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Richter JCO, Haj-Hosseini N, Hallbeck M, Wårdell K. Combination of hand-held probe and microscopy for fluorescence guided surgery in the brain tumor marginal zone. Photodiagnosis Photodyn Ther 2017; 18:185-192. [PMID: 28223144 DOI: 10.1016/j.pdpdt.2017.01.188] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 12/23/2016] [Accepted: 01/03/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Visualization of the tumor is crucial for differentiating malignant tissue from healthy brain during surgery, especially in the tumor marginal zone. The aim of the study was to introduce a fluorescence spectroscopy-based hand-held probe (HHF-probe) for tumor identification in combination with the fluorescence guided resection surgical microscope (FGR-microscope), and evaluate them in terms of diagnostic performance and practical aspects of fluorescence detection. MATERIAL AND METHODS Eighteen operations were performed on 16 patients with suspected high-grade glioma. The HHF-probe and the FGR-microscope were used for detection of protoporphyrin (PpIX) fluorescence induced by 5-aminolevulinic acid (5-ALA) and evaluated against histopathological analysis and visual grading done through the FGR-microscope by the surgeon. A ratio of PpIX fluorescence intensity to the autofluorescence intensity (fluorescence ratio) was used to quantify the spectra detected by the probe. RESULTS Fluorescence ratio medians (range 0 - 40) measured by the probe were related to the intensity of the fluorescence in the FGR-microscope, categorized as "none" (0.3, n=131), "weak" (1.6, n=34) and "strong" (5.4, n=28). Of 131 "none" points in the FGR-microscope, 88 (67%) exhibited fluorescence with the HHF-probe. For the tumor marginal zone, the area under the receiver operator characteristics (ROC) curve was 0.49 for the FGR-microscope and 0.65 for the HHF-probe. CONCLUSIONS The probe was integrated in the established routine of tumor resection using the FGR-microscope. The HHF-probe was superior to the FGR-microscope in sensitivity; it detected tumor remnants after debulking under the FGR-microscope. The combination of the HHF-probe and the FGR-microscope was beneficial especially in the tumor marginal zone.
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Affiliation(s)
- Johan C O Richter
- Department of Biomedical Engineering, Linköping University, Sweden; Department of Neurosurgery Linköping University Hospital, Region Östergötland, Linköping, Sweden.
| | | | - Martin Hallbeck
- Department of Clinical Pathology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Karin Wårdell
- Department of Biomedical Engineering, Linköping University, Sweden
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2
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Valdés PA, Roberts DW, Lu FK, Golby A. Optical technologies for intraoperative neurosurgical guidance. Neurosurg Focus 2016; 40:E8. [PMID: 26926066 DOI: 10.3171/2015.12.focus15550] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Biomedical optics is a broadly interdisciplinary field at the interface of optical engineering, biophysics, computer science, medicine, biology, and chemistry, helping us understand light-tissue interactions to create applications with diagnostic and therapeutic value in medicine. Implementation of biomedical optics tools and principles has had a notable scientific and clinical resurgence in recent years in the neurosurgical community. This is in great part due to work in fluorescence-guided surgery of brain tumors leading to reports of significant improvement in maximizing the rates of gross-total resection. Multiple additional optical technologies have been implemented clinically, including diffuse reflectance spectroscopy and imaging, optical coherence tomography, Raman spectroscopy and imaging, and advanced quantitative methods, including quantitative fluorescence and lifetime imaging. Here we present a clinically relevant and technologically informed overview and discussion of some of the major clinical implementations of optical technologies as intraoperative guidance tools in neurosurgery.
