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Bydlon TM, Torjesen A, Fokkenrood S, Di Tullio A, Flexman ML. 3D Visualisation of Navigation Catheters for Endovascular Procedures Using a 3D Hub and Fiber Optic RealShape Technology: Phantom Study Results. EJVES Vasc Forum 2023; 59:24-30. [PMID: 37389371 PMCID: PMC10300314 DOI: 10.1016/j.ejvsvf.2023.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 02/23/2023] [Accepted: 05/09/2023] [Indexed: 07/01/2023] Open
Abstract
Objective Fiber Optic RealShape (FORS) is a new technology that visualises the full three dimensional (3D) shape of guidewires using an optical fibre embedded in the device. Co-registering FORS guidewires with anatomical images, such as a digital subtraction angiography (DSA), provides anatomical context for navigating these devices during endovascular procedures. The objective of this study was to demonstrate the feasibility and usability of visualising compatible conventional navigation catheters, together with the FORS guidewire, in phantom with a new 3D Hub technology and to understand potential clinical benefits. Methods The accuracy of localising the 3D Hub and catheter in relation to the FORS guidewire, was evaluated using a translation stage test setup and a retrospective analysis of prior clinical data. Catheter visualisation accuracy and navigation success was assessed in a phantom study where 15 interventionists navigated devices to three pre-defined targets in an abdominal aortic phantom using an Xray or computed tomography angiography (CTA) roadmap. Additionally, the interventionists were surveyed about the usability and potential benefits of the 3D Hub. Results The location of the 3D Hub and catheter along the FORS guidewire was detected correctly 96.59% of the time. During the phantom study, all 15 interventionists successfully reached the target locations 100% of the time and the error in catheter visualisation was 0.69 mm. The interventionists agreed or strongly agreed that the 3D Hub was easy to use and the greatest potential clinical benefit over FORS is in offering interventionists choice over which catheter they used. Conclusion This set of studies has shown that FORS guided catheter visualisation, enabled by a 3D Hub, is accurate and easy to use in a phantom setting. Further evaluation is needed to understand the benefits and limitations of the 3D Hub technology during endovascular procedures.
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de Boer LL, Bydlon TM, van Duijnhoven F, Vranken Peeters MJTFD, Loo CE, Winter-Warnars GAO, Sanders J, Sterenborg HJCM, Hendriks BHW, Ruers TJM. Towards the use of diffuse reflectance spectroscopy for real-time in vivo detection of breast cancer during surgery. J Transl Med 2018; 16:367. [PMID: 30567584 PMCID: PMC6299954 DOI: 10.1186/s12967-018-1747-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 12/13/2018] [Indexed: 12/31/2022] Open
Abstract
Background Breast cancer surgeons struggle with differentiating healthy tissue from cancer at the resection margin during surgery. We report on the feasibility of using diffuse reflectance spectroscopy (DRS) for real-time in vivo tissue characterization. Methods Evaluating feasibility of the technology requires a setting in which measurements, imaging and pathology have the best possible correlation. For this purpose an optical biopsy needle was used that had integrated optical fibers at the tip of the needle. This approach enabled the best possible correlation between optical measurement volume and tissue histology. With this optical biopsy needle we acquired real-time DRS data of normal tissue and tumor tissue in 27 patients that underwent an ultrasound guided breast biopsy procedure. Five additional patients were measured in continuous mode in which we obtained DRS measurements along the entire biopsy needle trajectory. We developed and compared three different support vector machine based classification models to classify the DRS measurements. Results With DRS malignant tissue could be discriminated from healthy tissue. The classification model that was based on eight selected wavelengths had the highest accuracy and Matthews Correlation Coefficient (MCC) of 0.93 and 0.87, respectively. In three patients that were measured in continuous mode and had malignant tissue in their biopsy specimen, a clear transition was seen in the classified DRS measurements going from healthy tissue to tumor tissue. This transition was not seen in the other two continuously measured patients that had benign tissue in their biopsy specimen. Conclusions It was concluded that DRS is feasible for integration in a surgical tool that could assist the breast surgeon in detecting positive resection margins during breast surgery. Trail registration NIH US National Library of Medicine–clinicaltrails.gov, NCT01730365. Registered: 10/04/2012 https://clinicaltrials.gov/ct2/show/study/NCT01730365
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Affiliation(s)
- Lisanne L de Boer
- Department of Surgery, the Netherlands Cancer Institute-Antoni van Leeuwenhoek, Plesmanlaan 121, Postbus 90203, 1066 CX, Amsterdam, The Netherlands.
