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Piovesana M, Boscolo Nata F, Gardenal N, Tofanelli M, Boscolo-Rizzo P, Bussani R, Tirelli G. What's behind Margin Status in Oral Cancer? Indian J Otolaryngol Head Neck Surg 2024; 76:5001-5007. [PMID: 39376299 PMCID: PMC11455710 DOI: 10.1007/s12070-024-04943-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2024] [Accepted: 07/20/2024] [Indexed: 10/09/2024] Open
Abstract
In the 2nd century AD, Galen argued that the failure to remove any single 'root' of a malignant tumor could result in a local relapse. After nearly 2 millennia, this problem appears to be even more challenging due to our increased understanding of the complexity of tumor formation and spread. Pathological analysis of tumor margins under a microscope remains the primary and only accepted method for confirming the complete tumor removal. However, this method is not an all-or-nothing test, and it can be compromised by various intrinsic and extrinsic limitations. Among the intrinsic limitations of pathological analysis we recall the pathologist handling, tissue shrinkage, the detection of minimal residual disease and the persistence of a precancerous field. Extrinsic limitations relate to surgical tools and their thermal damage, the different kinds of surgical resections and frozen sections collection. Surgeons, as well as oncologists and radiotherapists, should be well aware of and deeply understand these limitations to avoid misinterpretation of margin status, which can have serious consequences. Meanwhile, new technologies such as Narrow band imaging have shown promising results in assisting with the achievement of clear superficial resection margins. More recently, emerging techniques like Raman spectroscopy and near-infrared fluorescence have shown potential as real-time guides for surgical resection. The aim of this narrative review is to provide valuable insights into the complex process of margin analysis and underscore the importance of interdisciplinary collaboration between pathologists, surgeons, oncologists, and radiotherapists to optimize patient outcomes in oral cancer surgery.
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Affiliation(s)
- Marco Piovesana
- Department of Otorhinolaryngology Head & Neck Surgery, ULSS 4 Veneto Orientale, Via Piemonte 1, Portogruaro, VE 30026 Italy
| | - Francesca Boscolo Nata
- Head and Neck Department, ENT Clinic, University of Trieste, Strada di Fiume 447, Trieste, Italy
| | - Nicoletta Gardenal
- Head and Neck Department, ENT Clinic, University of Trieste, Strada di Fiume 447, Trieste, Italy
| | - Margherita Tofanelli
- Head and Neck Department, ENT Clinic, University of Trieste, Strada di Fiume 447, Trieste, Italy
| | - Paolo Boscolo-Rizzo
- Department of Medical, Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, Piazzale Europa 1, Trieste, 34127 Italy
| | - Rossana Bussani
- UCO Pathological Anatomy and Histopathology Unit, Azienda Sanitaria Universitaria Integrata di Trieste, Strada di Fiume 447, Trieste, Italy
| | - Giancarlo Tirelli
- Head and Neck Department, ENT Clinic, University of Trieste, Strada di Fiume 447, Trieste, Italy
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Vasanthakumari P, Romano RA, Rosa RGT, Salvio AG, Yakovlev V, Kurachi C, Hirshburg JM, Jo JA. Pixel-level classification of pigmented skin cancer lesions using multispectral autofluorescence lifetime dermoscopy imaging. BIOMEDICAL OPTICS EXPRESS 2024; 15:4557-4583. [PMID: 39346997 PMCID: PMC11427192 DOI: 10.1364/boe.523831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 06/18/2024] [Accepted: 06/27/2024] [Indexed: 10/01/2024]
Abstract
There is no clinical tool available to primary care physicians or dermatologists that could provide objective identification of suspicious skin cancer lesions. Multispectral autofluorescence lifetime imaging (maFLIM) dermoscopy enables label-free biochemical and metabolic imaging of skin lesions. This study investigated the use of pixel-level maFLIM dermoscopy features for objective discrimination of malignant from visually similar benign pigmented skin lesions. Clinical maFLIM dermoscopy images were acquired from 60 pigmented skin lesions before undergoing a biopsy examination. Random forest and deep neural networks classification models were explored, as they do not require explicit feature selection. Feature pools with either spectral intensity or bi-exponential maFLIM features, and a combined feature pool, were independently evaluated with each classification model. A rigorous cross-validation strategy tailored for small-size datasets was adopted to estimate classification performance. Time-resolved bi-exponential autofluorescence features were found to be critical for accurate detection of malignant pigmented skin lesions. The deep neural network model produced the best lesion-level classification, with sensitivity and specificity of 76.84%±12.49% and 78.29%±5.50%, respectively, while the random forest classifier produced sensitivity and specificity of 74.73%±14.66% and 76.83%±9.58%, respectively. Results from this study indicate that machine-learning driven maFLIM dermoscopy has the potential to assist doctors with identifying patients in real need of biopsy examination, thus facilitating early detection while reducing the rate of unnecessary biopsies.
