1
|
Lim SY, Yoon HM, Kook MC, Jang JI, So PTC, Kang JW, Kim HM. Stomach tissue classification using autofluorescence spectroscopy and machine learning. Surg Endosc 2023:10.1007/s00464-023-10053-6. [PMID: 37055665 DOI: 10.1007/s00464-023-10053-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 03/26/2023] [Indexed: 04/15/2023]
Abstract
BACKGROUND AND OBJECTIVES Determination of stomach tumor location and invasion depth requires delineation of gastric histological structure, which has hitherto been widely accomplished by histochemical staining. In recent years, alternative histochemical evaluation methods have been pursued to accelerate intraoperative diagnosis, often by bypassing the time-consuming step of dyeing. Owing to strong endogenous signals from coenzymes, metabolites, and proteins, autofluorescence spectroscopy is a favorable candidate technique to achieve this aim. MATERIALS AND METHODS We investigated stomach tissue slices and block specimens using a fast fluorescence imaging scanner. To obtain histological information from broad and structureless fluorescence spectra, we analyzed tens of thousands of spectra with multiple machine-learning algorithms and built a tissue classification model trained with dissected gastric tissues. RESULTS A machine-learning-based spectro-histological model was built based on the autofluorescence spectra measured from stomach tissue samples with delineated and validated histological structures. The scores from a principal components analysis were employed as input features, and prediction accuracy was confirmed to be 92.0%, 90.1%, and 91.4% for mucosa, submucosa, and muscularis propria, respectively. We investigated the tissue samples in both sliced and block forms using a fast fluorescence imaging scanner. CONCLUSION We successfully demonstrated differentiation of multiple tissue layers of well-defined specimens with the guidance of a histologist. Our spectro-histology classification model is applicable to histological prediction for both tissue blocks and slices, even though only sliced samples were trained.
Collapse
Affiliation(s)
- Soo Yeong Lim
- Department of Chemistry, Kookmin University, 77, Jeongneung-ro, Seongbuk-gu, Seoul, 02707, Republic of Korea
| | - Hong Man Yoon
- Division of Convergence Technology, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10408, Republic of Korea
| | - Myeong-Cherl Kook
- Division of Convergence Technology, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10408, Republic of Korea
| | - Jin Il Jang
- Department of Chemistry, Kookmin University, 77, Jeongneung-ro, Seongbuk-gu, Seoul, 02707, Republic of Korea
| | - Peter T C So
- Laser Biomedical Research Center, G. R. Harrison Spectroscopy Laboratory, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Jeon Woong Kang
- Laser Biomedical Research Center, G. R. Harrison Spectroscopy Laboratory, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA.
| | - Hyung Min Kim
- Department of Chemistry, Kookmin University, 77, Jeongneung-ro, Seongbuk-gu, Seoul, 02707, Republic of Korea.
| |
Collapse
|
2
|
Yoshitake T, Rosen S, Cahill LC, Lamothe S, Ward A, Fujimoto JG. Rapid histological imaging of bone without microtome sectioning using nonlinear microscopy. Bone 2022; 154:116254. [PMID: 34743041 PMCID: PMC9832301 DOI: 10.1016/j.bone.2021.116254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 09/06/2021] [Accepted: 11/02/2021] [Indexed: 02/07/2023]
Abstract
Tissue preparation for histologic evaluation of bone is particularly lengthy, limiting its use in intraoperative or intraprocedural histological evaluation. Nonlinear microscopy (NLM) is an optical sectioning microscopy method that can visualize pathology in freshly excised tissue without requiring physical microtome sectioning. This study describes a rapid protocol for NLM imaging of bone and associated cartilage. NLM imaging was performed on 71 specimens of normal bone as well as arthritic, malignant and inflammatory bone tissue from 40 patients who underwent joint replacement, amputation, bone marrow biopsy or autopsy. Specimens ranged in size from core needle biopsies to transections of entire femoral heads. Specimens were stained with acridine orange and sulforhodamine 101, nuclear and cytoplasmic/stromal fluorescent dyes, for 5 min, then rinsed for 30 s. NLM fluorescent images were displayed using colors analogous to hematoxylin and eosin (H&E) to facilitate interpretation. Pathologists examined NLM images of the specimens in real time by rapidly translating the specimen to areas of interest, similar to a standard transmission light microscope. By adjusting the NLM focus depth, images from a few-μm-thick layer could be obtained down to ~100 μm below the tissue surface, analogous to serial sectioning. Following real-time NLM imaging, the tissue was processed for conventional paraffin histology, and H&E slides were compared to recorded NLM images. Similarities and differences between NLM and paraffin H&E were assessed. NLM enabled visualization of normal bone architecture, including the lamellar matrix and osteocytes of trabecular bone, articular cartilage, as well as pathological bone features such osteoarthritis, osteomyelitis, and malignancy with an appearance resembling the paraffin H&E. Differences such as changes in cell border sharpness, cellular and nucleolar size, and color patterns were noted, suggesting that training is required for accurate evaluation of bone pathology with NLM. Irregular surface contours and debris generated by gross tissue preparation of bone can make some regions difficult to evaluate with NLM, but the ability to perform rapid three-dimensional translation and sub-surface imaging reduced these problems. NLM is a promising technique for rapid evaluation of bone pathology. Further studies assessing diagnostic performance are warranted.
Collapse
Affiliation(s)
- Tadayuki Yoshitake
- Department of Electrical Engineering and Computer Science and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Seymour Rosen
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Lucas C Cahill
- Department of Electrical Engineering and Computer Science and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA, USA; Harvard-MIT Division of Health Sciences and Technology, Harvard Medical School and Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Simon Lamothe
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ashley Ward
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - James G Fujimoto
- Department of Electrical Engineering and Computer Science and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA, USA.
| |
Collapse
|
3
|
Fluorescent Imaging and Multifusion Segmentation for Enhanced Visualization and Delineation of Glioblastomas Margins. SIGNALS 2021. [DOI: 10.3390/signals2020020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study investigates the potential of fluorescence imaging in conjunction with an original, fused segmentation framework for enhanced detection and delineation of brain tumor margins. By means of a test bed optical microscopy system, autofluorescence is utilized to capture gray level images of brain tumor specimens through slices, obtained at various depths from the surface, each of 10 µm thickness. The samples used in this study originate from tumor cell lines characterized as Gli36ϑEGRF cells expressing a green fluorescent protein. An innovative three-step biomedical image analysis framework is presented aimed at enhancing the contrast and dissimilarity between the malignant and the remaining tissue regions to allow for enhanced visualization and accurate extraction of tumor boundaries. The fluorescence image acquisition system implemented with an appropriate unsupervised pipeline of image processing and fusion algorithms indicates clear differentiation of tumor margins and increased image contrast. Establishing protocols for the safe administration of fluorescent protein molecules, these would be introduced into glioma tissues or cells either at a pre-surgery stage or applied to the malignant tissue intraoperatively; typical applications encompass areas of fluorescence-guided surgery (FGS) and confocal laser endomicroscopy (CLE). As a result, this image acquisition scheme could significantly improve decision-making during brain tumor resection procedures and significantly facilitate brain surgery neuropathology during operation.
Collapse
|
4
|
Yoon HM, Kim H, Sohn DK, Park SC, Chang HJ, Oh JH, Dasari RR, So PTC, Kang JW. Dual modal spectroscopic tissue scanner for colorectal cancer diagnosis. Surg Endosc 2020; 35:4363-4370. [PMID: 32875410 DOI: 10.1007/s00464-020-07929-2] [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: 07/15/2019] [Accepted: 08/19/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Margin status is an important prognostic factor for treating colorectal cancer. This study aimed to investigate the usefulness of a multimodal spectroscopic tissue scanner for real-time cancer diagnosis without tissue staining. PATIENTS AND METHODS Diffuse reflectance spectra (DRS) and fluorescence spectra (FS) of < 1-mm-sized paired cancer and normal mucosa tissue were acquired using custom-built spectroscopic tissue scanners. For FS, we analyzed wavelengths and intensities at peaks and highest intensities near (± 1.25 nm) the known fluorescence spectral peaks of collagen (380 nm), reduced nicotinamide adenine dinucleotide (NADH, 460 nm), and flavin adenine dinucleotide (FAD, 550 nm). For DRS, we performed a similar analysis near the peaks of strong absorbers, oxyhemoglobin (oxyHb; 414 nm, 540 nm, and 576 nm) and deoxyhemoglobin (deoxyHb; 432 nm and 556 nm). Logistic regression analysis for these parameters was performed in the testing set. RESULTS We acquired 17,735 spectra of cancer tissues and 9438 of normal tissues from 30 patients. Intensity peaks of representative normal spectra for FS and DRS were higher than those of representative cancer spectra. Logistic regression analysis showed wavelength and intensity at peaks, and the intensities of the peak wavelength of NADH, FAD, deoxyHb, and oxyHb had significant coefficients. The area under the receiver operating characteristic curve was 0.927. The scanner had 100%, 64.3%, and 85.3% sensitivity, specificity, and accuracy, respectively. CONCLUSIONS The spectroscopic tissue scanner has high sensitivity and accuracy and provides real-time intraoperative resection margin assessments and should be further investigated as an alternative to frozen section.