| | - Torre M Bydlon
- In-body Systems, Philips Research, High Tech, Campus 34, 5656 AE, Eindhoven, The Netherlands
| | - Frederieke van Duijnhoven
- Department of Surgery, the Netherlands Cancer Institute-Antoni van Leeuwenhoek, Plesmanlaan 121, Postbus 90203, 1066 CX, Amsterdam, The Netherlands
| | - Marie-Jeanne T F D Vranken Peeters
- Department of Surgery, the Netherlands Cancer Institute-Antoni van Leeuwenhoek, Plesmanlaan 121, Postbus 90203, 1066 CX, Amsterdam, The Netherlands
| | - Claudette E Loo
- Department of Radiology, the Netherlands Cancer Institute-Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Gonneke A O Winter-Warnars
- Department of Radiology, the Netherlands Cancer Institute-Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Joyce Sanders
- Department of Pathology, the Netherlands Cancer Institute-Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Henricus J C M Sterenborg
- Department of Surgery, the Netherlands Cancer Institute-Antoni van Leeuwenhoek, Plesmanlaan 121, Postbus 90203, 1066 CX, Amsterdam, The Netherlands.,Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Benno H W Hendriks
- In-body Systems, Philips Research, High Tech, Campus 34, 5656 AE, Eindhoven, The Netherlands.,Biomechanical Engineering, Delft University of Technology, Mekelweg 5, 2628 CD, Delft, The Netherlands
| | - Theo J M Ruers
- Department of Surgery, the Netherlands Cancer Institute-Antoni van Leeuwenhoek, Plesmanlaan 121, Postbus 90203, 1066 CX, Amsterdam, The Netherlands.,Technical Medical Centre, University of Twente, Drienerlolaan 5, 7522 NB, Enschede, The Netherlands
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Balthasar AJR, Bydlon TM, Ippel H, van der Voort M, Hendriks BHW, Lucassen GW, van Geffen GJ, van Kleef M, van Dijk P, Lataster A. Optical signature of nerve tissue-Exploratory ex vivo study comparing optical, histological, and molecular characteristics of different adipose and nerve tissues. Lasers Surg Med 2018; 50:948-960. [PMID: 29756651 PMCID: PMC6220981 DOI: 10.1002/lsm.22938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2018] [Indexed: 02/02/2023]
Abstract
Background During several anesthesiological procedures, needles are inserted through the skin of a patient to target nerves. In most cases, the needle traverses several tissues—skin, subcutaneous adipose tissue, muscles, nerves, and blood vessels—to reach the target nerve. A clear identification of the target nerve can improve the success of the nerve block and reduce the rate of complications. This may be accomplished with diffuse reflectance spectroscopy (DRS) which can provide a quantitative measure of the tissue composition. The goal of the current study was to further explore the morphological, biological, chemical, and optical characteristics of the tissues encountered during needle insertion to improve future DRS classification algorithms. Methods To compare characteristics of nerve tissue (sciatic nerve) and adipose tissues, the following techniques were used: histology, DRS, absorption spectrophotometry, high‐resolution magic‐angle spinning nuclear magnetic resonance (HR‐MAS NMR) spectroscopy, and solution 2D 13C‐1H heteronuclear single‐quantum coherence spectroscopy. Tissues from five human freshly frozen cadavers were examined. Results Histology clearly highlights a higher density of cellular nuclei, collagen, and cytoplasm in fascicular nerve tissue (IFAS). IFAS showed lower absorption of light around 1200 nm and 1750 nm, higher absorption around 1500 nm and 2000 nm, and a shift in the peak observed around 1000 nm. DRS measurements showed a higher water percentage and collagen concentration in IFAS and a lower fat percentage compared to all other tissues. The scattering parameter (b) was highest in IFAS. The HR‐MAS NMR data showed three extra chemical peak shifts in IFAS tissue. Conclusion Collagen, water, and cellular nuclei concentration are clearly different between nerve fascicular tissue and other adipose tissue and explain some of the differences observed in the optical absorption, DRS, and HR‐NMR spectra of these tissues. Some differences observed between fascicular nerve tissue and adipose tissues cannot yet be explained but may be helpful in improving the discriminatory capabilities of DRS in anesthesiology procedures. Lasers Surg. Med. 50:948–960, 2018. © 2018 The Authors. Lasers in Surgery and Medicine Published by Wiley Periodicals, Inc.