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Affiliation(s)
| | - Renan A Romano
- University of São Paulo, São Carlos Institute of Physics, São Paulo, Brazil
| | - Ramon G T Rosa
- University of São Paulo, São Carlos Institute of Physics, São Paulo, Brazil
| | - Ana G Salvio
- Skin Department of Amaral Carvalho Hospital, São Paulo, Brazil
| | - Vladislav Yakovlev
- Texas A&M University, Department of Biomedical Engineering, College Station, TX, USA
| | - Cristina Kurachi
- University of São Paulo, São Carlos Institute of Physics, São Paulo, Brazil
| | - Jason M Hirshburg
- University of Oklahoma Health Science Center, Department of Dermatology, Oklahoma City, OK, USA
| | - Javier A Jo
- University of Oklahoma, School of Electrical and Computer Engineering, Norman, OK, USA
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Feenstra L, van der Stel SD, Da Silva Guimaraes M, Dashtbozorg B, Ruers TJM. Point Projection Mapping System for Tracking, Registering, Labeling, and Validating Optical Tissue Measurements. J Imaging 2024; 10:37. [PMID: 38392085 PMCID: PMC10890146 DOI: 10.3390/jimaging10020037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/23/2024] [Accepted: 01/27/2024] [Indexed: 02/24/2024] Open
Abstract
The validation of newly developed optical tissue-sensing techniques for tumor detection during cancer surgery requires an accurate correlation with the histological results. Additionally, such an accurate correlation facilitates precise data labeling for developing high-performance machine learning tissue-classification models. In this paper, a newly developed Point Projection Mapping system will be introduced, which allows non-destructive tracking of the measurement locations on tissue specimens. Additionally, a framework for accurate registration, validation, and labeling with the histopathology results is proposed and validated on a case study. The proposed framework provides a more-robust and accurate method for the tracking and validation of optical tissue-sensing techniques, which saves time and resources compared to the available conventional techniques.
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Affiliation(s)
- Lianne Feenstra
- Image-Guided Surgery, Department of Surgical Oncology, 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
| | - Stefan D van der Stel
- Image-Guided Surgery, Department of Surgical Oncology, 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
| | - Marcos Da Silva Guimaraes
- Department of Pathology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Behdad Dashtbozorg
- Image-Guided Surgery, Department of Surgical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Theo J M Ruers
- Image-Guided Surgery, Department of Surgical Oncology, 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
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Wu W, Xie B, Zhang X, Zheng C, Sun H, Jiang M, Hu T, Liu X, Zhang N, He K. Application of a Novel Miniaturized Histopathologic Microscope for Ex Vivo Identifying Cerebral Glioma Margins Rapidly During Surgery: A Parallel Control Study. J Craniofac Surg 2024; 35:228-232. [PMID: 37889070 DOI: 10.1097/scs.0000000000009787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 09/11/2023] [Indexed: 10/28/2023] Open
Abstract
PURPOSE The purpose of our study is to assess the clinical performance of the DiveScope, a novel handheld histopathologic microscope in rapidly differentiating glioma from normal brain tissue during neurosurgery. METHODS Thirty-two ex vivo specimens from 18 patients were included in the present study. The excised suspicious tissue was sequentially stained with sodium fluorescein and methylene blue and scanned with DiveScope during surgery. The adjacent tissue was sent to the department of pathology for frozen section examination. They would eventually be sent to the pathology department later for hematoxylin and eosin staining for final confirmation. The positive likelihood ratio, negative likelihood ratio, sensitivity, specificity, and area under the curve of the device were calculated. In addition, the difference in time usage between DiveScope and frozen sections was compared for the initial judgment. RESULTS The sensitivity and specificity of the DiveScope after analyzing hematoxylin and eosin -staining sections, were 88.29% and 100%, respectively. In contrast, the sensitivity and specificity of the frozen sections histopathology were 100% and 75%, respectively. The area under the curve of the DiveScope and the frozen sections histopathology was not significant ( P =0.578). Concerning time usage, DiveScope is significantly much faster than the frozen sections histopathology no matter the size of tissue. CONCLUSION Compared with traditional pathological frozen sections, DiveScope was faster and displayed an equal accuracy for judging tumor margins intraoperatively.