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Affiliation(s)
- Pablo A Valdés
- Departments of 1 Neurosurgery and.,Department of Neurosurgery, Harvard Medical School, Boston Children's Hospital, Boston
| | - David W Roberts
- Section of Neurosurgery, Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | | | - Alexandra Golby
- Departments of 1 Neurosurgery and.,Radiology, and.,Dana Farber Cancer Institute, Harvard Medical School, Brigham and Women's Hospital
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3
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Review: in vivo optical spectral tissue sensing-how to go from research to routine clinical application? Lasers Med Sci 2016; 32:711-719. [PMID: 27909918 DOI: 10.1007/s10103-016-2119-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 11/22/2016] [Indexed: 10/20/2022]
Abstract
Innovations in optical spectroscopy have helped the technology reach a point where performance previously seen only in laboratory settings can be translated and tested in real-world applications. In the field of oncology, spectral tissue sensing (STS) by means of optical spectroscopy is considered to have major potential for improving diagnostics and optimizing treatment outcome. The concept has been investigated for more than two decades and yet spectral tissue sensing is not commonly employed in routine medical practice. It is therefore important to understand what is needed to translate technological advances and insights generated through basic scientific research in this field into clinical practice. The aim of the discussion presented here is not to provide a comprehensive review of all work published over the last decades but rather to highlight some of the challenges found in literature and encountered by our group in the quest to translate optical technologies into useful clinical tools. Furthermore, an outlook is proposed on how translational researchers could proceed to eventually have STS incorporated in the process of clinical decision-making.
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Spliethoff JW, de Boer LL, Meier MAJ, Prevoo W, de Jong J, Kuhlmann K, Bydlon TM, Sterenborg HJCM, Hendriks BHW, Ruers TJM. In vivo characterization of colorectal metastases in human liver using diffuse reflectance spectroscopy: toward guidance in oncological procedures. JOURNAL OF BIOMEDICAL OPTICS 2016; 21:97004. [PMID: 27637008 PMCID: PMC8357329 DOI: 10.1117/1.jbo.21.9.097004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 08/30/2016] [Indexed: 05/15/2023]
Abstract
There is a strong need to develop clinical instruments that can perform rapid tissue assessment at the tip of smart clinical instruments for a variety of oncological applications. This study presents the first in vivo real-time tissue characterization during 24 liver biopsy procedures using diffuse reflectance (DR) spectroscopy at the tip of a core biopsy needle with integrated optical fibers. DR measurements were performed along each needle path, followed by biopsy of the target lesion using the same needle. Interventional imaging was coregistered with the DR spectra. Pathology results were compared with the DR spectroscopy data at the final measurement position. Bile was the primary discriminator between normal liver tissue and tumor tissue. Relative differences in bile content matched with the tissue diagnosis based on histopathological analysis in all 24 clinical cases. Continuous DR measurements during needle insertion in three patients showed that the method can also be applied for biopsy guidance or tumor recognition during surgery. This study provides an important validation step for DR spectroscopy-based tissue characterization in the liver. Given the feasibility of the outlined approach, it is also conceivable to make integrated fiber-optic tools for other clinical procedures that rely on accurate instrument positioning.
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Affiliation(s)
- Jarich W. Spliethoff
- Netherlands Cancer Institute, Department of Surgery, Plesmanlaan 121, 1066CX Amsterdam, The Netherlands
- Address all correspondence to: Jarich W. Spliethoff, E-mail:
| | - Lisanne L. de Boer
- Netherlands Cancer Institute, Department of Surgery, Plesmanlaan 121, 1066CX Amsterdam, The Netherlands
