Detection of precancerous lesions in the oral cavity using oblique polarized reflectance spectroscopy: a clinical feasibility study

A combined autofluorescence and diffuse reflectance spectroscopy for mucosa tissue diagnosis: Dual-distance system and data-driven decision

Combined autofluorescence (AF) and diffuse reflectance (DR) spectroscopies have been expected to offer enhanced diagnostic accuracies for noninvasive early detection of mucosa lesions, that is, oral cavity carcinoma and cervical carcinoma. This work reports on a hybrid AF and DR spectroscopic system that is developed for quantification and diagnosis of mucosa abnormalities. The system stability and reliability are firstly assessed by phantom experiments, showing a measurement variation lower than 1% within 20 min. In vitro and in vivo validations are then conducted for tissue identification and lesion differentiation. For enhanced decision, a data-driven diagnosis algorithm is explored in pilot under different experimental configurations. The results conclude a promising accuracy of >96% for the in vivo classification as well as an excellent sensitivity of >88% for the in vitro mucosa lesions detection, and demonstrate sound potential of the system in early detection of mucosa lesions.

Multimodal fluorescence imaging and spectroscopic techniques for oral cancer screening: a real-time approach

The survival rate of oral squamous cell carcinoma (OSCC) patients is very poor, but it can be improved using highly sensitive, specific, and accurate techniques. Autofluorescence and fluorescence techniques are very sensitive and helpful in cancer screening; being directly linked with the molecular levels of human tissue, they can be used as a quantitative tool for cancer detection. Here, we report the development of multi-modal autofluorescence and fluorescence imaging and spectroscopic (MAF-IS) smartphone-based systems for fast and real-time oral cancer screening. MAF-IS system is indigenously developed and offers the advantages of being a low-cost, handy, non-contact, non-invasive, and easily operable device that can be employed in hospitals, including low-resource settings. In this study, we report the results of 43 individuals with 28 OSCC and 15 oral potentially malignant disorders (OPMDs), i.e., epithelial dysplasia and oral submucous fibrosis, using the developed devices. We observed a red shift in fluorescence emission spectrain vivo. We found red-shift of 7.72 ± 6 nm, 3 ± 4.36 nm, and 1.33 ± 0.47 nm in the case of OSCC, epithelial dysplasia, and oral submucous fibrosis, respectively, compared to normal. The results were compared with histopathology and found to be consistent. Further, the MAF-IS system provides results in real-time with higher accuracy and sensitivity compared to devices using a single modality. Our system can achieve an accuracy of 97% with sensitivity and specificity of 100% and 94.7%, respectively, even with a smaller number of patients (28 patients of OSCC). The proposed MAF-IS device has great potential for fast screening and diagnosis of oral cancer in the future.

Polarized light diffuse reflectance FT-NIR MEMS spectrometer enabling the detection of powder samples through a thin plastic layer

Polarized scattered light Fourier transform infrared (FTIR) spectroscopy is used for measuring the absorbance of highly scattering materials overcoming the multiple scattering effect. It has been reported for in vivo for biomedical applications and in-field for agricultural and for environmental monitoring. In this paper, we report a polarized light microelectromechanical system (MEMS)-based FTIR in the extended near infrared (NIR) that utilizes a bistate polarizer in a diffuse reflectance measurement setup. The spectrometer is capable of distinguishing between single backscattering from the uppermost layer and multiple scattering from the deep layers. The spectrometer has a spectral resolution of 64c m ^-1 (about 16 nm at a wavelength of 1550 nm) and operates in the spectral range of 4347c m ^-1 to 7692c m ^-1 (1300 nm to 2300 nm). The technique implies de-embedding of the MEMS spectrometer polarization response by normalizing its effect; this is applied on three different samples: milk powder, sugar, and flour in plastic bags. The technique is examined on different scattering size particles. The scattering particles diameter's range is expected to vary from 10 µm to 400 µm. The absorbance spectra of the samples are extracted and compared to the direct diffuse reflectance measurements of the samples, showing good agreement. By using the proposed technique, the calculated error for the flour was decreased from 43.2% to 2.9% at 1935 nm wavelength. The wavelength error dependence is also reduced.

Bimodal multispectral imaging system with cloud-based machine learning algorithm for real-time screening and detection of oral potentially malignant lesions and biopsy guidance

SIGNIFICANCE

Screening and early detection of oral potentially malignant lesions (OPMLs) are of great significance in reducing the mortality rates associated with head and neck malignancies. Intra-oral multispectral optical imaging of tissues in conjunction with cloud-based machine learning (CBML) can be used to detect oral precancers at the point-of-care (POC) and guide the clinician to the most malignant site for biopsy.

AIM

Develop a bimodal multispectral imaging system (BMIS) combining tissue autofluorescence and diffuse reflectance (DR) for mapping changes in oxygenated hemoglobin (HbO2) absorption in the oral mucosa, quantifying tissue abnormalities, and guiding biopsies.

APPROACH

The hand-held widefield BMIS consisting of LEDs emitting at 405, 545, 575, and 610 nm, 5MPx monochrome camera, and proprietary Windows-based software was developed for image capture, processing, and analytics. The DR image ratio (R610/R545) was compared with pathologic classification to develop a CBML algorithm for real-time assessment of tissue status at the POC.