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Affiliation(s)
- Weichi Wu
- Department of Neurosurgery, Institute of Precision Medicine, the First Affiliated Hospital of Sun Yat-sen University, Guangdong Provincial Key Laboratory of Brain Function and Disease, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Baoshu Xie
- Department of Neurosurgery, Institute of Precision Medicine, the First Affiliated Hospital of Sun Yat-sen University, Guangdong Provincial Key Laboratory of Brain Function and Disease, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xiaowei Zhang
- Department of Neurosurgery, Institute of Precision Medicine, the First Affiliated Hospital of Sun Yat-sen University, Guangdong Provincial Key Laboratory of Brain Function and Disease, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Chen Zheng
- Department of Neurosurgery, Institute of Precision Medicine, the First Affiliated Hospital of Sun Yat-sen University, Guangdong Provincial Key Laboratory of Brain Function and Disease, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Huixin Sun
- Department of Neurosurgery, Institute of Precision Medicine, the First Affiliated Hospital of Sun Yat-sen University, Guangdong Provincial Key Laboratory of Brain Function and Disease, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Mingyang Jiang
- Department of Neurosurgery, Institute of Precision Medicine, the First Affiliated Hospital of Sun Yat-sen University, Guangdong Provincial Key Laboratory of Brain Function and Disease, Sun Yat-sen University, Guangzhou, Guangdong, China
| | | | - Xinman Liu
- Department of Neurosurgery, Institute of Precision Medicine, the First Affiliated Hospital of Sun Yat-sen University, Guangdong Provincial Key Laboratory of Brain Function and Disease, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Nu Zhang
- Department of Neurosurgery, Institute of Precision Medicine, the First Affiliated Hospital of Sun Yat-sen University, Guangdong Provincial Key Laboratory of Brain Function and Disease, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Kejun He
- Department of Neurosurgery, Institute of Precision Medicine, the First Affiliated Hospital of Sun Yat-sen University, Guangdong Provincial Key Laboratory of Brain Function and Disease, Sun Yat-sen University, Guangzhou, Guangdong, China
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Vlocskó M, Piffkó J, Janovszky Á. Intraoperative Assessment of Resection Margin in Oral Cancer: The Potential Role of Spectroscopy. Cancers (Basel) 2023; 16:121. [PMID: 38201548 PMCID: PMC10777979 DOI: 10.3390/cancers16010121] [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: 10/25/2023] [Revised: 12/21/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024] Open
Abstract
In parallel with the increasing number of oncological cases, the need for faster and more efficient diagnostic tools has also appeared. Different diagnostic approaches are available, such as radiological imaging or histological staining methods, but these do not provide adequate information regarding the resection margin, intraoperatively, or are time consuming. The purpose of this review is to summarize the current knowledge on spectrometric diagnostic modalities suitable for intraoperative use, with an emphasis on their relevance in the management of oral cancer. The literature agrees on the sensitivity, specificity, and accuracy of spectrometric diagnostic modalities, but further long-term prospective, multicentric clinical studies are needed, which may standardize the intraoperative assessment of the resection margin and the use of real-time spectroscopic approaches.
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Affiliation(s)
| | | | - Ágnes Janovszky
- Department of Oral and Maxillofacial Surgery, Albert Szent-Györgyi Medical School, University of Szeged, Kálvária 57, H-6725 Szeged, Hungary; (M.V.); (J.P.)