| | - Mark A. J. Meier
- Netherlands Cancer Institute, Department of Radiology, Plesmanlaan 121, 1066CX Amsterdam, The Netherlands
| | - Warner Prevoo
- Netherlands Cancer Institute, Department of Radiology, Plesmanlaan 121, 1066CX Amsterdam, The Netherlands
| | - Jeroen de Jong
- Netherlands Cancer Institute, Department of Pathology, Plesmanlaan 121, 1066CX Amsterdam, The Netherlands
| | - Koert Kuhlmann
- Netherlands Cancer Institute, Department of Surgery, Plesmanlaan 121, 1066CX Amsterdam, The Netherlands
| | - Torre M. Bydlon
- Philips Research, Department In-body Systems, High Tech Campus 34, 5656AE Eindhoven, The Netherlands
| | - Henricus J. C. M. Sterenborg
- Academic Medical Center, Department of Biomedical Engineering and Physics, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands
| | - Benno H. W. Hendriks
- Philips Research, Department In-body Systems, High Tech Campus 34, 5656AE Eindhoven, The Netherlands
| | - Theo J. M. Ruers
- Netherlands Cancer Institute, Department of Surgery, Plesmanlaan 121, 1066CX Amsterdam, The Netherlands
- University of Twente, MIRA Institute, Drienerlolaan 5, Zuidhorst ZH116, 7522 NB Enschede, The Netherlands
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5
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Valdés PA, Jacobs V, Harris BT, Wilson BC, Leblond F, Paulsen KD, Roberts DW. Quantitative fluorescence using 5-aminolevulinic acid-induced protoporphyrin IX biomarker as a surgical adjunct in low-grade glioma surgery. J Neurosurg 2015; 123:771-80. [PMID: 26140489 DOI: 10.3171/2014.12.jns14391] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECT Previous studies in high-grade gliomas (HGGs) have indicated that protoporphyrin IX (PpIX) accumulates in higher concentrations in tumor tissue, and, when used to guide surgery, it has enabled improved resection leading to increased progression-free survival. Despite the benefits of complete resection and the advances in fluorescence-guided surgery, few studies have investigated the use of PpIX in low-grade gliomas (LGGs). Here, the authors describe their initial experience with 5-aminolevulinic acid (ALA)-induced PpIX fluorescence in a series of patients with LGG. METHODS Twelve patients with presumed LGGs underwent resection of their tumors after receiving 20 mg/kg of ALA approximately 3 hours prior to surgery under an institutional review board-approved protocol. Intraoperative assessments of the resulting PpIX emissions using both qualitative, visible fluorescence and quantitative measurements of PpIX concentration were obtained from tissue locations that were subsequently biopsied and evaluated histopathologically. Mixed models for random effects and receiver operating characteristic curve analysis for diagnostic performance were performed on the fluorescence data relative to the gold-standard histopathology. RESULTS Five of the 12 LGGs (1 ganglioglioma, 1 oligoastrocytoma, 1 pleomorphic xanthoastrocytoma, 1 oligodendroglioma, and 1 ependymoma) demonstrated at least 1 instance of visible fluorescence during surgery. Visible fluorescence evaluated on a specimen-by-specimen basis yielded a diagnostic accuracy of 38.0% (cutoff threshold: visible fluorescence score ≥ 1, area under the curve = 0.514). Quantitative fluorescence yielded a diagnostic accuracy of 67% (for a cutoff threshold of the concentration of PpIX [CPpIX] > 0.0056 μg/ml, area under the curve = 0.66). The authors found that 45% (9/20) of nonvisibly fluorescent tumor specimens, which would have otherwise gone undetected, accumulated diagnostically significant levels of CPpIX that were detected quantitatively. CONCLUSIONS The authors' initial experience with ALA-induced PpIX fluorescence in LGGs concurs with other literature reports that the resulting visual fluorescence has poor diagnostic accuracy. However, the authors also found that diagnostically significant levels of CPpIX do accumulate in LGGs, and the resulting fluorescence emissions are very often below the detection threshold of current visual fluorescence imaging methods. Indeed, at least in the authors' initial experience reported here, if quantitative detection methods are deployed, the diagnostic performance of ALA-induced PpIX fluorescence in LGGs approaches the accuracy associated with visual fluorescence in HGGs.