Collapse
Affiliation(s)
- Hong Man Yoon
- Division of Convergence Technology, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Hongrae Kim
- Division of Convergence Technology, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Dae Kyung Sohn
- Division of Convergence Technology, Research Institute and Hospital, National Cancer Center, Goyang, Korea.
| | - Sung Chan Park
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang, 10408, Korea
| | - Hee Jin Chang
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang, 10408, Korea
| | - Jae Hwan Oh
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang, 10408, Korea
| | - Ramachandra R Dasari
- Laser Biomedical Research Center, G. R. Harrison Spectroscopy Laboratory, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA, 02139, USA
| | - Peter T C So
- Laser Biomedical Research Center, G. R. Harrison Spectroscopy Laboratory, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA, 02139, USA
| | - Jeon Woong Kang
- Laser Biomedical Research Center, G. R. Harrison Spectroscopy Laboratory, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA, 02139, USA.
| |
Collapse
|
5
|
Optical percutaneous needle biopsy of the liver: a pilot animal and clinical study. Sci Rep 2020; 10:14200. [PMID: 32848190 PMCID: PMC7449966 DOI: 10.1038/s41598-020-71089-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 08/10/2020] [Indexed: 12/15/2022] Open
Abstract
This paper presents the results of the experiments which were performed using the optical biopsy system specially developed for in vivo tissue classification during the percutaneous needle biopsy (PNB) of the liver. The proposed system includes an optical probe of small diameter acceptable for use in the PNB of the liver. The results of the feasibility studies and actual tests on laboratory mice with inoculated hepatocellular carcinoma and in clinical conditions on patients with liver tumors are presented and discussed. Monte Carlo simulations were carried out to assess the diagnostic volume and to trace the sensing depth. Fluorescence and diffuse reflectance spectroscopy measurements were used to monitor metabolic and morphological changes in tissues. The tissue oxygen saturation was evaluated using a recently developed approach to neural network fitting of diffuse reflectance spectra. The Support Vector Machine Classification was applied to identify intact liver and tumor tissues. Analysis of the obtained results shows the high sensitivity and specificity of the proposed multimodal method. This approach allows to obtain information before the tissue sample is taken, which makes it possible to significantly reduce the number of false-negative biopsies.
Collapse
|
6
|
Kosik I, Brackstone M, Kornecki A, Chamson-Reig A, Wong P, Araghi MH, Carson JJL. Intraoperative photoacoustic screening of breast cancer: a new perspective on malignancy visualization and surgical guidance. JOURNAL OF BIOMEDICAL OPTICS 2019; 24:1-12. [PMID: 31111698 PMCID: PMC6993064 DOI: 10.1117/1.jbo.24.5.056002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 04/23/2019] [Indexed: 05/07/2023]
Abstract
High re-excision rates in breast-conserving surgery call for a new intraoperative approach to the lumpectomy margin evaluation problem. The unique intraoperative imaging system, presented here, demonstrated the capability of photoacoustic tomography (PAT) to deliver optical sensitivity and specificity, along with over 2-cm imaging depth, in a clinical setting. The system enabled the evaluation of tumor extent, shape, morphology, and position within lumpectomy specimens measuring up to 11 cm in diameter. The investigation included all major breast cancer-related lesions, such as invasive ductal carcinoma (IDC), multifocal IDC, ductal carcinoma in situ and combinations of these variants. Coregistration with established ultrasound (US) technology, as well as comparison to specimen radiography, validated the performance of PAT, which appeared to facilitate better tumor visualization. Contrary to expected PA contrast mechanisms, PAT images of hemoglobin distribution correlated poorly with US-determined tumor location, while hypointense regions in lipid-weighted PAT images were in better agreement with US.
Collapse
MESH Headings
- Aged
- Aged, 80 and over
- Algorithms
- Breast Neoplasms/diagnostic imaging
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/diagnostic imaging
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Intraductal, Noninfiltrating/diagnostic imaging
- Carcinoma, Intraductal, Noninfiltrating/surgery
- Diagnosis, Computer-Assisted/methods
- Female
- Hemoglobins/analysis
- Humans
- Image Processing, Computer-Assisted
- Lipids/chemistry
- Margins of Excision
- Mastectomy, Segmental/methods
- Middle Aged
- Monitoring, Intraoperative
- Phantoms, Imaging
- Photoacoustic Techniques/methods
- Ultrasonography/methods
Collapse
Affiliation(s)
- Ivan Kosik
- Lawson Health Research Institute, Imaging Program, London, Ontario, Canada
- Schulich School of Medicine and Dentistry, Department of Medical Biophysics, London, Ontario, Canada
- Address all correspondence to Ivan Kosik, E-mail:
| | - Muriel Brackstone
- Schulich School of Medicine and Dentistry, Department of Oncology, London, Ontario, Canada
- Schulich School of Medicine and Dentistry, Department of Surgery, London, Ontario, Canada
| | - Anat Kornecki
- Lawson Health Research Institute, Imaging Program, London, Ontario, Canada
- Schulich School of Medicine and Dentistry, Department of Medical Imaging, London, Ontario, Canada
| | | | - Philip Wong
- Lawson Health Research Institute, Imaging Program, London, Ontario, Canada
- Schulich School of Medicine and Dentistry, Department of Medical Biophysics, London, Ontario, Canada
| | | | - Jeffrey J. L. Carson
- Lawson Health Research Institute, Imaging Program, London, Ontario, Canada
- Schulich School of Medicine and Dentistry, Department of Medical Biophysics, London, Ontario, Canada
- Schulich School of Medicine and Dentistry, Department of Surgery, London, Ontario, Canada
| |
Collapse
|
7
|
Schartner EP, Henderson MR, Purdey M, Dhatrak D, Monro TM, Gill PG, Callen DF. Cancer Detection in Human Tissue Samples Using a Fiber-Tip pH Probe. Cancer Res 2017; 76:6795-6801. [PMID: 27903493 DOI: 10.1158/0008-5472.can-16-1285] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 08/24/2016] [Accepted: 09/13/2016] [Indexed: 11/16/2022]
Abstract
Intraoperative detection of tumorous tissue is an important unresolved issue for cancer surgery. Difficulty in differentiating between tissue types commonly results in the requirement for additional surgeries to excise unremoved cancer tissue or alternatively in the removal of excess amounts of healthy tissue. Although pathologic methods exist to determine tissue type during surgery, these methods can compromise postoperative pathology, have a lag of minutes to hours before the surgeon receives the results of the tissue analysis, and are restricted to excised tissue. In this work, we report the development of an optical fiber probe that could potentially find use as an aid for margin detection during surgery. A fluorophore-doped polymer coating is deposited on the tip of an optical fiber, which can then be used to record the pH by monitoring the emission spectra from this dye. By measuring the tissue pH and comparing with the values from regular tissue, the tissue type can be determined quickly and accurately. The use of a novel lift-and-measure technique allows for these measurements to be performed without influence from the inherent autofluorescence that commonly affects fluorescence-based measurements on biological samples. The probe developed here shows strong potential for use during surgery, as the probe design can be readily adapted to a low-cost portable configuration, which could find use in the operating theater. Use of this probe in surgery either on excised or in vivo tissue has the potential to improve success rates for complete removal of cancers. Cancer Res; 76(23); 6795-801. ©2016 AACR.
Collapse
Affiliation(s)
- Erik P Schartner
- Institute for Photonics and Advanced Sensing, School of Physical Sciences, The University of Adelaide, Adelaide, Australia. .,ARC Centre for Nanoscale BioPhotonics, The University of Adelaide, Adelaide, Australia
| | - Matthew R Henderson
- Institute for Photonics and Advanced Sensing, School of Physical Sciences, The University of Adelaide, Adelaide, Australia
| | - Malcolm Purdey
- Institute for Photonics and Advanced Sensing, School of Physical Sciences, The University of Adelaide, Adelaide, Australia.,ARC Centre for Nanoscale BioPhotonics, The University of Adelaide, Adelaide, Australia.,Heart Health Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
| | | | - Tanya M Monro
- Institute for Photonics and Advanced Sensing, School of Physical Sciences, The University of Adelaide, Adelaide, Australia.,ARC Centre for Nanoscale BioPhotonics, The University of Adelaide, Adelaide, Australia.,University of South Australia, Adelaide, Australia
| | - P Grantley Gill
- Department of Surgery, University of Adelaide & Breast, Endocrine & Surgical Oncology Unit, Royal Adelaide Hospital, Adelaide, Australia
| | - David F Callen
- Centre for Personalised Cancer Medicine, School of Medicine, University of Adelaide, Adelaide, Australia
| |
Collapse
|
8
|
Raman Spectroscopy Differentiates Each Tissue from the Skin to the Spinal Cord: A Novel Method for Epidural Needle Placement? Anesthesiology 2017; 125:793-804. [PMID: 27466032 DOI: 10.1097/aln.0000000000001249] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Neuraxial anesthesia and epidural steroid injection techniques require precise anatomical targeting to ensure successful and safe analgesia. Previous studies suggest that only some of the tissues encountered during these procedures can be identified by spectroscopic methods, and no previous study has investigated the use of Raman, diffuse reflectance, and fluorescence spectroscopies. The authors hypothesized that real-time needle-tip spectroscopy may aid epidural needle placement and tested the ability of spectroscopy to distinguish each of the tissues in the path of neuraxial needles. METHODS For comparison of detection methods, the spectra of individual, dissected ex vivo paravertebral and neuraxial porcine tissues were collected using Raman spectroscopy (RS), diffuse reflectance spectroscopy, and fluorescence spectroscopy. Real-time spectral guidance was tested using a 2-mm inner-diameter fiber-optic probe-in-needle device. Raman spectra were collected during the needle's passage through intact paravertebral and neuraxial porcine tissue and analyzed afterward. The RS tissue signatures were verified as mapping to individual tissue layers using histochemical staining and widefield microscopy. RESULTS RS revealed a unique spectrum for all ex vivo paravertebral and neuraxial tissue layers; diffuse reflectance spectroscopy and fluorescence spectroscopy were not distinct for all tissues. Moreover, when accounting for the expected order of tissues, real-time Raman spectra recorded during needle insertion also permitted identification of each paravertebral and neuraxial porcine tissue. CONCLUSIONS This study demonstrates that RS can distinguish the tissues encountered during epidural needle insertion. This technology may prove useful during needle placement by providing evidence of its anatomical localization.