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Kouri MA, Karnachoriti M, Spyratou E, Orfanoudakis S, Kalatzis D, Kontos AG, Seimenis I, Efstathopoulos EP, Tsaroucha A, Lambropoulou M. Shedding Light on Colorectal Cancer: An In Vivo Raman Spectroscopy Approach Combined with Deep Learning Analysis. Int J Mol Sci 2023; 24:16582. [PMID: 38068905 PMCID: PMC10706261 DOI: 10.3390/ijms242316582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/07/2023] [Accepted: 11/13/2023] [Indexed: 12/18/2023] Open
Abstract
Raman spectroscopy has emerged as a powerful tool in medical, biochemical, and biological research with high specificity, sensitivity, and spatial and temporal resolution. Recent advanced Raman systems, such as portable Raman systems and fiber-optic probes, provide the potential for accurate in vivo discrimination between healthy and cancerous tissues. In our study, a portable Raman probe spectrometer was tested in immunosuppressed mice for the in vivo localization of colorectal cancer malignancies from normal tissue margins. The acquired Raman spectra were preprocessed, and principal component analysis (PCA) was performed to facilitate discrimination between malignant and normal tissues and to highlight their biochemical differences using loading plots. A transfer learning model based on a one-dimensional convolutional neural network (1D-CNN) was employed for the Raman spectra data to assess the classification accuracy of Raman spectra in live animals. The 1D-CNN model yielded an 89.9% accuracy and 91.4% precision in tissue classification. Our results contribute to the field of Raman spectroscopy in cancer diagnosis, highlighting its promising role within clinical applications.
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Affiliation(s)
- Maria Anthi Kouri
- 2nd Department of Radiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (M.A.K.); (E.S.); (D.K.); (E.P.E.)
- Medical Physics Program, Department of Physics and Applied Physics, Kennedy College of Sciences, University of Massachusetts Lowell, 265 Riverside St., Lowell, MA 01854, USA
| | - Maria Karnachoriti
- Physics Department, School of Applied Mathematical and Physical Sciences, National Technical University of Athens, Iroon Politechniou 9, 15780 Athens, Greece; (M.K.); (S.O.)
| | - Ellas Spyratou
- 2nd Department of Radiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (M.A.K.); (E.S.); (D.K.); (E.P.E.)
| | - Spyros Orfanoudakis
- Physics Department, School of Applied Mathematical and Physical Sciences, National Technical University of Athens, Iroon Politechniou 9, 15780 Athens, Greece; (M.K.); (S.O.)
| | - Dimitris Kalatzis
- 2nd Department of Radiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (M.A.K.); (E.S.); (D.K.); (E.P.E.)
| | - Athanassios G. Kontos
- Physics Department, School of Applied Mathematical and Physical Sciences, National Technical University of Athens, Iroon Politechniou 9, 15780 Athens, Greece; (M.K.); (S.O.)
| | - Ioannis Seimenis
- Medical School, National and Kapodistrian University of Athens, 75 Mikras Assias Str., 11527 Athens, Greece;
| | - Efstathios P. Efstathopoulos
- 2nd Department of Radiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (M.A.K.); (E.S.); (D.K.); (E.P.E.)
