Fluorescence lifetime needle optical biopsy discriminates hepatocellular carcinoma

Artificial intelligence in surgical pathology - Where do we stand, where do we go?

Surgical and neuropathologists continuously search for new and disease-specific features, such as independent predictors of tumor prognosis or determinants of tumor entities and sub-entities. This is a task where artificial intelligence (AI)/machine learning (ML) systems could significantly contribute to help with tumor outcome prediction and the search for new diagnostic or treatment stratification biomarkers. AI systems are increasingly integrated into routine pathology workflows to improve accuracy, reproducibility, productivity and to reveal difficult-to-see features in complicated histological slides, including the quantification of important markers for tumor grading and staging. In this article, we review the infrastructure needed to facilitate digital and computational pathology. We address the barriers for its full deployment in the clinical setting and describe the use of AI in intraoperative or postoperative settings were frozen or formalin-fixed, paraffin-embedded materials are used. We also summarize quality assessment issues of slide digitization, new spatial biology approaches, and the determination of specific gene-expression from whole slide images. Finally, we highlight new innovative and future technologies, such as large language models, optical biopsies, and mass spectrometry imaging.

In Vivo Time-Resolved Fluorescence Detection of Liver Cancer Supported by Machine Learning

OBJECTIVES

One of the widely used optical biopsy methods for monitoring cellular and tissue metabolism is time-resolved fluorescence. The use of this method in optical liver biopsy has a high potential for studying the shift in energy-type production from oxidative phosphorylation to glycolysis and changes in the antioxidant defense of malignant cells. On the other hand, machine learning methods have proven to be an excellent solution to classification problems in medical practice, including biomedical optics. We aim to combine time-resolved fluorescence measurements and machine learning to automate the division of liver parenchyma and tumors (primary malignant, metastases and benign tumors) into classes.

MATERIALS AND METHODS

An optical biopsy was performed using a developed setup with a fine-needle optical probe in clinical conditions under ultrasound control. Fluorescence decays were recorded in a conditionally healthy liver and lesions during percutaneous needle biopsy. The labeled data set was created on the basis of the recorded fluorescence results and the histopathological classification of the biopsies obtained. Several machine learning methods were trained using different separation strategies of the training test set, and their respective accuracy was compared.

RESULTS

Our results show that each of the tumor types had its own characteristic metabolic shifts recorded by the time-resolved fluorescence spectroscopy. The application of machine learning demonstrates a reliable separation of the liver and all tumor types into cancer and noncancer classes with sensitivity, specificity and corresponding accuracy greater than 0.91, 0.79 and 0.90, using the random forest method. We also show that our method is capable of giving a preliminary diagnosis of the type of liver tumor (primary malignant, metastases and benign tumors) with a sensitivity, specificity and accuracy of at least 0.80, 0.95 and 0.90.

CONCLUSIONS

These promising results highlight its potential as a key tool in the future development of diagnostic and therapeutic strategies for liver cancers. Lasers Surg. Med. 00:00-00, 2024. 2024 Wiley Periodicals LLC.

Detection of NADH and NADPH levels in vivo identifies shift of glucose metabolism in cancer to energy production

Profound changes in the metabolism of cancer cells have been known for almost 100 years, and many aspects of these changes have continued to be actively studied and discussed. Differences in the results of various studies can be explained by the diversity of tumours, which have differing processes of energy metabolism, and by limitations in the methods used. Here, using fluorescence lifetime needle optical biopsy in a hepatocellular carcinoma (HCC) mouse model and patients with HCC, we measured reduced nicotinamide adenine dinucleotide (NADH) and reduced nicotinamide adenine dinucleotide phosphate (NADPH) in control liver, and in HCC tumours and their adjacent regions. We found that NADH level (mostly responsible for energy metabolism) is increased in tumours but also in adjacent regions of the same liver. NADPH level is significantly decreased in the tumours of patients but increased in the HCC mouse model. However, in the ex vivo tumour slices of mouse HCC, reactive oxygen species production and glutathione level (both dependent on NADPH) were significantly suppressed. Thus, glucose-dependent NADH and NADPH production in tumours changed but with a more pronounced shift to energy production (NADH), rather than NADPH synthesis for redox balance.

Dual excitation spectral autofluorescence lifetime and reflectance imaging for fast macroscopic characterization of tissues

Advancements in optical imaging techniques have revolutionized the field of biomedical research, allowing for the comprehensive characterization of tissues and their underlying biological processes. Yet, there is still a lack of tools to provide quantitative and objective characterization of tissues that can aid clinical assessment in vivo to enhance diagnostic and therapeutic interventions. Here, we present a clinically viable fiber-based imaging system combining time-resolved spectrofluorimetry and reflectance spectroscopy to achieve fast multiparametric macroscopic characterization of tissues. An essential feature of the setup is its ability to perform dual wavelength excitation in combination with recording time-resolved fluorescence data in several spectral intervals. Initial validation of this bimodal system was carried out in freshly resected human colorectal cancer specimens, where we demonstrated the ability of the system to differentiate normal from malignant tissues based on their autofluorescence and reflectance properties. To further highlight the complementarity of autofluorescence and reflectance measurements and demonstrate viability in a clinically relevant scenario, we also collected in vivo data from the skin of a volunteer. Altogether, integration of these modalities in a single platform can offer multidimensional characterization of tissues, thus facilitating a deeper understanding of biological processes and potentially advancing diagnostic and therapeutic approaches in various medical applications.