Collapse
|
9
|
Miller DM, Jokerst NM. Flexible silicon sensors for diffuse reflectance spectroscopy of tissue. BIOMEDICAL OPTICS EXPRESS 2017; 8:1512-1524. [PMID: 28663846 PMCID: PMC5480561 DOI: 10.1364/boe.8.001512] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 01/28/2017] [Accepted: 02/09/2017] [Indexed: 05/03/2023]
Abstract
Diffuse reflectance spectroscopy (DRS) is being used in exploratory clinical applications such as cancer margin assessment on excised tissue. However, when interrogating nonplanar tissue anomalies can arise from non-uniform pressure. Herein is reported the design, fabrication, and test of flexible, thin film silicon photodetectors (PDs) bonded to a flexible substrate designed for use in conformal DRS. The PDs have dark currents and responsivities comparable to conventional Si PDs, and were characterized while flat and while flexed at multiple radii of curvature using liquid phantoms mimicking adipose and malignant breast tissue. The DRS and nearest neighbor crosstalk results were compared with Monte Carlo simulations, showing good agreement between simulation and experiment.
Collapse
|
10
|
Nichols BS, Llopis A, Palmer GM, McCachren SS, Senlik O, Miller D, Brooke MA, Jokerst NM, Geradts J, Greenup R, Ramanujam N. Miniature spectral imaging device for wide-field quantitative functional imaging of the morphological landscape of breast tumor margins. JOURNAL OF BIOMEDICAL OPTICS 2017; 22:26007. [PMID: 28241273 PMCID: PMC5321165 DOI: 10.1117/1.jbo.22.2.026007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 01/26/2017] [Indexed: 05/14/2023]
Abstract
We have developed a portable, breast margin assessment probe leveraging diffuse optical spectroscopy to quantify the morphological landscape of breast tumor margins during breast conserving surgery. The approach presented here leverages a custom-made 16-channel annular photodiode imaging array (arranged in a 4 × 4 grid), a raster-scanning imaging platform with precision pressure control, and compressive sensing with an optimized set of eight wavelengths in the visible spectral range. A scalable Monte-Carlo-based inverse model is used to generate optical property [ ? s ? ( ? ) and ? a ( ? ) ] measures for each of the 16 simultaneously captured diffuse reflectance spectra. Subpixel sampling (0.75 mm) is achieved through incremental x , y raster scanning of the imaging probe, providing detailed optical parameter maps of breast margins over a 2 × 2 ?? cm 2 area in ? 9 ?? min . The morphological landscape of a tumor margin is characterized using optical surrogates for the fat to fibroglandular content ratio, which has demonstrated diagnostic utility in delineating tissue subtypes in the breast.
Collapse
Affiliation(s)
- Brandon S. Nichols
- Duke University, Pratt School of Engineering, Department of Biomedical Engineering, Durham, North Carolina, United States
| | - Antonio Llopis
- Duke University, Pratt School of Engineering, Department of Electrical Engineering, Durham, North Carolina, United States
| | - Gregory M. Palmer
- Duke University Medical Center, Department of Radiation Oncology, Medicine Circle, Durham, North Carolina, United States
| | - Samuel S. McCachren
- Duke University, Pratt School of Engineering, Department of Biomedical Engineering, Durham, North Carolina, United States
| | - Ozlem Senlik
- Duke University, Pratt School of Engineering, Department of Electrical Engineering, Durham, North Carolina, United States
| | - David Miller
- Duke University, Pratt School of Engineering, Department of Electrical Engineering, Durham, North Carolina, United States
| | - Martin A. Brooke
- Duke University, Pratt School of Engineering, Department of Electrical Engineering, Durham, North Carolina, United States
| | - Nan M. Jokerst
- Duke University, Pratt School of Engineering, Department of Electrical Engineering, Durham, North Carolina, United States
| | - Joseph Geradts
- Duke University Medical Center, Department of Pathology, Durham, North Carolina, United States
| | - Rachel Greenup
- Duke University Medical Center, Department of Surgery, Durham, North Carolina, United States
| | - Nimmi Ramanujam
- Duke University, Pratt School of Engineering, Department of Biomedical Engineering, Durham, North Carolina, United States
- Address all correspondence to: Nimmi Ramanujam, E-mail:
| |
Collapse
|
11
|
Birtoiu IA, Rizea C, Togoe D, Munteanu RM, Micsa C, Rusu MI, Tautan M, Braic L, Scoicaru LO, Parau A, Becherescu-Barbu ND, Udrea MV, Tonetto A, Notonier R, Grigorescu CEA. Diagnosing clean margins through Raman spectroscopy in human and animal mammary tumour surgery: a short review. Interface Focus 2016; 6:20160067. [PMID: 27920899 DOI: 10.1098/rsfs.2016.0067] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Breast cancer frequency in human and other mammal female populations has worryingly increased lately. The acute necessity for taxonomy of the aetiological factors along with seeking for new diagnostic tools and therapy procedures aimed at reducing mortality have yielded in an intense research effort worldwide. Surgery is a regular method to counteract extensive development of breast cancer and prevent metastases provided that negative surgical margins are achieved. This highly technical challenge requires fast, extremely sensitive and selective discrimination between malignant and benign tissues even down to molecular level. The particular advantages of Raman spectroscopy, such as high chemical specificity, and the ability to measure raw samples and optical responses in the visible or near-infrared spectral range, have recently recommended it as a means with elevated potential in precise diagnostic in oncology surgery. This review spans mainly the latter 10 years of exceptional efforts of scientists implementing Raman spectroscopy as a nearly real-time diagnostic tool for clean margins assessment in mastectomy and lumpectomy. Although greatly contributing to medical discoveries for the wealth of humanity, animals as patients have benefitted less from advances in surgery diagnostic using Raman spectroscopy. This work also dedicates a few lines to applications of surface enhanced Raman spectroscopy in veterinary oncological surgery.
Collapse
Affiliation(s)
- I A Birtoiu
- Faculty of Veterinary Medicine-University of Agronomic Sciences and Veterinary Medicine , Bucharest , Romania
| | - C Rizea
- ROXY VETERINARY S.R.L , Magurele , Romania
| | - D Togoe
- Faculty of Veterinary Medicine-University of Agronomic Sciences and Veterinary Medicine , Bucharest , Romania
| | - R M Munteanu
- Faculty of Veterinary Medicine-University of Agronomic Sciences and Veterinary Medicine , Bucharest , Romania
| | - C Micsa
- Faculty of Veterinary Medicine-University of Agronomic Sciences and Veterinary Medicine , Bucharest , Romania
| | - M I Rusu
- National Institute of Research and Development for Optoelectronics INOE 2000 , Magurele , Romania
| | - M Tautan
- National Institute of Research and Development for Optoelectronics INOE 2000 , Magurele , Romania
| | - L Braic
- National Institute of Research and Development for Optoelectronics INOE 2000 , Magurele , Romania
| | - L O Scoicaru
- National Institute of Research and Development for Optoelectronics INOE 2000 , Magurele , Romania
| | - A Parau
- National Institute of Research and Development for Optoelectronics INOE 2000 , Magurele , Romania
| | - N D Becherescu-Barbu
- APEL LASER S.R.L., Bucharest, Romania; Faculty of Physics, University of Bucharest, Bucharest, Romania
| | - M V Udrea
- APEL LASER S.R.L. , Bucharest , Romania
| | - A Tonetto
- Aix-Marseille Université , Centrale Marseille, CNRS, Fédération Sciences Chimiques Marseille (FR 1739) - PRATIM, 13000 Marseille , France
| | - R Notonier
- Aix-Marseille Université , Centrale Marseille, CNRS, Fédération Sciences Chimiques Marseille (FR 1739) - PRATIM, 13000 Marseille , France
| | - C E A Grigorescu
- National Institute of Research and Development for Optoelectronics INOE 2000 , Magurele , Romania
| |
Collapse
|
12
|
de Boer LL, Hendriks BHW, van Duijnhoven F, Peeters-Baas MJTFDV, Van de Vijver K, Loo CE, Jóźwiak K, Sterenborg HJCM, Ruers TJM. Using DRS during breast conserving surgery: identifying robust optical parameters and influence of inter-patient variation. BIOMEDICAL OPTICS EXPRESS 2016; 7:5188-5200. [PMID: 28018735 PMCID: PMC5175562 DOI: 10.1364/boe.7.005188] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 11/11/2016] [Accepted: 11/13/2016] [Indexed: 05/12/2023]
Abstract
Successful breast conserving surgery consists of complete removal of the tumor while sparing healthy surrounding tissue. Despite currently available imaging and margin assessment tools, recognizing tumor tissue at a resection margin during surgery is challenging. Diffuse reflectance spectroscopy (DRS), which uses light for tissue characterization, can potentially guide surgeons to prevent tumor positive margins. However, inter-patient variation and changes in tissue physiology occurring during the resection might hamper this light-based technology. Here we investigate how inter-patient variation and tissue status (in vivo vs ex vivo) affect the performance of the DRS optical parameters. In vivo and ex vivo measurements of 45 breast cancer patients were obtained and quantified with an analytical model to acquire the optical parameters. The optical parameter representing the ratio between fat and water provided the best discrimination between normal and tumor tissue, with an area under the receiver operating characteristic curve of 0.94. There was no substantial influence of other patient factors such as menopausal status on optical measurements. Contrary to expectations, normalization of the optical parameters did not improve the discriminative power. Furthermore, measurements taken in vivo were not significantly different from the measurements taken ex vivo. These findings indicate that DRS is a robust technology for the detection of tumor tissue during breast conserving surgery.