| | - Alexandra Tsaroucha
- Laboratory of Bioethics, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Maria Lambropoulou
- Laboratory of Histology-Embryology, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece;
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Alix JJP, Plesia M, Shaw PJ, Mead RJ, Day JCC. Combining electromyography and Raman spectroscopy: optical EMG. Muscle Nerve 2023; 68:464-470. [PMID: 37477391 PMCID: PMC10952815 DOI: 10.1002/mus.27937] [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: 12/22/2022] [Revised: 06/21/2023] [Accepted: 06/25/2023] [Indexed: 07/22/2023]
Abstract
INTRODUCTION/AIMS Electromyography (EMG) remains a key component of the diagnostic work-up for suspected neuromuscular disease, but it does not provide insight into the molecular composition of muscle which can provide diagnostic information. Raman spectroscopy is an emerging neuromuscular biomarker capable of generating highly specific, molecular fingerprints of tissue. Here, we present "optical EMG," a combination of EMG and Raman spectroscopy, achieved using a single needle. METHODS An optical EMG needle was created to collect electrophysiological and Raman spectroscopic data during a single insertion. We tested functionality with in vivo recordings in the SOD1G93A mouse model of amyotrophic lateral sclerosis (ALS), using both transgenic (n = 10) and non-transgenic (NTg, n = 7) mice. Under anesthesia, compound muscle action potentials (CMAPs), spontaneous EMG activity and Raman spectra were recorded from both gastrocnemius muscles with the optical EMG needle. Standard concentric EMG needle recordings were also undertaken. Electrophysiological data were analyzed with standard univariate statistics, Raman data with both univariate and multivariate analyses. RESULTS A significant difference in CMAP amplitude was observed between SOD1G93A and NTg mice with optical EMG and standard concentric needles (p = .015 and p = .011, respectively). Spontaneous EMG activity (positive sharp waves) was detected in transgenic SOD1G93A mice only. Raman spectra demonstrated peaks associated with key muscle components. Significant differences in molecular composition between SOD1G93A and NTg muscle were identified through the Raman spectra. DISCUSSION Optical EMG can provide standard electrophysiological data and molecular Raman data during a single needle insertion and represents a potential biomarker for neuromuscular disease.
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Affiliation(s)
- James J. P. Alix
- Sheffield Institute for Translational NeuroscienceUniversity of SheffieldSheffieldUK
- Cross‐Faculty Neuroscience InstituteUniversity of SheffieldSheffieldUK
| | - Maria Plesia
- Sheffield Institute for Translational NeuroscienceUniversity of SheffieldSheffieldUK
| | - Pamela J. Shaw
- Sheffield Institute for Translational NeuroscienceUniversity of SheffieldSheffieldUK
- Cross‐Faculty Neuroscience InstituteUniversity of SheffieldSheffieldUK
| | - Richard J. Mead
- Sheffield Institute for Translational NeuroscienceUniversity of SheffieldSheffieldUK
- Cross‐Faculty Neuroscience InstituteUniversity of SheffieldSheffieldUK
| | - John C. C. Day
- Interface Analysis Centre, School of PhysicsUniversity of BristolBristolUK
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Dinh J, Yamashita A, Kang H, Gioux S, Choi HS. Optical Tissue Phantoms for Quantitative Evaluation of Surgical Imaging Devices. ADVANCED PHOTONICS RESEARCH 2023; 4:2200194. [PMID: 36643020 PMCID: PMC9838008 DOI: 10.1002/adpr.202200194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Optical tissue phantoms (OTPs) have been extensively applied to the evaluation of imaging systems and surgical training. Due to their human tissue-mimicking characteristics, OTPs can provide accurate optical feedback on the performance of image-guided surgical instruments, simulating the biological sizes and shapes of human organs, and preserving similar haptic responses of original tissues. This review summarizes the essential components of OTPs (i.e., matrix, scattering and absorbing agents, and fluorophores) and the various manufacturing methods currently used to create suitable tissue-mimicking phantoms. As photobleaching is a major challenge in OTP fabrication and its feedback accuracy, phantom photostability and how the photobleaching phenomenon can affect their optical properties are discussed. Consequently, the need for novel photostable OTPs for the quantitative evaluation of surgical imaging devices is emphasized.