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Affiliation(s)
- Pablo A Valdés
- Department of Neurosurgery, Brigham and Women's/Boston Children's Hospitals, Harvard Medical School;,Geisel School of Medicine at Dartmouth, Hanover;,Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon;,Thayer School of Engineering, Hanover, New Hampshire
| | - Valerie Jacobs
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts;,Geisel School of Medicine at Dartmouth, Hanover
| | | | - Brian C Wilson
- Ontario Cancer Institute, University of Toronto, Ontario; and
| | - Frederic Leblond
- Department of Engineering Physics, Polytechnique Montreal, Quebec, Canada
| | | | - David W Roberts
- Geisel School of Medicine at Dartmouth, Hanover;,Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon
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Low dose 5-aminolevulinic acid: Implications in spectroscopic measurements during brain tumor surgery. Photodiagnosis Photodyn Ther 2015; 12:209-14. [DOI: 10.1016/j.pdpdt.2015.03.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 03/14/2015] [Accepted: 03/18/2015] [Indexed: 11/17/2022]
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7
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Barman I, Dingari NC, Saha A, McGee S, Galindo LH, Liu W, Plecha D, Klein N, Dasari RR, Fitzmaurice M. Application of Raman spectroscopy to identify microcalcifications and underlying breast lesions at stereotactic core needle biopsy. Cancer Res 2014; 73:3206-15. [PMID: 23729641 DOI: 10.1158/0008-5472.can-12-2313] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Microcalcifications are a feature of diagnostic significance on a mammogram and a target for stereotactic breast needle biopsy. Here, we report development of a Raman spectroscopy technique to simultaneously identify microcalcification status and diagnose the underlying breast lesion, in real-time, during stereotactic core needle biopsy procedures. Raman spectra were obtained ex vivo from 146 tissue sites from fresh stereotactic breast needle biopsy tissue cores from 33 patients, including 50 normal tissue sites, 77 lesions with microcalcifications, and 19 lesions without microcalcifications, using a compact clinical system. The Raman spectra were modeled on the basis of the breast tissue components, and a support vector machine framework was used to develop a single-step diagnostic algorithm to distinguish normal tissue, fibrocystic change (FCC), fibroadenoma, and breast cancer, in the absence and presence of microcalcifications. This algorithm was subjected to leave-one-site-out cross-validation, yielding a positive predictive value, negative predictive value, sensitivity, and specificity of 100%, 95.6%, 62.5%, and 100% for diagnosis of breast cancer (with or without microcalcifications) and an overall accuracy of 82.2% for classification into specific categories of normal tissue, FCC, fibroadenoma, or breast cancer (with and without microcalcifications). Notably, the majority of breast cancers diagnosed are ductal carcinoma in situ (DCIS), the most common lesion associated with microcalcifications, which could not be diagnosed using previous Raman algorithm(s). Our study shows the potential of Raman spectroscopy to concomitantly detect microcalcifications and diagnose associated lesions, including DCIS, and thus provide real-time feedback to radiologists during such biopsy procedures, reducing nondiagnostic and false-negative biopsies.
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Affiliation(s)
- Ishan Barman
- G.R. Harrison Spectroscopy Laboratory, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
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8
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A facile and real-time spectroscopic method for biofluid analysis in point-of-care diagnostics. Bioanalysis 2013; 5:1853-61. [PMID: 23905859 DOI: 10.4155/bio.13.126] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Accurate and real-time information is critical for decision making, especially in medical applications, where any delay in diagnosis due to collection, transport and storage of biofluids can have substantial ramifications for disease management. RESULTS We present a facile method for point-of-care biofluid diagnostics based on the spectroscopic analysis of cotton-swab contents using a Raman probe. A PCA algorithm was developed in order to understand the clustering behavior of different off-the-shelf pharmaceutical formulations based on the recorded spectral data. Furthermore, we employed the Raman probe to detect antibiotics in a human urine sample. Our observations suggest that it is possible to provide quantitative concentration determination of Raman-active analytes by using cotton swabs as a sampling probe, which offers a wealth of possibility for real-time measurement in clinical situations. CONCLUSION We envision that the intrinsic simplicity of the proposed approach in conjunction with its capability for accurate analyte determination in biofluids will lead to its clinical translation and application in point-of-care settings in the near future.
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9
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Sathyavathi R, Dingari NC, Barman I, Prasad PSR, Prabhakar S, Rao DN, Dasari RR, Undamatla J. Raman spectroscopy provides a powerful, rapid diagnostic tool for the detection of tuberculous meningitis in ex vivo cerebrospinal fluid samples. JOURNAL OF BIOPHOTONICS 2013; 6:567-72. [PMID: 22887773 PMCID: PMC4094343 DOI: 10.1002/jbio.201200110] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Revised: 07/11/2012] [Accepted: 07/12/2012] [Indexed: 05/25/2023]
Abstract
In this letter, we propose a novel method for diagnosis of tuberculous meningitis using Raman spectroscopy. The silicate Raman signature obtained from Mycobacterium tuberculosis positive cases enables specific and sensitive detection of tuberculous meningitis from acquired cerebrospinal fluid samples. The association of silicates with the tuberculosis mycobacterium is discussed. We envision that this new method will facilitate rapid diagnosis of tuberculous meningitis without application of exogenous reagents or dyes and can be aptly used as a complementary screening tool to the existing gold standard methods.