Collapse
Affiliation(s)
- Lisanne L. de Boer
- Netherlands Cancer Institute – Antoni van Leeuwenhoek, Amsterdam The Netherlands
| | - Benno H. W. Hendriks
- Philips Research, Eindhoven, The Netherlands
- Biomechanical Engineering Department, Delft University of Technology, Delft, The Netherlands
| | | | | | - Koen Van de Vijver
- Netherlands Cancer Institute – Antoni van Leeuwenhoek, Amsterdam The Netherlands
| | - Claudette E. Loo
- Netherlands Cancer Institute – Antoni van Leeuwenhoek, Amsterdam The Netherlands
| | - Katarzyna Jóźwiak
- Netherlands Cancer Institute – Antoni van Leeuwenhoek, Amsterdam The Netherlands
| | - Henricus J. C. M. Sterenborg
- Netherlands Cancer Institute – Antoni van Leeuwenhoek, Amsterdam The Netherlands
- Academic Medical Center, Department of Biomedical Engineering and Physics, Meibergdreef 9, 1105AZ, Amsterdam, Netherlands
| | - Theo J. M. Ruers
- Netherlands Cancer Institute – Antoni van Leeuwenhoek, Amsterdam The Netherlands
- MIRA Institute, University Twente, The Netherlands
| |
Collapse
|
13
|
Abstract
Indocyanine green (ICG) is the only near-infrared dye approved by the U.S. Food and Drug Administration for clinical use. When injected in blood, ICG binds primarily to plasma proteins and lipoproteins, resulting in enhanced fluorescence. Recently, the optofluidic laser has emerged as a novel tool in bio-analysis. Laser emission has advantages over fluorescence in signal amplification, narrow linewidth, and strong intensity, leading to orders of magnitude increase in detection sensitivity and imaging contrast. Here we successfully demonstrate, to the best of our knowledge, the first ICG lasing in human serum and whole blood with the clinical ICG concentrations and the pump intensity far below the clinically permissible level. Furthermore, we systematically study ICG laser emission within each major serological component (albumins, globulins, and lipoproteins) and reveal the critical elements and conditions responsible for lasing. Our work marks a critical step toward eventual clinical and biomedical applications of optofluidic lasers using FDA approved fluorophores, which may complement or even supersede conventional fluorescence-based sensing and imaging.
Collapse
Affiliation(s)
- Yu-Cheng Chen
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, 1101 Beal Ave., Ann Arbor, Michigan 48109, USA
| | - Qiushu Chen
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, 1101 Beal Ave., Ann Arbor, Michigan 48109, USA
| | - Xudong Fan
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, 1101 Beal Ave., Ann Arbor, Michigan 48109, USA
| |
Collapse
|
14
|
Brachtel EF, Johnson NB, Huck AE, Rice-Stitt TL, Vangel MG, Smith BL, Tearney GJ, Kang D. Spectrally encoded confocal microscopy for diagnosing breast cancer in excision and margin specimens. J Transl Med 2016; 96:459-67. [PMID: 26779830 PMCID: PMC5027883 DOI: 10.1038/labinvest.2015.158] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Revised: 11/01/2015] [Accepted: 11/04/2015] [Indexed: 11/09/2022] Open
Abstract
A large percentage of breast cancer patients treated with breast conserving surgery need to undergo multiple surgeries due to positive margins found during post-operative margin assessment. Carcinomas could be removed completely during the initial surgery and additional surgery avoided if positive margins can be determined intraoperatively. Spectrally encoded confocal microscopy (SECM) is a high-speed reflectance confocal microscopy technology that has a potential to rapidly image the entire surgical margin at subcellular resolution and accurately determine margin status intraoperatively. In this study, in order to test the feasibility of using SECM for intraoperative margin assessment, we have evaluated the diagnostic accuracy of SECM for detecting various types of breast cancers. Forty-six surgically removed breast specimens were imaged with an SECM system. Side-by-side comparison between SECM and histologic images showed that SECM images can visualize key histomorphologic patterns of normal/benign and malignant breast tissues. Small (500 μm × 500 μm) spatially registered SECM and histologic images (n=124 for each) were diagnosed independently by three pathologists with expertise in breast pathology. Diagnostic accuracy of SECM for determining malignant tissues was high, average sensitivity of 0.91, specificity of 0.93, positive predictive value of 0.95, and negative predictive value of 0.87. Intra-observer agreement and inter-observer agreement for SECM were also high, 0.87 and 0.84, respectively. Results from this study suggest that SECM may be developed into an intraoperative margin assessment tool for guiding breast cancer excisions.
Collapse
Affiliation(s)
| | | | | | | | - Mark G. Vangel
- Department of Radiology, Massachusetts General Hospital,Biostatistics Center, Massachusetts General Hospital
| | - Barbara L. Smith
- Gillette Center for Women’s Cancers and Department of Surgery, Massachusetts General Hospital
| | - Guillermo J. Tearney
- Department of Pathology, Massachusetts General Hospital,Wellman Center for Photomedicine, Massachusetts General Hospital,Harvard-MIT division of Health Sciences and Technology
| | - Dongkyun Kang
- Wellman Center for Photomedicine, Massachusetts General Hospital,Corresponding author: Dongkyun Kang, 40 Blossom St. BAR802, Boston, MA 02114, , Phone: 617-726-1699, Fax: 617-726-4103
| |
Collapse
|
15
|
Light Reflectance Spectroscopy to Detect Positive Surgical Margins on Prostate Cancer Specimens. J Urol 2015; 195:479-83. [PMID: 26410735 DOI: 10.1016/j.juro.2015.05.115] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2015] [Indexed: 11/22/2022]
Abstract
PURPOSE Intraoperative frozen section analysis is not routinely performed to determine positive surgical margins at radical prostatectomy due to time requirements and unproven clinical usefulness. Light reflectance spectroscopy, which measures light intensity reflected or backscattered from tissues, can be applied to differentiate malignant from benign tissue. We used a novel light reflectance spectroscopy probe to evaluate positive surgical margins on ex vivo radical prostatectomy specimens and correlate its findings with pathological examination. MATERIALS AND METHODS Patients with intermediate to high risk disease undergoing radical prostatectomy were enrolled. Light reflectance spectroscopy was performed on suspected malignant and benign prostate capsule immediately following organ extraction. Each light reflectance spectroscopy at 530 to 830 nm was analyzed and correlated with pathological results. A regression model and forward sequential selection algorithm were developed for optimal feature selection. Eighty percent of light reflectance spectroscopy data were selected to train a logistic regression model, which was evaluated by the remaining 20% data. This was repeated 5 times to calculate averaged sensitivity, specificity and accuracy. RESULTS Light reflectance spectroscopy analysis was performed on 17 ex vivo prostate specimens, on which a total of 11 histologically positive and 22 negative surgical margins were measured. Two select features from 700 to 830 nm were identified as unique to malignant tissue. Cross-validation when performing the predictive model showed that the optical probe predicted positive surgical margins with 85% sensitivity, 86% specificity, 86% accuracy and an AUC of 0.95. CONCLUSIONS Light reflectance spectroscopy can identify positive surgical margins accurately in fresh ex vivo radical prostatectomy specimens. Further study is required to determine whether such analysis may be used in real time to improve surgical decision making and decrease positive surgical margin rates.
Collapse
|
16
|
Pandey R, Paidi SK, Kang JW, Spegazzini N, Dasari RR, Valdez TA, Barman I. Discerning the differential molecular pathology of proliferative middle ear lesions using Raman spectroscopy. Sci Rep 2015; 5:13305. [PMID: 26289566 PMCID: PMC4542608 DOI: 10.1038/srep13305] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 07/13/2015] [Indexed: 11/10/2022] Open
Abstract
Despite its widespread prevalence, middle ear pathology, especially the development of proliferative lesions, remains largely unexplored and poorly understood. Diagnostic evaluation is still predicated upon a high index of clinical suspicion on otoscopic examination of gross morphologic features. We report the first technique that has the potential to non-invasively identify two key lesions, namely cholesteatoma and myringosclerosis, by providing real-time information of differentially expressed molecules. In addition to revealing signatures consistent with the known pathobiology of these lesions, our observations provide the first evidence of the presence of carbonate- and silicate-substitutions in the calcium phosphate plaques found in myringosclerosis. Collectively, these results demonstrate the potential of Raman spectroscopy to not only provide new understanding of the etiology of these conditions by defining objective molecular markers but also aid in margin assessment to improve surgical outcome.
Collapse
Affiliation(s)
- Rishikesh Pandey
- Laser Biomedical Research Center, Massachusetts Institute of Technology, Cambridge, Massachusetts, 02139, USA
| | - Santosh Kumar Paidi
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, Maryland 21218, USA
| | - Jeon Woong Kang
- Laser Biomedical Research Center, Massachusetts Institute of Technology, Cambridge, Massachusetts, 02139, USA
| | - Nicolas Spegazzini
- Laser Biomedical Research Center, Massachusetts Institute of Technology, Cambridge, Massachusetts, 02139, USA
| | - Ramachandra Rao Dasari
- Laser Biomedical Research Center, Massachusetts Institute of Technology, Cambridge, Massachusetts, 02139, USA
| | - Tulio Alberto Valdez
- Otolaryngology, Head and Neck Surgery, University of Connecticut, 263 Farmington Ave, Farmington, Connecticut, 06030, USA.,Otolaryngology, Head and Neck Surgery, Connecticut Children's Medical Center, 282 Washington St, Hartford, Connecticut, 06106, USA
| | - Ishan Barman
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, Maryland 21218, USA.,Department of Oncology, Johns Hopkins University, Baltimore, Maryland 21287, USA
| |
Collapse
|
17
|
Wang W, Zhao J, Short M, Zeng H. Real-time in vivo cancer diagnosis using Raman spectroscopy. JOURNAL OF BIOPHOTONICS 2015; 8:527-45. [PMID: 25220508 DOI: 10.1002/jbio.201400026] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 07/25/2014] [Accepted: 08/12/2014] [Indexed: 05/02/2023]
Abstract
Raman spectroscopy has becoming a practical tool for rapid in vivo tissue diagnosis. This paper provides an overview on the latest development of real-time in vivo Raman systems for cancer detection. Instrumentation, data handling, as well as oncology applications of Raman techniques were covered. Optic fiber probes designs for Raman spectroscopy were discussed. Spectral data pre-processing, feature extraction, and classification between normal/benign and malignant tissues were surveyed. Applications of Raman techniques for clinical diagnosis for different types of cancers, including skin cancer, lung cancer, stomach cancer, oesophageal cancer, colorectal cancer, cervical cancer, and breast cancer, were summarized. Schematic of a real-time Raman spectrometer for skin cancer detection. Without correction, the image captured on CCD camera for a straight entrance slit has a curvature. By arranging the optic fiber array in reverse orientation, the curvature could be effectively corrected.