RESULTS

Sensitivity of 97.5% and specificity of 92.5% were achieved for discrimination of OPML from patient normal in 40 sites, whereas 82% sensitivity and 96.6% specificity were obtained for discrimination of abnormal (OPML + SCC) in 89 sites. Site-specific algorithms derived for buccal mucosa (27 sites) showed improved sensitivity and specificity of 96.3% for discrimination of OPML from normal.

CONCLUSIONS

Assessment of oral cancer risk is possible by mapping of HbO2 absorption in tissues, and the BMIS system developed appears to be suitable for biopsy guidance and early detection of oral cancers.

MiR-302b Suppresses Tumor Metastasis by Targeting Frizzled 6 in OSCC

Oral squamous cell carcinoma (OSCC) accounts for approximately 90% of malignant epithelial tumors of the oral and maxillofacial region. OSCC has high rate of metastasis and poor prognosis. Tobacco and/or alcohol consumption and human papillomavirus infection are relatively exact susceptibility factors for OSCC, but the specific process of oral mucosal carcinogenesis and progression is very complicated. microRNA-302b (miR-302b) could regulate various characteristics of many tumor cells, such as proliferation and apoptosis, but its role and mechanism in OSCC have not been reported. This research aims to study the effect of miR-302b on the invasion and migration ability of OSCC and the mechanism by which it functions as well as to identify new prognostic indicators and therapeutic targets for OSCC patients. Functional studies showed that the miR-302b level was negatively correlated with the invasion and migration ability of OSCC. The studies also showed that the overexpression of miR-302b could attenuate the invasion and migration ability of OSCC cells and reduce lymphangiogenesis and the lung metastasis rate of OSCC cells in a mouse model. Mechanistic studies were performed by quantitative polymerase chain reactions, luciferase assays, and RNA pull-down experiments. The results verified that frizzled class receptor 6 (FZD6) is a target gene of miR-302b in OSCC that could promote cell invasion and migration. Clinical studies demonstrate that the protein expression level of FZD6 was higher in OSCC and metastatic lymph nodes than in normal oral mucosa epithelium. Taken together, these data showed that miR-302b could inhibit the invasion and migration ability of OSCC cells by targeting and downregulating FZD6, thereby inhibiting OSCC metastasis. As a new target gene of miR-302b, FZD6 has the potential to become a prognostic and therapeutic target for OSCC patients.

Optical Biopsy of the Upper GI Tract Using Fluorescence Lifetime and Spectra

Screening and surveillance for gastrointestinal (GI) cancers by endoscope guided biopsy is invasive, time consuming, and has the potential for sampling error. Tissue endogenous fluorescence spectra contain biochemical and physiological information, which may enable real-time, objective diagnosis. We first briefly reviewed optical biopsy modalities for GI cancer diagnosis with a focus on fluorescence-based techniques. In an ex vivo pilot clinical study, we measured fluorescence spectra and lifetime on fresh biopsy specimens obtained during routine upper GI screening procedures. Our results demonstrated the feasibility of rapid acquisition of time-resolved fluorescence (TRF) spectra from fresh GI mucosal specimens. We also identified spectroscopic signatures that can differentiate between normal mucosal samples obtained from the esophagus, stomach, and duodenum.

A Sensitive Fibre Optic Probe for Autofluorescence Spectroscopy of Oral Tongue Cancer: Monte Carlo Simulation Study

The objective of this paper is to determine the best optical probe configuration that would help to detect neoplastic lesions in oral tongue epithelial tissue. Three geometrical configurations are investigated. The first one is a single-fibre probe with different fibre diameters. The second one is a multitilted fibre probe that employs different tilting angles for emission and collection fibres. While the third one is a multidiameter probe that employs different fibre diameters and distances between the emission and the collection fibres. All probes were evaluated for their depth-limited sensitivity in the epithelium layer of the tongue. Probes that showed efficient sensitivities were then compared for their fluorescence intensities acquired from both tissue types. The sensitivity for the first two types of probes was found to be roughly comparable. However, the differentiation capability of the multitilted fibre probe between dysplastic and healthy tissue was found to be noticeably larger by 30% of that of the single-fibre probe. The third type showed more sensitivity to fluorescence emerging from deeper layers. Finally, the proposed configuration is presented and proved to achieve higher sensitivity for both superficial and deep layers.

Clinical biomarkers for cancer recognition and prevention: A novel approach with optical measurements

Cancer is the most important cause of death worldwide, and early cancer detection is the most fundamental factor for efficacy of treatment, prognosis, and increasing survival rate. Over the years great effort has been devoted to discovering and testing new biomarkers that can improve its diagnosis, especially at an early stage. Here we report the potential usefulness of new, easily applicable, non-invasive and relatively low-cost clinical biomarkers, based on abnormalities of oral mucosa spectral reflectance and fractal geometry of the vascular networks in several different tissues, for identification of hereditary non-polyposis colorectal cancer carriers as well for detection of other tumors, even at an early stage. In the near future the methodology/technology of these procedures should be improved, thus making possible their applicability worldwide as screening tools for early recognition and prevention of cancer.