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Affiliation(s)
- R. Sathyavathi
- School of Physics, University of Hyderabad, Hyderabad, India
| | - Narahara Chari Dingari
- George R. Harrison Spectroscopy Laboratory, Massachusetts Institute of Technology, Cambridge, USA
| | - Ishan Barman
- George R. Harrison Spectroscopy Laboratory, Massachusetts Institute of Technology, Cambridge, USA
| | - P. S. R. Prasad
- National Geophysical Research Institute (Council for Scientific and Industrial Research), Hyderabad, India
| | | | - D. Narayana Rao
- School of Physics, University of Hyderabad, Hyderabad, India
| | - Ramachandra R. Dasari
- George R. Harrison Spectroscopy Laboratory, Massachusetts Institute of Technology, Cambridge, USA
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10
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Dingari NC, Barman I, Saha A, McGee S, Galindo LH, Liu W, Plecha D, Klein N, Dasari RR, Fitzmaurice M. Development and comparative assessment of Raman spectroscopic classification algorithms for lesion discrimination in stereotactic breast biopsies with microcalcifications. JOURNAL OF BIOPHOTONICS 2013; 6:371-81. [PMID: 22815240 PMCID: PMC4094342 DOI: 10.1002/jbio.201200098] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Revised: 06/19/2012] [Accepted: 06/28/2012] [Indexed: 05/02/2023]
Abstract
Microcalcifications are an early mammographic sign of breast cancer and a target for stereotactic breast needle biopsy. Here, we develop and compare different approaches for developing Raman classification algorithms to diagnose invasive and in situ breast cancer, fibrocystic change and fibroadenoma that can be associated with microcalcifications. In this study, Raman spectra were acquired from tissue cores obtained from fresh breast biopsies and analyzed using a constituent-based breast model. Diagnostic algorithms based on the breast model fit coefficients were devised using logistic regression, C4.5 decision tree classification, k-nearest neighbor (k -NN) and support vector machine (SVM) analysis, and subjected to leave-one-out cross validation. The best performing algorithm was based on SVM analysis (with radial basis function), which yielded a positive predictive value of 100% and negative predictive value of 96% for cancer diagnosis. Importantly, these results demonstrate that Raman spectroscopy provides adequate diagnostic information for lesion discrimination even in the presence of microcalcifications, which to the best of our knowledge has not been previously reported.
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11
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Diagnostic power of diffuse reflectance spectroscopy for targeted detection of breast lesions with microcalcifications. Proc Natl Acad Sci U S A 2012; 110:471-6. [PMID: 23267090 DOI: 10.1073/pnas.1215473110] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Microcalcifications geographically target the location of abnormalities within the breast and are of critical importance in breast cancer diagnosis. However, despite stereotactic guidance, core needle biopsy fails to retrieve microcalcifications in up to 15% of patients. Here, we introduce an approach based on diffuse reflectance spectroscopy for detection of microcalcifications that focuses on variations in optical absorption stemming from the calcified clusters and the associated cross-linking molecules. In this study, diffuse reflectance spectra are acquired ex vivo from 203 sites in fresh biopsy tissue cores from 23 patients undergoing stereotactic breast needle biopsies. By correlating the spectra with the corresponding radiographic and histologic assessment, we have developed a support vector machine-derived decision algorithm, which shows high diagnostic power (positive predictive value and negative predictive value of 97% and 88%, respectively) for diagnosis of lesions with microcalcifications. We further show that these results are robust and not due to any spurious correlations. We attribute our findings to the presence of proteins (such as elastin), and desmosine and isodesmosine cross-linkers in the microcalcifications. It is important to note that the performance of the diffuse reflectance decision algorithm is comparable to one derived from the corresponding Raman spectra, and the considerably higher intensity of the reflectance signal enables the detection of the targeted lesions in a fraction of the spectral acquisition time. Our findings create a unique landscape for spectroscopic validation of breast core needle biopsy for detection of microcalcifications that can substantially improve the likelihood of an adequate, diagnostic biopsy in the first attempt.