Collapse
Affiliation(s)
- Wenbo Wang
- Imaging Unit - Integrative Oncology Department, British Columbia Cancer Agency Research Centre, 675 West 10th Avenue, Vancouver, B.C., V5Z 1L3, Canada
- Photomedicine Institute, Department of Dermatology and Skin Science, University of British Columbia and Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Jianhua Zhao
- Imaging Unit - Integrative Oncology Department, British Columbia Cancer Agency Research Centre, 675 West 10th Avenue, Vancouver, B.C., V5Z 1L3, Canada
- Photomedicine Institute, Department of Dermatology and Skin Science, University of British Columbia and Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Michael Short
- Imaging Unit - Integrative Oncology Department, British Columbia Cancer Agency Research Centre, 675 West 10th Avenue, Vancouver, B.C., V5Z 1L3, Canada
| | - Haishan Zeng
- Imaging Unit - Integrative Oncology Department, British Columbia Cancer Agency Research Centre, 675 West 10th Avenue, Vancouver, B.C., V5Z 1L3, Canada
- Photomedicine Institute, Department of Dermatology and Skin Science, University of British Columbia and Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| |
Collapse
|
18
|
Nichols BS, Schindler CE, Brown JQ, Wilke LG, Mulvey CS, Krieger MS, Gallagher J, Geradts J, Greenup RA, Von Windheim JA, Ramanujam N. A Quantitative Diffuse Reflectance Imaging (QDRI) System for Comprehensive Surveillance of the Morphological Landscape in Breast Tumor Margins. PLoS One 2015; 10:e0127525. [PMID: 26076123 PMCID: PMC4468201 DOI: 10.1371/journal.pone.0127525] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 04/16/2015] [Indexed: 11/18/2022] Open
Abstract
In an ongoing effort to address the clear clinical unmet needs surrounding breast conserving surgery (BCS), our group has developed a next-generation multiplexed optical-fiber-based tool to assess breast tumor margin status during initial surgeries. Specifically detailed in this work is the performance and clinical validation of a research-grade intra-operative tool for margin assessment based on diffuse optical spectroscopy. Previous work published by our group has illustrated the proof-of-concept generations of this device; here we incorporate a highly optimized quantitative diffuse reflectance imaging (QDRI) system utilizing a wide-field (imaging area = 17cm2) 49-channel multiplexed fiber optic probe, a custom raster-scanning imaging platform, a custom dual-channel white LED source, and an astronomy grade imaging CCD and spectrograph. The system signal to noise ratio (SNR) was found to be greater than 40dB for all channels. Optical property estimation error was found to be less than 10%, on average, over a wide range of absorption (μa = 0–8.9cm-1) and scattering (μs’ = 7.0–9.7cm-1) coefficients. Very low inter-channel and CCD crosstalk was observed (2% max) when used on turbid media (including breast tissue). A raster-scanning mechanism was developed to achieve sub-pixel resolution and was found to be optimally performed at an upsample factor of 8, affording 0.75mm spatially resolved diffuse reflectance images (λ = 450–600nm) of an entire margin (area = 17cm2) in 13.8 minutes (1.23cm2/min). Moreover, controlled pressure application at the probe-tissue interface afforded by the imaging platform reduces repeated scan variability, providing <1% variation across repeated scans of clinical specimens. We demonstrate the clinical utility of this device through a pilot 20-patient study of high-resolution optical parameter maps of the ratio of the β-carotene concentration to the reduced scattering coefficient. An empirical cumulative distribution function (eCDF) analysis is used to reduce optical property maps to quantitative distributions representing the morphological landscape of breast tumor margins. The optimizations presented in this work provide an avenue to rapidly survey large tissue areas on intra-operative time scales with improved sensitivity to regions of focal disease that may otherwise be overlooked.
Collapse
Affiliation(s)
- Brandon S. Nichols
- Department of Biomedical Engineering, Duke University, Durham, NC, United States of America
- * E-mail:
| | - Christine E. Schindler
- Department of Biomedical Engineering, Duke University, Durham, NC, United States of America
| | - Jonathon Q. Brown
- Zenalux Biomedical, Research Triangle Park, NC, United States of America
- Department of Biomedical Engineering, Tulane University, New Orleans, LA, United States of America
| | - Lee G. Wilke
- Department of Surgery, The University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States of America
| | - Christine S. Mulvey
- Department of Biomedical Engineering, Duke University, Durham, NC, United States of America
| | - Marlee S. Krieger
- Department of Biomedical Engineering, Duke University, Durham, NC, United States of America
- Zenalux Biomedical, Research Triangle Park, NC, United States of America
| | - Jennifer Gallagher
- Department of Surgery, Duke University Medical Center, Durham, NC, United States of America
| | - Joseph Geradts
- Department of Pathology, Duke University Medical Center, Durham, NC, United States of America
| | - Rachel A. Greenup
- Department of Surgery, Duke University Medical Center, Durham, NC, United States of America
| | - Jesko A. Von Windheim
- Zenalux Biomedical, Research Triangle Park, NC, United States of America
- The Division of Environmental Sciences and Policy, Duke University, Durham, NC, United States of America
| | - Nirmala Ramanujam
- Department of Biomedical Engineering, Duke University, Durham, NC, United States of America
- Zenalux Biomedical, Research Triangle Park, NC, United States of America
| |
Collapse
|
19
|
Miles BA, Patsias A, Quang T, Polydorides AD, Richards-Kortum R, Sikora AG. Operative margin control with high-resolution optical microendoscopy for head and neck squamous cell carcinoma. Laryngoscope 2015; 125:2308-16. [PMID: 26059758 DOI: 10.1002/lary.25400] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2015] [Indexed: 12/27/2022]
Abstract
OBJECTIVES/HYPOTHESIS High-resolution microendoscopy (HRME) provides real-time visualization of the mucosal surface in the upper aerodigestive tract. This technology allows noninvasive discrimination of benign and neoplastic epithelium and has potential applications for intraoperative margin detection. STUDY DESIGN Single institution, prospective, feasibility trial (phase I) of in vivo optical imaging. METHODS The study was conducted on patients with squamous cell carcinoma of the upper aerodigestive tract. High-resolution microendoscopy images obtained during surgery were correlated with histopathologic diagnosis to determine the ability of HRME to differentiate between benign and malignant mucosa. Blinded reviewers evaluated HRME images and made determinations of the status of the mucosa. Accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and interrater agreement between multiple raters were calculated to determine the accuracy of HRME imaging. RESULTS The mean accuracy of reviewers in differentiating neoplastic or benign mucosa was 95.1% (95% confidence interval [CI], 94%-96%). Sensitivity and specificity were 96% (95% CI, 94%-99%) and 95% (95 % CI, 90%-99%), respectively. The NPV was 98% (95% CI, 97%-99%), and PPV was 91% (95% CI, 85%-98%). The Fleiss kappa statistic for interrater reliability was 0.81, with a standard error of 0.014 and a 95% CI (0.78-0.84). CONCLUSION High-resolution microendoscopy allows real-time discrimination between benign and neoplastic mucosa. High levels of sensitivity and specificity can be obtained with this technology when interrogating mucosal surfaces. Despite several technical limitations, HRME shows promise as a technique for intraoperative margin control and platform for molecular imaging technologies. LEVEL OF EVIDENCE 3b.
Collapse
Affiliation(s)
- Brett A Miles
- Department of Otolaryngology-Head and Neck Surgery, Division of Head and Neck Oncology
| | - Alexis Patsias
- Department of Otolaryngology-Head and Neck Surgery, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
| | | | | | | | - Andrew G Sikora
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A
| |
Collapse
|
20
|
Zheludev V, Pölönen I, Neittaanmäki-Perttu N, Averbuch A, Neittaanmäki P, Grönroos M, Saari H. Delineation of malignant skin tumors by hyperspectral imaging using diffusion maps dimensionality reduction. Biomed Signal Process Control 2015. [DOI: 10.1016/j.bspc.2014.10.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
21
|
Lu G, Wang D, Qin X, Halig L, Muller S, Zhang H, Chen A, Pogue BW, Chen ZG, Fei B. Framework for hyperspectral image processing and quantification for cancer detection during animal tumor surgery. JOURNAL OF BIOMEDICAL OPTICS 2015; 20:126012. [PMID: 26720879 PMCID: PMC4691647 DOI: 10.1117/1.jbo.20.12.126012] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Accepted: 11/25/2015] [Indexed: 05/15/2023]
Abstract
Hyperspectral imaging (HSI) is an imaging modality that holds strong potential for rapid cancer detection during image-guided surgery. But the data from HSI often needs to be processed appropriately in order to extract the maximum useful information that differentiates cancer from normal tissue. We proposed a framework for hyperspectral image processing and quantification, which includes a set of steps including image preprocessing, glare removal, feature extraction, and ultimately image classification. The framework has been tested on images from mice with head and neck cancer, using spectra from 450- to 900-nm wavelength. The image analysis computed Fourier coefficients, normalized reflectance, mean, and spectral derivatives for improved accuracy. The experimental results demonstrated the feasibility of the hyperspectral image processing and quantification framework for cancer detection during animal tumor surgery, in a challenging setting where sensitivity can be low due to a modest number of features present, but potential for fast image classification can be high. This HSI approach may have potential application in tumor margin assessment during image-guided surgery, where speed of assessment may be the dominant factor.
