hampshire, United States
| | - Richard J. Barth
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire, United States
- Geisel School of Medicine, Department of Surgery, Hanover, New Hampshire, United States
- Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, United States
- Geisel School of Medicine, Department of Pathology and Laboratory Medicine, Hanover, New Hampshire, United States
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39
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Giacomelli MG, Yoshitake T, Cahill LC, Vardeh H, Quintana LM, Faulkner-Jones BE, Brooker J, Connolly JL, Fujimoto JG. Multiscale nonlinear microscopy and widefield white light imaging enables rapid histological imaging of surgical specimen margins. BIOMEDICAL OPTICS EXPRESS 2018; 9:2457-2475. [PMID: 29761001 PMCID: PMC5946802 DOI: 10.1364/boe.9.002457] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 04/10/2018] [Accepted: 04/18/2018] [Indexed: 05/07/2023]
Abstract
The ability to histologically assess surgical specimens in real-time is a long-standing challenge in cancer surgery, including applications such as breast conserving therapy (BCT). Up to 40% of women treated with BCT for breast cancer require a repeat surgery due to postoperative histological findings of close or positive surgical margins using conventional formalin fixed paraffin embedded histology. Imaging technologies such as nonlinear microscopy (NLM), combined with exogenous fluorophores can rapidly provide virtual H&E imaging of surgical specimens without requiring microtome sectioning, facilitating intraoperative assessment of margin status. However, the large volume of typical surgical excisions combined with the need for rapid assessment, make comprehensive cellular resolution margin assessment during surgery challenging. To address this limitation, we developed a multiscale, real-time microscope with variable magnification NLM and real-time, co-registered position display using a widefield white light imaging system. Margin assessment can be performed rapidly under operator guidance to image specific regions of interest located using widefield imaging. Using simulated surgical margins dissected from human breast excisions, we demonstrate that multi-centimeter margins can be comprehensively imaged at cellular resolution, enabling intraoperative margin assessment. These methods are consistent with pathology assessment performed using frozen section analysis (FSA), however NLM enables faster and more comprehensive assessment of surgical specimens because imaging can be performed without freezing and cryo-sectioning. Therefore, NLM methods have the potential to be applied to a wide range of intra-operative applications.
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Affiliation(s)
- Michael G Giacomelli
- Massachusetts Institute of Technology, Department of Electrical Engineering and Computer Science and Research Laboratory of Electronics, 32 Vassar Street, Cambridge, MA 02139,USA
| | - Tadayuki Yoshitake
- Massachusetts Institute of Technology, Department of Electrical Engineering and Computer Science and Research Laboratory of Electronics, 32 Vassar Street, Cambridge, MA 02139,USA
| | - Lucas C Cahill
- Massachusetts Institute of Technology, Department of Electrical Engineering and Computer Science and Research Laboratory of Electronics, 32 Vassar Street, Cambridge, MA 02139,USA
| | - Hilde Vardeh
- Harvard Medical School, Department of Pathology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Liza M Quintana
- Harvard Medical School, Department of Pathology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Beverly E Faulkner-Jones
- Harvard Medical School, Department of Pathology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Jeff Brooker
- Thorlabs Advanced Imaging Group, 108 Powers Court, Sterling, VA 20166, USA
| | - James L Connolly
- Harvard Medical School, Department of Pathology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA
| | - James G Fujimoto
- Massachusetts Institute of Technology, Department of Electrical Engineering and Computer Science and Research Laboratory of Electronics, 32 Vassar Street, Cambridge, MA 02139,USA
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