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Affiliation(s)
- Jason Dinh
- Gordon Center for Medical Imaging, Department of Radiology, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Atsushi Yamashita
- Gordon Center for Medical Imaging, Department of Radiology, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Homan Kang
- Gordon Center for Medical Imaging, Department of Radiology, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Sylvain Gioux
- Intuitive Surgical Sàrl, 1170 Aubonne, Switzerland
- ICube Laboratory, University of Strasbourg, 67081 Strasbourg, France
| | - Hak Soo Choi
- Gordon Center for Medical Imaging, Department of Radiology, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA
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Horgan CC, Jensen M, Chiappini C, Vercauteren T, Cook R, Bergholt MS. Hybrid confocal Raman endomicroscopy for morpho-chemical tissue characterization. BIOMEDICAL OPTICS EXPRESS 2022; 13:2278-2285. [PMID: 35519240 PMCID: PMC9045932 DOI: 10.1364/boe.449110] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/06/2022] [Accepted: 02/09/2022] [Indexed: 06/14/2023]
Abstract
Confocal laser endomicroscopy (CLE) offers imaging of tissue microarchitecture and has emerged as a promising tool for in vivo clinical diagnosis of cancer across many organs. CLE, however, can show high inter-observer dependency and does not provide information about tissue molecular composition. In contrast, Raman spectroscopy is a label-free optical technique that provides detailed biomolecular compositional information but offers limited or no morphological information. Here we present a novel hybrid fiber-optic confocal Raman endomicroscopy system for morpho-chemical tissue imaging and analysis. The developed confocal endomicroscopy system is based on a novel detection scheme for rejecting Raman silica fiber interference permitting simultaneous CLE imaging and Raman spectral acquisition of tissues through a coherent fiber bundle. We show that this technique enables real-time microscopic visualization of tissue architecture as well as simultaneous pointwise label-free biomolecular characterization and fingerprinting of tissue paving the way for multimodal diagnostics at endoscopy.
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Affiliation(s)
- Conor C. Horgan
- Centre for Craniofacial and Regenerative Biology, King’s College London, London SE1 9RT, UK
| | - Magnus Jensen
- Centre for Craniofacial and Regenerative Biology, King’s College London, London SE1 9RT, UK
| | - Ciro Chiappini
- Centre for Craniofacial and Regenerative Biology, King’s College London, London SE1 9RT, UK
- London Centre for Nanotechnology, King’s College London, London WC2R 2LS, UK
| | - Tom Vercauteren
- School of Biomedical Engineering and Imaging Sciences, King's College London, London WC2R 2LS, UK
| | - Richard Cook
- Centre for Oral, Clinical and Translational Sciences, King’s College London, London SE1 9RT, UK
| | - Mads S. Bergholt
- Centre for Craniofacial and Regenerative Biology, King’s College London, London SE1 9RT, UK
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The development and clinical application of microscopic endoscopy for in vivo optical biopsies: Endocytoscopy and confocal laser endomicroscopy. Photodiagnosis Photodyn Ther 2022; 38:102826. [PMID: 35337998 DOI: 10.1016/j.pdpdt.2022.102826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 03/21/2022] [Indexed: 12/20/2022]
Abstract
Endoscopies are crucial for detecting and diagnosing diseases in gastroenterology, pulmonology, urology, and other fields. To accurately diagnose diseases, sample biopsies are indispensable and are currently considered the gold standard. However, random 4-quadrant biopsies have sampling errors and time delays. To provide intraoperative real-time microscopic images of suspicious lesions, microscopic endoscopy for in vivo optical biopsy has been developed, including endocytoscopy and confocal laser endomicroscopy. This article reviews recent advances in technology and clinical applications, as well as their shortcomings and future directions.
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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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Gkouzionis I, Nazarian S, Kawka M, Darzi A, Patel N, Peters CJ, Elson DS. Real-time tracking of a diffuse reflectance spectroscopy probe used to aid histological validation of margin assessment in upper gastrointestinal cancer resection surgery. JOURNAL OF BIOMEDICAL OPTICS 2022; 27:JBO-210293R. [PMID: 35106980 PMCID: PMC8804336 DOI: 10.1117/1.jbo.27.2.025001] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 01/10/2022] [Indexed: 05/27/2023]
Abstract
SIGNIFICANCE Diffuse reflectance spectroscopy (DRS) allows discrimination of tissue type. Its application is limited by the inability to mark the scanned tissue and the lack of real-time measurements. AIM This study aimed to develop a real-time tracking system to enable localization of a DRS probe to aid the classification of tumor and non-tumor tissue. APPROACH A green-colored marker attached to the DRS probe was detected using hue-saturation-value (HSV) segmentation. A live, augmented view of tracked optical biopsy sites was recorded in real time. Supervised classifiers were evaluated in terms of sensitivity, specificity, and overall accuracy. A developed software was used for data collection, processing, and statistical analysis. RESULTS The measured root mean square error (RMSE) of DRS probe tip tracking was 1.18 ± 0.58 mm and 1.05 ± 0.28 mm for the x and y dimensions, respectively. The diagnostic accuracy of the system to classify tumor and non-tumor tissue in real time was 94% for stomach and 96% for the esophagus. CONCLUSIONS We have successfully developed a real-time tracking and classification system for a DRS probe. When used on stomach and esophageal tissue for tumor detection, the accuracy derived demonstrates the strength and clinical value of the technique to aid margin assessment in cancer resection surgery.