Collapse
Affiliation(s)
- Guolan Lu
- Georgia Institute of Technology and Emory University, The Wallace H. Coulter Department of Biomedical Engineering, Atlanta, Georgia 30332, United States
| | - Dongsheng Wang
- Emory University, School of Medicine, Department of Hematology and Medical Oncology, , Atlanta, Georgia 30332, United States
| | - Xulei Qin
- Emory University, School of Medicine, Department of Radiology and Imaging Sciences, , Atlanta, Georgia 30332, United States
| | - Luma Halig
- Emory University, School of Medicine, Department of Radiology and Imaging Sciences, , Atlanta, Georgia 30332, United States
| | - Susan Muller
- Emory University, School of Medicine, Department of Otolaryngology, , Atlanta, Georgia 30332, United States
| | - Hongzheng Zhang
- Emory University, School of Medicine, Department of Otolaryngology, , Atlanta, Georgia 30332, United States
| | - Amy Chen
- Emory University, School of Medicine, Department of Otolaryngology, , Atlanta, Georgia 30332, United States
| | - Brian W. Pogue
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire 03755, United States
| | - Zhuo Georgia Chen
- Emory University, School of Medicine, Department of Hematology and Medical Oncology, , Atlanta, Georgia 30332, United States
| | - Baowei Fei
- Georgia Institute of Technology and Emory University, The Wallace H. Coulter Department of Biomedical Engineering, Atlanta, Georgia 30332, United States
- Emory University, School of Medicine, Department of Radiology and Imaging Sciences, , Atlanta, Georgia 30332, United States
- Winship Cancer Institute of Emory University, Atlanta, Georgia 30322, United States
- Address all correspondence to: Baowei Fei, E-mail:
| |
Collapse
|
22
|
Li M, Kang JW, Sukumar S, Dasari RR, Barman I. Multiplexed detection of serological cancer markers with plasmon-enhanced Raman spectro-immunoassay. Chem Sci 2015; 6:3906-3914. [PMID: 26405519 PMCID: PMC4577055 DOI: 10.1039/c5sc01054c] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Circulating biomarkers have emerged as promising non-invasive, real-time surrogates for cancer diagnosis, prognostication and monitoring of therapeutic response. Emerging data, however, suggest that single markers are inadequate in describing complex pathologic transformations. Architecting assays capable of parallel measurements of multiple biomarkers can help achieve the desired clinical sensitivity and specificity while conserving patient specimen and reducing turn-around time. Here we describe a plasmon-enhanced Raman spectroscopic assay featuring nanostructured biomolecular probes and spectroscopic imaging for multiplexed detection of disseminated breast cancer markers cancer antigen (CA) 15-3, CA 27-29 and cancer embryonic antigen (CEA). In the developed SERS assay, both the assay chip and surface-enhanced Raman spectroscopy (SERS) tags are functionalized with monoclonal antibodies against CA15-3, CA27-29 and CEA, respectively. Sequential addition of biomarkers and functionalized SERS tags onto the functionalized assay chip enable the specific recognition of these biomarkers through the antibody-antigen interactions, leading to a sandwich spectro-immunoassay. In addition to offering extensive multiplexing capability, our method provides higher sensitivity than conventional immunoassays and demonstrates exquisite specificity owing to selective formation of conjugated complexes and fingerprint spectra of the Raman reporter. We envision that clinical translation of this assay may further enable asymptomatic surveillance of cancer survivors and speedy assessment of treatment benefit through a simple blood test.
Collapse
Affiliation(s)
- Ming Li
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, Maryland 21218, United States ; Laser Biomedical Research Center, George R. Harrison Spectroscopy Laboratory, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
| | - Jeon Woong Kang
- Laser Biomedical Research Center, George R. Harrison Spectroscopy Laboratory, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
| | - Saraswati Sukumar
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, United States
| | - Ramachandra Rao Dasari
- Laser Biomedical Research Center, George R. Harrison Spectroscopy Laboratory, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
| | - Ishan Barman
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, Maryland 21218, United States ; Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, United States
| |
Collapse
|
23
|
Boughey JC, Hieken TJ, Jakub JW, Degnim AC, Grant CS, Farley DR, Thomsen KM, Osborn JB, Keeney GL, Habermann EB. Impact of analysis of frozen-section margin on reoperation rates in women undergoing lumpectomy for breast cancer: Evaluation of the National Surgical Quality Improvement Program data. Surgery 2014; 156:190-7. [DOI: 10.1016/j.surg.2014.03.025] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2013] [Accepted: 03/11/2014] [Indexed: 11/29/2022]
|
24
|
Thill M, Baumann K, Barinoff J. Intraoperative assessment of margins in breast conservative surgery--still in use? J Surg Oncol 2014; 110:15-20. [PMID: 24863286 DOI: 10.1002/jso.23634] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Accepted: 04/05/2014] [Indexed: 01/20/2023]
Abstract
A positive margin in breast conserving surgery is associated with an increased risk of local recurrence. Failure to achieve clear margins results in re-excision procedures. Methods for intraoperative assessment of margins have been developed, such as frozen section analysis, touch preparation cytology, near-infrared fluorescence optical imaging, x-ray diffraction technology, high-frequency ultrasound, micro-CT, and radiofrequency spectroscopy. In this article, options that might become the method of choice in the future are discussed.
Collapse
Affiliation(s)
- Marc Thill
- Department of Gynecology and Obstetrics, Breast Center, AGAPLESION Markus Hospital, Frankfurt am Main, Germany
| | | | | |
Collapse
|
25
|
Sharma V, Olweny EO, Kapur P, Cadeddu JA, Roehrborn CG, Liu H. Prostate cancer detection using combined auto-fluorescence and light reflectance spectroscopy: ex vivo study of human prostates. BIOMEDICAL OPTICS EXPRESS 2014; 5:1512-29. [PMID: 24877012 PMCID: PMC4026896 DOI: 10.1364/boe.5.001512] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 04/01/2014] [Accepted: 04/07/2014] [Indexed: 05/23/2023]
Abstract
This study was conducted to evaluate the capability of detecting prostate cancer (PCa) using auto-fluorescence lifetime spectroscopy (AFLS) and light reflectance spectroscopy (LRS). AFLS used excitation at 447 nm with four emission wavelengths (532, 562, 632, and 684 nm), where their lifetimes and weights were analyzed using a double exponent model. LRS was measured between 500 and 840 nm and analyzed by a quantitative model to determine hemoglobin concentrations and light scattering. Both AFLS and LRS were taken on n = 724 distinct locations from both prostate capsular (nc = 185) and parenchymal (np = 539) tissues, including PCa tissue, benign peripheral zone tissue and benign prostatic hyperplasia (BPH), of fresh ex vivo radical prostatectomy specimens from 37 patients with high volume, intermediate-to-high-grade PCa (Gleason score, GS ≥7). AFLS and LRS parameters from parenchymal tissues were analyzed for statistical testing and classification. A feature selection algorithm based on multinomial logistic regression was implemented to identify critical parameters in order to classify high-grade PCa tissue. The regression model was in turn used to classify PCa tissue at the individual aggressive level of GS = 7,8,9. Receiver operating characteristic curves were generated and used to determine classification accuracy for each tissue type. We show that our dual-modal technique resulted in accuracies of 87.9%, 90.1%, and 85.1% for PCa classification at GS = 7, 8, 9 within parenchymal tissues, and up to 91.1%, 91.9%, and 94.3% if capsular tissues were included for detection. Possible biochemical and physiological mechanisms causing signal differences in AFLS and LRS between PCa and benign tissues were also discussed.
Collapse
Affiliation(s)
- Vikrant Sharma
- Department of Bioengineering, University of Texas at Arlington, Arlington, TX 76019, USA
- Joint Program of Biomedical Engineering between University of Texas at Arlington and University of Texas Southwestern Medical Center at Dallas, Arlington, TX 76019, USA
| | - Ephrem O. Olweny
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Payal Kapur
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Jeffrey A. Cadeddu
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Claus G. Roehrborn
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Hanli Liu
- Department of Bioengineering, University of Texas at Arlington, Arlington, TX 76019, USA
- Joint Program of Biomedical Engineering between University of Texas at Arlington and University of Texas Southwestern Medical Center at Dallas, Arlington, TX 76019, USA
| |
Collapse
|
26
|
Dehghani-Bidgoli Z, Baygi MHM, Kabir E, Malekfar R. Developing an Instrument-Independent Algorithm for Raman Spectroscopy: A Case of Cancer Detection. Technol Cancer Res Treat 2014; 13:119-27. [DOI: 10.7785/tcrt.2012.500373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
One of the problems in the use of Raman spectroscopy for cancer detection in clinical application is the variety of Raman instruments, producing different spectra for the same sample, due to the nature of the measurement system. This prevents the measured spectra from different systems to be compared against one another without appropriate tools and techniques. Therefore, for each instrument one needs to spend considerable amount of time to prepare a set of reference data based on which the future measurements to be interpreted. For early diagnosis of cancer by Raman spectroscopy, there is a need for an algorithm by which such diagnosis can be made by any type of Raman instrument giving rise to the same findings. In the present study we have investigated the detection of breast cancer in three classes of breast samples (normal, benign and cancer) using three different Raman instruments (Almega, Bruker and R3000) to develop an algorithm that, irrespective of the type of Raman instrument, can be applied to the spectra to extract the features necessary to arrive at the same diagnosis. In doing so, we employed different pre-processing methods to eliminate the instrument-dependent effects on the spectra enabling us to fuse such spectra obtained from different instruments. Then, we classified the data using support vector machine (SVM) and multi-layer perception (MLP) to assess the degree to which the employed methods have been able to detect cancer. The results of the study showed that the range and resolution matching using spline interpolation, and noise and fluorescence elimination using wavelet and SNV normalizations were the most sensitive and accurate procedures for eliminating the instrumental specification-based effects and fusing the data from different instruments.