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Barman I, Dingari NC, Singh GP, Kumar R, Lang S, Nabi G. Selective sampling using confocal Raman spectroscopy provides enhanced specificity for urinary bladder cancer diagnosis. Anal Bioanal Chem 2012; 404:3091-9. [DOI: 10.1007/s00216-012-6424-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2012] [Revised: 08/25/2012] [Accepted: 09/13/2012] [Indexed: 11/29/2022]
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Saha A, Barman I, Dingari NC, McGee S, Volynskaya Z, Galindo LH, Liu W, Plecha D, Klein N, Dasari RR, Fitzmaurice M. Raman spectroscopy: a real-time tool for identifying microcalcifications during stereotactic breast core needle biopsies. BIOMEDICAL OPTICS EXPRESS 2011; 2:2792-803. [PMID: 22025985 PMCID: PMC3191446 DOI: 10.1364/boe.2.002792] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Revised: 09/09/2011] [Accepted: 09/13/2011] [Indexed: 05/05/2023]
Abstract
Microcalcifications are an early mammographic sign of breast cancer and a target for stereotactic breast needle biopsy. We present here a Raman spectroscopic tool for detecting microcalcifications in breast tissue based on their chemical composition. We collected ex vivo Raman spectra from 159 tissue sites in fresh stereotactic breast needle biopsies from 33 patients, including 54 normal sites, 75 lesions with microcalcifications and 30 lesions without microcalcifications. Application of our Raman technique resulted in a positive predictive value of 97% for detecting microcalcifications. This study shows that Raman spectroscopy has the potential to detect microcalcifications during stereotactic breast core biopsies and provide real-time feedback to radiologists, thus reducing non-diagnostic and false negative biopsies.
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Affiliation(s)
- A. Saha
- Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA
| | - I. Barman
- Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA, USA
| | - N. C. Dingari
- Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA, USA
| | - S. McGee
- Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA
- Current Address, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Z. Volynskaya
- Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA, USA
- Current Address, Aperio Technologies, Inc., 1360 Park Center Dr., Vista, CA 92081, USA
| | - L. H. Galindo
- Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA, USA
| | - W. Liu
- Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA
- University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, USA
| | - D. Plecha
- Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA
- University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, USA
| | - N. Klein
- Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA
- University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, USA
| | - R. R. Dasari
- Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA, USA
| | - M. Fitzmaurice
- Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA
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Volynskaya Z, Haka AS, Bechtel KL, Fitzmaurice M, Shenk R, Wang N, Nazemi J, Dasari RR, Feld MS. Diagnosing breast cancer using diffuse reflectance spectroscopy and intrinsic fluorescence spectroscopy. JOURNAL OF BIOMEDICAL OPTICS 2008; 13:024012. [PMID: 18465975 DOI: 10.1117/1.2909672] [Citation(s) in RCA: 112] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Using diffuse reflectance spectroscopy and intrinsic fluorescence spectroscopy, we have developed an algorithm that successfully classifies normal breast tissue, fibrocystic change, fibroadenoma, and infiltrating ductal carcinoma in terms of physically meaningful parameters. We acquire 202 spectra from 104 sites in freshly excised breast biopsies from 17 patients within 30 min of surgical excision. The broadband diffuse reflectance and fluorescence spectra are collected via a portable clinical spectrometer and specially designed optical fiber probe. The diffuse reflectance spectra are fit using modified diffusion theory to extract absorption and scattering tissue parameters. Intrinsic fluorescence spectra are extracted from the combined fluorescence and diffuse reflectance spectra and analyzed using multivariate curve resolution. Spectroscopy results are compared to pathology diagnoses, and diagnostic algorithms are developed based on parameters obtained via logistic regression with cross-validation. The sensitivity, specificity, positive predictive value, negative predictive value, and overall diagnostic accuracy (total efficiency) of the algorithm are 100, 96, 69, 100, and 91%, respectively. All invasive breast cancer specimens are correctly diagnosed. The combination of diffuse reflectance spectroscopy and intrinsic fluorescence spectroscopy yields promising results for discrimination of breast cancer from benign breast lesions and warrants a prospective clinical study.