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Affiliation(s)
- Ioannis Gkouzionis
- Imperial College London, Department of Surgery and Cancer, London, United Kingdom
- Imperial College London, Hamlyn Centre, London, United Kingdom
| | - Scarlet Nazarian
- Imperial College London, Department of Surgery and Cancer, London, United Kingdom
| | - Michal Kawka
- Imperial College London, Department of Surgery and Cancer, London, United Kingdom
| | - Ara Darzi
- Imperial College London, Department of Surgery and Cancer, London, United Kingdom
- Imperial College London, Hamlyn Centre, London, United Kingdom
| | - Nisha Patel
- Imperial College London, Department of Surgery and Cancer, London, United Kingdom
| | | | - Daniel S. Elson
- Imperial College London, Department of Surgery and Cancer, London, United Kingdom
- Imperial College London, Hamlyn Centre, London, United Kingdom
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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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Yoon K, Kim K, Lee S. A Surgical Pen-Type Probe Design for Real-Time Optical Diagnosis of Tumor Status Using 5-Aminolevulinic Acid. Diagnostics (Basel) 2021; 11:diagnostics11061014. [PMID: 34206028 PMCID: PMC8228542 DOI: 10.3390/diagnostics11061014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/28/2021] [Accepted: 05/29/2021] [Indexed: 12/18/2022] Open
Abstract
A surgical microscope is large in size, which makes it impossible to be portable. The distance between the surgical microscope and the observation tissue is 15–30 cm, and the adjustment range of the right and left of the camera is a maximum of 30°. Therefore, the surgical microscope generates an attenuation (above 58%) of irradiation of the optical source owing to the long working distance (WD). Moreover, the observation of tissue is affected because of dazzling by ambient light as the optical source power is strong (55 to 160 mW/cm2). Further, observation blind spot phenomena will occur due to the limitations in adjusting the right and left of the camera. Therefore, it is difficult to clearly observe the tumor. To overcome these problems, several studies on the handheld surgical microscope have been reported. In this study, a compact pen-type probe with a portable surgical microscope is presented. The proposed surgical microscope comprises a small and portable pen-type probe that can adjust the WD between the probe and the observed tissue. In addition, it allows the adjustment of the viewing angle and fluorescence brightness. The proposed probe has no blind spots or optical density loss.
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Affiliation(s)
- Kicheol Yoon
- Department of Biomedical Engineering, College of Medicine, Gachon University, 38-13, Dokjom-ro 3, Namdong-gu, Incheon 21565, Korea;
- Medical Devices R&D Center, Gachon University Gil Hospital, 21, 774 beon-gil, Namdong-daero Namdong-gu, Incheon 21565, Korea
| | - Kwanggi Kim
- Department of Biomedical Engineering, College of Medicine, Gachon University, 38-13, Dokjom-ro 3, Namdong-gu, Incheon 21565, Korea;
- Medical Devices R&D Center, Gachon University Gil Hospital, 21, 774 beon-gil, Namdong-daero Namdong-gu, Incheon 21565, Korea
- Department of Biomedical Engineering, College of Health Science, Gachon University, 191 Hambakmoero, Yeonsu-gu, Incheon 21936, Korea
- Department of Health Sciences and Technology, Gachon Advanced Institute for Health Sciences and Technology (GAIHST), Gachon University, 38-13, 3 Dokjom-ro, Namdong-gu, Incheon 21565, Korea
- Correspondence: ; Tel.: +82-32-458-2770
| | - Seunghoon Lee
- Department of Neurosurgery, Daejeon Eulji Medical Center (Eulji University Hospital), Dunsanseo-ro, Seo-gu, Daejeon 35233, Korea;
- School of Medicine, Eulji University, 77 Gyeryong-ro 771 Beon-gil, Jung-gu, Daejeon 34824, Korea
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