Collapse
Affiliation(s)
- Z. Dehghani-Bidgoli
- Department of Electrical and Computer Engineering, Tarbiat Modares University, Tehran, I. R. Iran
| | - M. H. Miran Baygi
- Department of Electrical and Computer Engineering, Tarbiat Modares University, Tehran, I. R. Iran
| | - E. Kabir
- Department of Electrical and Computer Engineering, Tarbiat Modares University, Tehran, I. R. Iran
| | - R. Malekfar
- Department of Basic Sciences, Tarbiat Modares University, Tehran, I. R. Iran
| |
Collapse
|
27
|
Angarita FA, Nadler A, Zerhouni S, Escallon J. Perioperative measures to optimize margin clearance in breast conserving surgery. Surg Oncol 2014; 23:81-91. [PMID: 24721660 DOI: 10.1016/j.suronc.2014.03.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 02/28/2014] [Accepted: 03/04/2014] [Indexed: 01/15/2023]
Abstract
Margin status is one of the most important determinants of local recurrence following breast conserving surgery. The fact that up to 60% of patients undergoing breast conserving surgery require re-excision highlights the importance of optimizing margin clearance. In this review we summarize the following perioperative measures that aim to enhance margin clearance: (1) patient risk stratification, specifically risk factors and nomograms, (2) preoperative imaging, (3) intraoperative techniques including wire-guided localization, radioguided surgery, intraoperative ultrasound-guided resection, intraoperative specimen radiography, standardized cavity shaving, and ink-directed focal re-excision; (4) and intraoperative pathology assessment techniques, namely frozen section analysis and imprint cytology. Novel surgical techniques as well as emerging technologies are also reviewed. Effective treatment requires accurate preoperative planning, developing and implementing a consistent definition of margin clearance, and using tools that provide detailed real-time intraoperative information on margin status.
Collapse
Affiliation(s)
- Fernando A Angarita
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario M5S 1A1, Canada.
| | - Ashlie Nadler
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario M5S 1A1, Canada.
| | - Siham Zerhouni
- Department of Surgery, University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada.
| | - Jaime Escallon
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario M5S 1A1, Canada; Department of Surgical Oncology, University of Toronto, Princess Margaret Hospital, Toronto, Ontario M5T 2M9, Canada; Marvelle Koffler Breast Centre, Mount Sinai Hospital, Toronto, Ontario M5G 1X5, Canada.
| |
Collapse
|
28
|
Thill M. MarginProbe: intraoperative margin assessment during breast conserving surgery by using radiofrequency spectroscopy. Expert Rev Med Devices 2014; 10:301-15. [PMID: 23668703 DOI: 10.1586/erd.13.5] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
In breast conserving surgery, the tumor should be removed with a clean margin, a rim of healthy tissue surrounding. Failure to achieve clean margins in the initial surgery results in a re-excision procedure. Re-excision rates are reported as being 11-46% for invasive carcinoma and ductal carcinoma in situ (DCIS). Re-excisions can have negative consequences such as increased postoperative infections, negative impact on cosmesis, patient anxiety and increased medical costs. Therefore, the surgical margin of invasive and intraductal (DCIS) breast tissue is a subject of intense discussion. Different options for intraoperative assessment are available, but all in all, they are unsatisfying. Frozen section margin examination is possible but is time consuming and restricted to the assessment of invasive carcinoma. In the case of DCIS, there is no procedure for intraoperative margin assessment. Thus, a solution for efficient intraoperative surgical margin assessment is needed. For this purpose, an innovative, real-time, intraoperative margin-assessment device (MarginProbe, Dune Medical Devices, Caesarea, Israel) was designed, and recent published clinical data reported a reduction of re-excisions by more than 50%.
Collapse
Affiliation(s)
- Marc Thill
- Department of Gynecology and Obstetrics and Breast Cancer Center, Agaplesion Markus Hospital, Wilhelm-Epstein-Strasse 4, 60431 Frankfurt, Germany.
| |
Collapse
|
29
|
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.
Collapse
|
30
|
Optical spectroscopic methods for intraoperative diagnosis. Anal Bioanal Chem 2013; 406:21-5. [PMID: 24136252 DOI: 10.1007/s00216-013-7401-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 09/12/2013] [Accepted: 09/25/2013] [Indexed: 10/26/2022]
Abstract
Molecular analytical methods are increasingly needed for a quick and reliable analysis of tissue in an operating room to provide more information during operations. In this Trends article, we highlight the current state and the developments of optical spectroscopic methods as intra operative tools. The clinical problem and challenges are illustrated on the example of brain tumor surgery. While fluorescence microscopy is already used, vibrational spectroscopy techniques will complement the standard method for brain tissue diagnostics. New portable instruments are currently available and can be stationed in the operating room for quick evaluation of tissue. The promise and limitations of fluorescence and vibrational spectroscopy as intraoperative tools are surveyed in this report.
Collapse
|
31
|
Brown JQ, Bydlon TM, Kennedy SA, Caldwell ML, Gallagher JE, Junker M, Wilke LG, Barry WT, Geradts J, Ramanujam N. Optical spectral surveillance of breast tissue landscapes for detection of residual disease in breast tumor margins. PLoS One 2013; 8:e69906. [PMID: 23922850 PMCID: PMC3724737 DOI: 10.1371/journal.pone.0069906] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 06/13/2013] [Indexed: 12/05/2022] Open
Abstract
We demonstrate a strategy to “sense” the micro-morphology of a breast tumor margin over a wide field of view by creating quantitative hyperspectral maps of the tissue optical properties (absorption and scattering), where each voxel can be deconstructed to provide information on the underlying histology. Information about the underlying tissue histology is encoded in the quantitative spectral information (in the visible wavelength range), and residual carcinoma is detected as a shift in the histological landscape to one with less fat and higher glandular content. To demonstrate this strategy, fully intact, fresh lumpectomy specimens (n = 88) from 70 patients were imaged intra-operatively. The ability of spectral imaging to sense changes in histology over large imaging areas was determined using inter-patient mammographic breast density (MBD) variation in cancer-free tissues as a model system. We discovered that increased MBD was associated with higher baseline β-carotene concentrations (p = 0.066) and higher scattering coefficients (p = 0.007) as measured by spectral imaging, and a trend toward decreased adipocyte size and increased adipocyte density as measured by histological examination in BMI-matched patients. The ability of spectral imaging to detect cancer intra-operatively was demonstrated when MBD-specific breast characteristics were considered. Specifically, the ratio of β-carotene concentration to the light scattering coefficient can report on the relative amount of fat to glandular density at the tissue surface to determine positive margin status, when baseline differences in these parameters between patients with low and high MBD are taken into account by the appropriate selection of threshold values. When MBD was included as a variable a priori, the device was estimated to have a sensitivity of 74% and a specificity of 86% in detecting close or positive margins, regardless of tumor type. Superior performance was demonstrated in high MBD tissue, a population that typically has a higher percentage of involved margins.
Collapse
Affiliation(s)
- J Quincy Brown
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, United States of America.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Fu HL, Mueller JL, Javid MP, Mito JK, Kirsch DG, Ramanujam N, Brown JQ. Optimization of a widefield structured illumination microscope for non-destructive assessment and quantification of nuclear features in tumor margins of a primary mouse model of sarcoma. PLoS One 2013; 8:e68868. [PMID: 23894357 PMCID: PMC3720887 DOI: 10.1371/journal.pone.0068868] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 06/02/2013] [Indexed: 11/25/2022] Open
Abstract
Cancer is associated with specific cellular morphological changes, such as increased nuclear size and crowding from rapidly proliferating cells. In situ tissue imaging using fluorescent stains may be useful for intraoperative detection of residual cancer in surgical tumor margins. We developed a widefield fluorescence structured illumination microscope (SIM) system with a single-shot FOV of 2.1×1.6 mm (3.4 mm2) and sub-cellular resolution (4.4 µm). The objectives of this work were to measure the relationship between illumination pattern frequency and optical sectioning strength and signal-to-noise ratio in turbid (i.e. thick) samples for selection of the optimum frequency, and to determine feasibility for detecting residual cancer on tumor resection margins, using a genetically engineered primary mouse model of sarcoma. The SIM system was tested in tissue mimicking solid phantoms with various scattering levels to determine impact of both turbidity and illumination frequency on two SIM metrics, optical section thickness and modulation depth. To demonstrate preclinical feasibility, ex vivo 50 µm frozen sections and fresh intact thick tissue samples excised from a primary mouse model of sarcoma were stained with acridine orange, which stains cell nuclei, skeletal muscle, and collagenous stroma. The cell nuclei were segmented using a high-pass filter algorithm, which allowed quantification of nuclear density. The results showed that the optimal illumination frequency was 31.7 µm−1 used in conjunction with a 4×0.1 NA objective ( = 0.165). This yielded an optical section thickness of 128 µm and an 8.9×contrast enhancement over uniform illumination. We successfully demonstrated the ability to resolve cell nuclei in situ achieved via SIM, which allowed segmentation of nuclei from heterogeneous tissues in the presence of considerable background fluorescence. Specifically, we demonstrate that optical sectioning of fresh intact thick tissues performed equivalently in regards to nuclear density quantification, to physical frozen sectioning and standard microscopy.
Collapse
Affiliation(s)
- Henry L Fu
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA.
| | | | | | | | | | | | | |
Collapse
|
33
|
Krishnaswamy V, Laughney AM, Wells WA, Paulsen KD, Pogue BW. Scanning in situ spectroscopy platform for imaging surgical breast tissue specimens. OPTICS EXPRESS 2013; 21:2185-94. [PMID: 23389199 PMCID: PMC3601741 DOI: 10.1364/oe.21.002185] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
A non-contact localized spectroscopic imaging platform has been developed and optimized to scan 1 x 1 cm² square regions of surgically resected breast tissue specimens with ~150-micron resolution. A color corrected, image-space telecentric scanning design maintained a consistent sampling geometry and uniform spot size across the entire imaging field. Theoretical modeling in ZEMAX allowed estimation of the spot size, which is equal at both the center and extreme positions of the field with ~5% variation across the designed waveband, indicating excellent color correction. The spot sizes at the center and an extreme field position were also measured experimentally using the standard knife-edge technique and were found to be within ~8% of the theoretical predictions. Highly localized sampling offered inherent insensitivity to variations in background absorption allowing direct imaging of local scattering parameters, which was validated using a matrix of varying concentrations of Intralipid and blood in phantoms. Four representative, pathologically distinct lumpectomy tissue specimens were imaged, capturing natural variations in tissue scattering response within a given pathology. Variations as high as 60% were observed in the average reflectance and relative scattering power images, which must be taken into account for robust classification performance. Despite this variation, the preliminary data indicates discernible scatter power contrast between the benign vs malignant groups, but reliable discrimination of pathologies within these groups would require investigation into additional contrast mechanisms.