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Affiliation(s)
- Andrea J R Balthasar
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Hans Ippel
- Department of Biochemistry, Faculty of Health Medicine and Life Science, Maastricht University, Maastricht, The Netherlands
| | | | - Benno H W Hendriks
- Philips Research, Eindhoven, The Netherlands.,Delft University of Technology, Department of BioMechanical Engineering, Delft, The Netherlands
| | | | - Geert-Jan van Geffen
- Department of Anesthesiology, University Medical Center St. Radboud, Nijmegen, The Netherlands
| | - Maarten van Kleef
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Paul van Dijk
- Department of Anatomy and Embryology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Arno Lataster
- Department of Anatomy and Embryology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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Langhout GC, Kuhlmann KFD, Wouters MWJM, van der Hage JA, van Coevorden F, Müller M, Bydlon TM, Sterenborg HJCM, Hendriks BHW, Ruers TJM. Nerve detection during surgery: optical spectroscopy for peripheral nerve localization. Lasers Med Sci 2018; 33:619-625. [PMID: 29396730 DOI: 10.1007/s10103-017-2433-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Accepted: 12/26/2017] [Indexed: 10/18/2022]
Abstract
Precise nerve localization is of major importance in both surgery and regional anesthesia. Optically based techniques can identify tissue through differences in optical properties, like absorption and scattering. The aim of this study was to evaluate the potential of optical spectroscopy (diffuse reflectance spectroscopy) for clinical nerve identification in vivo. Eighteen patients (8 male, 10 female, age 53 ± 13 years) undergoing inguinal lymph node resection or resection or a soft tissue tumor in the groin were included to measure the femoral or sciatic nerve and the surrounding tissues. In vivo optical measurements were performed using Diffuse Reflectance Spectroscopy (400-1600 nm) on nerve, near nerve adipose tissue, muscle, and subcutaneous fat using a needle-shaped probe. Model-based analyses were used to derive verified quantitative parameters as concentrations of optical absorbers and several parameters describing scattering. A total of 628 optical spectra were recorded. Measured spectra reveal noticeable tissue specific characteristics. Optical absorption of water, fat, and oxy- and deoxyhemoglobin was manifested in the measured spectra. The parameters water and fat content showed significant differences (P < 0.005) between nerve and all surrounding tissues. Classification using k-Nearest Neighbor based on the derived parameters revealed a sensitivity of 85% and a specificity of 79%, for identifying nerve from surrounding tissues. Diffuse Reflectance Spectroscopy identifies peripheral nerve bundles. The differences found between tissue groups are assignable to the tissue composition and structure.