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Affiliation(s)
- Zoya Volynskaya
- Massachusetts Institute of Technology, Laser Biomedical Research Center, G. R. Harrison Spectroscopy Laboratory, 77 Massachusetts Avenue, 6-218M, Cambridge, Massachusetts 02139, USA.
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Majumder SK, Ghosh N, Gupta PK. N2 laser excited autofluorescence spectroscopy of formalin-fixed human breast tissue. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2005; 81:33-42. [PMID: 16107317 DOI: 10.1016/j.jphotobiol.2005.06.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/01/2005] [Revised: 05/24/2005] [Accepted: 06/09/2005] [Indexed: 10/25/2022]
Abstract
The paper reports results of an in vitro study on autofluorescence spectroscopy of fresh and formalin-fixed human breast tissue samples to investigate the effect of formalin fixation on the measured autofluorescence spectra. It also explores the applicability of the approach in discriminating cancerous from the uninvolved sites of the formalin-fixed breast tissues based on their autofluorescence spectra. A probability-based diagnostic algorithm, making use of the theory of relevance vector machine (RVM), a powerful recent approach for statistical pattern recognition, was developed for that purpose. The algorithm provided sensitivity values of up to 97% and specificity values of up to 100% towards cancer for both the independent validation data set as well as for the training data set based on leave-one-out cross-validation. These results suggest that autofluorescence spectroscopy may prove to be a valuable additional in vitro diagnostic modality in clinical pathology setting for discriminating cancerous tissue sites from normal sites.
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Affiliation(s)
- S K Majumder
- Biomedical Applications Section, R&D Block-D, Centre for Advanced Technology, Indore 452013, India.
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16
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Crane NJ, Morris MD, Ignelzi MA, Yu G. Raman imaging demonstrates FGF2-induced craniosynostosis in mouse calvaria. JOURNAL OF BIOMEDICAL OPTICS 2005; 10:031119. [PMID: 16229644 DOI: 10.1117/1.1908057] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Craniosynostosis is a severe craniofacial disease where one or more sutures, the fibrous tissue that lies between the cranial bones, fuses prematurely. Some craniosynostosis syndromes are known to be caused by mutations in fibroblast growth factor (FGF) receptors. Mutated FGF receptors are thought to cause constitutive signaling. In this study, heparin acrylic beads released fibroblast growth factor 2 (FGF2) to mimic constitutive signaling by mutated receptors, delivering FGF2 in addition to already existing normal tissue amounts. Fetal day 18.5 mouse sutures were treated with FGF2-soaked beads and cultured in serum free media for 48 h. We have shown previously that this treatment leads to fusion and increased Msx2 expression, but here we use near-infrared Raman imaging to simultaneously examine the mineral components and matrix components of cranial tissue while providing light microscopic spatial information. FGF2-treated mouse sutures show increased v1 phosphate and v1 carbonate bandwidths, indicating a slightly chemically modified mineral being rapidly deposited. In addition, FGF2-treated mouse sutures show a marked increase in mineral-to-matrix ratios compared to control mouse sutures, typical of increased mineralization.