High levels of FAD autofluorescence indicate pathology preceding cell death

Flavin adenine dinucleotide (FAD) autofluorescence from cells reports on the enzymatic activity which involves FAD as a cofactor. Most of the cellular FAD fluorescence comes from complex II of the electron transport chain in mitochondria and can be assessed with inhibitor analysis. The intensity of FAD autofluorescence is not homogeneous and vary between cells in tissue and in cell culture types. Using primary co-culture of neurons and astrocytes, and human skin fibroblasts we have found that very high FAD autofluorescence is a result of an overactivation of the mitochondrial complex II from ETC and from the activity of monoamine oxidases. Cells with high FAD autofluorescence were mostly intact and were not co-labelled with indicators for necrosis or apoptosis. However, cells with high FAD fluorescence showed activation of apoptosis and necrosis within 24 h after initial measurements. Thus, high level of FAD autofluorescence is an indicator of cell pathology and reveals an upcoming apoptosis and necrosis.

Deconvolution of the fluorescence spectra measured through a needle probe to assess the functional state of the liver

OBJECTIVES

Currently, one of the most pressing issues for surgeons in the treatment of obstructive jaundice is the ability to assess the functional state of the liver and to detect and determine the degree of liver failure in a timely manner with simple and objective techniques. In this regard, the use of fluorescence spectroscopy method can be considered as one of the ways to improve the informativity of existing diagnostic algorithms in clinical practice and to introduce new diagnostic tools. Thus, the aim of the work was to study in vivo the functional state of liver parenchyma by the method of fluorescence spectroscopy implemented through a needle probe and assess the contribution of the main tissue fluorophores to reveal new diagnostic criteria.

MATERIALS AND METHODS

We compared data from 20 patients diagnosed with obstructive jaundice and 11 patients without this syndrome. Measurements were performed using a fluorescence spectroscopy method at excitation wavelengths of 365 and 450 nm. Data were collected using a 1 mm fiber optic needle probe. The analysis was based on the comparison of the results of deconvolution with the combinations of Gaussian curves reflecting the contribution of the pure fluorophores in the liver tissues.

RESULTS

The results showed a statistically significant increase in the contribution of curves reflecting NAD(P)H fluorescence, bilirubin, and flavins in the group of patients with obstructive jaundice. This and the calculated redox ratio values indicated that the energy metabolism of the hepatocytes may have shifted to glycolysis due to hypoxia. An increase in vitamin A fluorescence was also observed. It may also serve as a marker of liver damage, indicating impaired vitamin A mobilization from the liver due to cholestasis.

CONCLUSIONS

The results obtained reflect changes associated with shifts in the content of the main fluorophores characterizing hepatocyte dysfunction caused by accumulation of bilirubin and bile acids and after disturbance of oxygen utilization. The contributions of NAD(P)H, flavins, and bilirubin as well as vitamin A can be used for further studies as promising diagnostic and prognostic markers for the course of liver failure. Further work will include collecting fluorescence spectroscopy data in patients with different clinical effects of obstructive jaundice on postoperative clinical outcome after biliary decompression.

Fluorescence microscopy imaging of mitochondrial metabolism in cancer cells

Mitochondrial metabolism is an important contributor to cancer cell survival and proliferation that coexists with enhanced glycolytic activity. Measuring mitochondrial activity is useful to characterize cancer metabolism patterns, to identify metabolic vulnerabilities and to identify new drug targets. Optical imaging, especially fluorescent microscopy, is one of the most valuable tools for studying mitochondrial bioenergetics because it provides semiquantitative and quantitative readouts as well as spatiotemporal resolution of mitochondrial metabolism. This review aims to acquaint the reader with microscopy imaging techniques currently used to determine mitochondrial membrane potential (ΔΨm), nicotinamide adenine dinucleotide (NADH), ATP and reactive oxygen species (ROS) that are major readouts of mitochondrial metabolism. We describe features, advantages, and limitations of the most used fluorescence imaging modalities: widefield, confocal and multiphoton microscopy, and fluorescent lifetime imaging (FLIM). We also discus relevant aspects of image processing. We briefly describe the role and production of NADH, NADHP, flavins and various ROS including superoxide and hydrogen peroxide and discuss how these parameters can be analyzed by fluorescent microscopy. We also explain the importance, value, and limitations of label-free autofluorescence imaging of NAD(P)H and FAD. Practical hints for the use of fluorescent probes and newly developed sensors for imaging ΔΨm, ATP and ROS are described. Overall, we provide updated information about the use of microscopy to study cancer metabolism that will be of interest to all investigators regardless of their level of expertise in the field.

Lesion Detection and Analysis Using Optical Imaging

The biomedical application of optical spectroscopy and imaging is currently an active, developing area of research, supported by recent technical progress in the development of light sources and detectors [...].

Biomedical Photonics Methods in Solving Diagnostic Tasks

Modern photonics methods are considered in relation to solving a number of diagnostic problems in practical medicine. The basic principles of the application of optical noninvasive diagnostic methods are described and examples are given: laser Doppler flowmetry, digital diaphanoscopy, Raman spectroscopy, spectrophotometry, time-resolved fluorescence spectroscopy, and video capillaroscopy. The advantages and prospects of using photonics methods in clinical practice, making it possible to detect various pathological conditions of biological tissues, including those at the early stages of diseases, are demonstrated.