Collapse
Affiliation(s)
| | - Ashley M. Laughney
- Thayer School of Engineering, Dartmouth College, 14 Engineering Drive, Hanover, New Hampshire 03755,
USA
| | - Wendy A. Wells
- Department of Pathology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire 03755,
USA
| | - Keith D. Paulsen
- Thayer School of Engineering, Dartmouth College, 14 Engineering Drive, Hanover, New Hampshire 03755,
USA
| | - Brian W. Pogue
- Thayer School of Engineering, Dartmouth College, 14 Engineering Drive, Hanover, New Hampshire 03755,
USA
| |
Collapse
|
34
|
Rollakanti KR, Kanick SC, Davis SC, Pogue BW, Maytin EV. Techniques for fluorescence detection of protoporphyrin IX in skin cancers associated with photodynamic therapy. ACTA ACUST UNITED AC 2013; 2:287-303. [PMID: 25599015 DOI: 10.1515/plm-2013-0030] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Photodynamic therapy (PDT) is a treatment modality that uses a specific photosensitizing agent, molecular oxygen, and light of a particular wavelength to kill cells targeted by the therapy. Topically administered aminolevulinic acid (ALA) is widely used to effectively treat cancerous and precancerous skin lesions, resulting in targeted tissue damage and little to no scarring. The targeting aspect of the treatment arises from the fact that ALA is preferentially converted into protoporphyrin IX (PpIX) in neoplastic cells. To monitor the amount of PpIX in tissues, techniques have been developed to measure PpIX-specific fluorescence, which provides information useful for monitoring the abundance and location of the photosensitizer before and during the illumination phase of PDT. This review summarizes the current state of these fluorescence detection techniques. Non-invasive devices are available for point measurements, or for wide-field optical imaging, to enable monitoring of PpIX in superficial tissues. To gain access to information at greater tissue depths, multi-modal techniques are being developed which combine fluorescent measurements with ultrasound or optical coherence tomography, or with microscopic techniques such as confocal or multiphoton approaches. The tools available at present, and newer devices under development, offer the promise of better enabling clinicians to inform and guide PDT treatment planning, thereby optimizing therapeutic outcomes for patients.
Collapse
Affiliation(s)
- Kishore R Rollakanti
- Department of Chemical and Biomedical Engineering, Cleveland State University, 2121 Euclid Avenue, Cleveland, OH 44115, USA; and Department of Biomedical Engineering, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Stephen C Kanick
- Thayer School of Engineering, Dartmouth College, 14 Engineering Drive, Hanover, NH 03755, USA
| | - Scott C Davis
- Thayer School of Engineering, Dartmouth College, 14 Engineering Drive, Hanover, NH 03755, USA
| | - Brian W Pogue
- Thayer School of Engineering, Dartmouth College, 14 Engineering Drive, Hanover, NH 03755, USA
| | - Edward V Maytin
- Department of Chemical and Biomedical Engineering, Cleveland State University, 2121 Euclid Avenue, Cleveland, OH 44115, USA; Department of Biomedical Engineering, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA; and Department of Dermatology, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| |
Collapse
|
35
|
Dhar S, Lo JY, Palmer GM, Brooke MA, Nichols BS, Yu B, Ramanujam N, Jokerst NM. A diffuse reflectance spectral imaging system for tumor margin assessment using custom annular photodiode arrays. BIOMEDICAL OPTICS EXPRESS 2012; 3:3211-22. [PMID: 23243571 PMCID: PMC3521310 DOI: 10.1364/boe.3.003211] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 11/07/2012] [Accepted: 11/07/2012] [Indexed: 05/04/2023]
Abstract
Diffuse reflectance spectroscopy (DRS) is a well-established method to quantitatively distinguish between benign and cancerous tissue for tumor margin assessment. Current multipixel DRS margin assessment tools are bulky fiber-based probes that have limited scalability. Reported herein is a new approach to multipixel DRS probe design, which utilizes direct detection of the DRS signal by using optimized custom photodetectors in direct contact with the tissue. This first fiberless DRS imaging system for tumor margin assessment consists of a 4 × 4 array of annular silicon photodetectors and a constrained free-space light delivery tube optimized to deliver light across a 256 mm(2) imaging area. This system has 4.5 mm spatial resolution. The signal-to-noise ratio measured for normal and malignant breast tissue-mimicking phantoms was 35 dB to 45 dB for λ = 470 nm to 600 nm.
Collapse
Affiliation(s)
- Sulochana Dhar
- Department of Electrical and Computer Engineering, Duke University, Research Drive, Durham, NC 27708, USA
| | - Justin Y. Lo
- Department of Biomedical Engineering, Duke University, Research Drive, Durham, NC 27708, USA
| | - Gregory M. Palmer
- Department of Radiation Oncology, Duke University, Research Drive, Durham, NC 27710, USA
| | - Martin A. Brooke
- Department of Electrical and Computer Engineering, Duke University, Research Drive, Durham, NC 27708, USA
| | - Brandon S. Nichols
- Department of Biomedical Engineering, Duke University, Research Drive, Durham, NC 27708, USA
| | - Bing Yu
- Department of Biomedical Engineering, Duke University, Research Drive, Durham, NC 27708, USA
- Currently at Department of Biomedical Engineering, University of Akron, Akron, Ohio 44325,USA
| | - Nirmala Ramanujam
- Department of Biomedical Engineering, Duke University, Research Drive, Durham, NC 27708, USA
| | - Nan M. Jokerst
- Department of Electrical and Computer Engineering, Duke University, Research Drive, Durham, NC 27708, USA
| |
Collapse
|
36
|
Cohen G, Lecht S, Arien-Zakay H, Ettinger K, Amsalem O, Oron-Herman M, Yavin E, Prus D, Benita S, Nissan A, Lazarovici P. Bio-imaging of colorectal cancer models using near infrared labeled epidermal growth factor. PLoS One 2012; 7:e48803. [PMID: 23144978 PMCID: PMC3493605 DOI: 10.1371/journal.pone.0048803] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2012] [Accepted: 10/01/2012] [Indexed: 01/11/2023] Open
Abstract
Novel strategies that target the epidermal growth factor receptor (EGFR) have led to the clinical development of monoclonal antibodies, which treat metastatic colorectal cancer (mCRC) but only subgroups of patients with increased wild type KRAS and EGFR gene copy, respond to these agents. Furthermore, resistance to EGFR blockade inevitably occurred, making future therapy difficult. Novel bio-imaging (BOI) methods may assist in quantization of EGFR in mCRC tissue thus complementing the immunohistochemistry methodology, in guiding the future treatment of these patients. The aim of the present study was to explore the usefulness of near infrared-labeled EGF (EGF-NIR) for bio-imaging of CRC using in vitro and in vivo orthotopic tumor CRC models and ex vivo human CRC tissues. We describe the preparation and characterization of EGF-NIR and investigate binding, using BOI of a panel of CRC cell culture models resembling heterogeneity of human CRC tissues. EGF-NIR was specifically and selectively bound by EGFR expressing CRC cells, the intensity of EGF-NIR signal to background ratio (SBR) reflected EGFR levels, dose-response and time course imaging experiments provided optimal conditions for quantization of EGFR levels by BOI. EGF-NIR imaging of mice with HT-29 orthotopic CRC tumor indicated that EGF-NIR is more slowly cleared from the tumor and the highest SBR between tumor and normal adjacent tissue was achieved two days post-injection. Furthermore, images of dissected tissues demonstrated accumulation of EGF-NIR in the tumor and liver. EGF-NIR specifically and strongly labeled EGFR positive human CRC tissues while adjacent CRC tissue and EGFR negative tissues expressed weak NIR signals. This study emphasizes the use of EGF-NIR for preclinical studies. Combined with other methods, EGF-NIR could provide an additional bio-imaging specific tool in the standardization of measurements of EGFR expression in CRC tissues.
Collapse
Affiliation(s)
- Gadi Cohen
- School of Pharmacy Institute for Drug Research, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Shimon Lecht
- School of Pharmacy Institute for Drug Research, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Hadar Arien-Zakay
- School of Pharmacy Institute for Drug Research, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Keren Ettinger
- School of Pharmacy Institute for Drug Research, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Orit Amsalem
- School of Pharmacy Institute for Drug Research, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Mor Oron-Herman
- Advanced Technology Center, The Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Eylon Yavin
- School of Pharmacy Institute for Drug Research, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Diana Prus
- Department of Pathology and Surgical Oncology Laboratory, Hadassah-Hebrew University Medical Center, Mount Scopus, Jerusalem, Israel
| | - Simon Benita
- School of Pharmacy Institute for Drug Research, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Aviram Nissan
- Department of Surgery, Hadassah-Hebrew University Medical Center, Mount Scopus, Jerusalem, Israel
| | - Philip Lazarovici
- School of Pharmacy Institute for Drug Research, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
- * E-mail:
| |
Collapse
|
37
|
Abstract
Since breast-conserving surgery has become the gold standard for early breast cancer, the development of less radical or less burdensome technologies has been pressed for in order to preserve the patient from unnecessary harm through the operative procedure. Different technical approaches are under evaluation, and some of them are already being used in the clinical setting. The aim of this article is to present a perspective on future breast cancer surgery by shedding light on the current innovative and new techniques.
Collapse
Affiliation(s)
- Marc Thill
- Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Lübeck Campus, Frankfurt, Germany
- Department of Gynecology and Obstetrics, Agaplesion Markus Hospital, Frankfurt, Germany
| | - Kristin Baumann
- Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Lübeck Campus, Frankfurt, Germany
| |
Collapse
|