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Affiliation(s)
- Nicole J Crane
- The University of Michigan, Department of Chemistry, Ann Arbor, Michigan 48109-1055, USA
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Morris MD, Crane NJ, Gomez LE, Ignelzi MA. Compatibility of staining protocols for bone tissue with Raman imaging. Calcif Tissue Int 2004; 74:86-94. [PMID: 14564434 DOI: 10.1007/s00223-003-0038-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2003] [Accepted: 05/06/2003] [Indexed: 11/26/2022]
Abstract
We report the use of Raman microscopy to image mouse calvaria stained with hematoxylin, eosin and toluidine blue. Raman imaging of stained specimens allows for direct correlation of histological and spectral information. A line-focus 785 nm laser imaging system with specialized near-infrared (NIR) microscope objectives and CCD detector were used to collect approximately 100 x 450 micro m Raman images. Principal components analysis, a multivariate analysis technique, was used to determine whether the histological stains cause spectral interference (band shifts or intensity changes) or result in thermal damage to the examined tissue. Image analysis revealed factors for tissue components and the embedding medium, glycol methacrylate, only. Thus, Raman imaging proved to be compatible with histological stains such as hematoxylin, eosin and toluidine blue.
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Affiliation(s)
- M D Morris
- Department of Chemistry, University of Michigan, 930 N. University Avenue, Ann Arbor, MI 48109-1055, USA.
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Molckovsky A, Song LMWK, Shim MG, Marcon NE, Wilson BC. Diagnostic potential of near-infrared Raman spectroscopy in the colon: differentiating adenomatous from hyperplastic polyps. Gastrointest Endosc 2003; 57:396-402. [PMID: 12612529 DOI: 10.1067/mge.2003.105] [Citation(s) in RCA: 167] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Near-infrared Raman spectroscopy is a promising optical technique for GI tissue diagnosis. This study assessed the diagnostic potential of near-infrared Raman spectroscopy in the colon by evaluating its ability to distinguish between adenomatous and hyperplastic polyps. METHODS Ex vivo and in vivo Raman spectra of colon polyps were collected by using a custom-built, fiber-optic, near-infrared Raman spectroscopic system. Multivariate statistical techniques, including principal component analysis and linear discriminant analysis, were used to develop diagnostic algorithms for classifying colon polyps based on their spectral characteristics. With the number of samples available, spectral classification of polyps was tested by using a leave-one-out, cross-validation method. RESULTS Fifty-four ex vivo Raman spectra were analyzed (20 hyperplastic, 34 adenomatous). The spectral-based diagnostic algorithms identified adenomatous polyps with 91% sensitivity, 95% specificity, and 93% accuracy. In vivo, adenomas (n = 10) were distinguished from hyperplastic polyps (n = 9) with 100% sensitivity, 89% specificity, and 95% accuracy. CONCLUSIONS Near-infrared Raman spectroscopy differentiated adenomatous from hyperplastic polyps with high diagnostic accuracy. To our knowledge, this is the first demonstration of the potential of near-infrared Raman spectroscopy for differentiation of colonic polyps during GI endoscopy.
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Affiliation(s)
- Andrea Molckovsky
- Department of Medical Biophysics, Ontario Cancer Institute/University Health Network, University of Toronto, Toronto, Ontario, Canada
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Wallace VP, Bamber JC, Crawford DC, Ott RJ, Mortimer PS. Classification of reflectance spectra from pigmented skin lesions, a comparison of multivariate discriminant analysis and artificial neural networks. Phys Med Biol 2000; 45:2859-71. [PMID: 11049176 DOI: 10.1088/0031-9155/45/10/309] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Successful treatment of skin cancer, especially melanoma, depends on early detection, but diagnostic accuracy, even by experts, can be as low as 56% so there is an urgent need for a simple, accurate, non-invasive diagnostic tool. In this paper we have compared the performance of an artificial neural network (ANN) and multivariate discriminant analysis (MDA) for the classification of optical reflectance spectra (320 to 1100 nm) from malignant melanoma and benign naevi. The ANN was significantly better than MDA, especially when a larger data set was used, where the classification accuracy was 86.7% for ANN and 72.0% for MDA (p < 0.001). ANN was better at learning new cases than MDA for this particular classification task. This study has confirmed that the convenience of ANNs could lead to the medical community and patients benefiting from the improved diagnostic performance which can be achieved by objective measurement of pigmented skin lesions using spectrophotometry.
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Affiliation(s)
- V P Wallace
- Department of Physics, Institute of Cancer Research and Royal Marsden NHS Trust, Sutton, Surrey, UK
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