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Affiliation(s)
- Gerrit C Langhout
- Department of Surgery, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
| | - Koert F D Kuhlmann
- Department of Surgery, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Michel W J M Wouters
- Department of Surgery, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Jos A van der Hage
- Department of Surgery, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Frits van Coevorden
- Department of Surgery, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Manfred Müller
- Philips Research, In-Body Systems Department, HTC 34, 5656 AE, Eindhoven, The Netherlands
| | - Torre M Bydlon
- Philips Research, In-Body Systems Department, HTC 34, 5656 AE, Eindhoven, The Netherlands
| | - Henricus J C M Sterenborg
- Department of Biomedical Engineering and Physics, Amsterdam Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Benno H W Hendriks
- Philips Research, In-Body Systems Department, HTC 34, 5656 AE, Eindhoven, The Netherlands.,Department of Biomechanical Engineering, Delft University of Technology, Mekelweg 2, 2628 CD, Delft, The Netherlands
| | - Theo J M Ruers
- Department of Surgery, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.,Nanobiophysics Group, MIRA Institute, University of Twente, Post Box 217, 7500 AE, Enschede, The Netherlands
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Bydlon TM, Langhout GC, Lalezari F, Hartemink KJ, Nijkamp J, Brouwer de Koning SG, Burgers S, Hendriks BHW, Ruers TJM. Optimal endobronchial tool sizes for targeting lung lesions based on 3D modeling. PLoS One 2017; 12:e0189963. [PMID: 29261769 PMCID: PMC5736231 DOI: 10.1371/journal.pone.0189963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 12/05/2017] [Indexed: 11/18/2022] Open
Abstract
Background For patients with suspicious lung lesions found on chest x-ray or CT, endo/trans- bronchial biopsy of the lung is the preferred method for obtaining a diagnosis. With the addition of new screening programs, a higher number of patients will require diagnostic biopsy which will prove even more challenging due to the small size of lesions found with screening. There are many endobronchial tools available on the market today and a wide range of new tools under investigation to improve diagnostic yield. However, there is little information available about the optimal tool size required to reach the majority of lesions, especially peripheral ones. In this manuscript we investigate the percentage of lesions that can be reached for various diameter tools if the tools remain inside the airways (i.e. endobronchial biopsy) and the distance a tool must travel “off-road” (or outside of the airways) to reach all lesions. Methods and findings To further understand the distribution of lung lesions with respect to airway sizes and distances from the airways, six 3D models of the lung were generated. The airways were modeled at two different respiratory phases (inspiration and expiration). Three sets of 1,000 lesions were randomly distributed throughout the lung for each respiratory phase. The simulations showed that the percentage of reachable lesions decreases with increasing tool diameter and decreasing lesion diameter. A 1mm diameter tool will reach <25% of 1cm lesions if it remains inside the airways. To reach all 1cm lesions this 1mm tool would have to navigate through the parenchyma up to 8.5mm. CT scans of 21 patient lesions confirm these results reasonably well. Conclusions The smaller the tool diameter the more likely it will be able to reach a lung lesion, whether it be for diagnostic biopsy, ablation, or resection. However, even a 1mm tool is not small enough to reach the majority of small (1-2cm) lesions. Therefore, it is necessary for endobronchial tools to be able to navigate through the parenchyma to reach the majority of lesions.
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Affiliation(s)
- Torre M. Bydlon
- Philips Research, 2 Canal Park, Third Floor, Cambridge, MA, United States of America
- Philips Research, High Tech Campus 34, AE Eindhoven, The Netherlands
- * E-mail:
| | - Gerrit C. Langhout
- Department of Surgery, Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, CX Amsterdam, The Netherlands
| | - Ferry Lalezari
- Department of Radiology, Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, CX Amsterdam, The Netherlands
| | - Koen J. Hartemink
- Department of Surgery, Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, CX Amsterdam, The Netherlands
| | - Jasper Nijkamp
- Department of Surgery, Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, CX Amsterdam, The Netherlands
| | - Susan G. Brouwer de Koning
- Department of Surgery, Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, CX Amsterdam, The Netherlands
| | - Sjaak Burgers
- Department of Thoracic Oncology, Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, CX Amsterdam, The Netherlands
| | - Benno H. W. Hendriks
- Philips Research, High Tech Campus 34, AE Eindhoven, The Netherlands
- Biomechanical Engineering Department, Technical University of Delft, Mekelweg 2, CD Delft, The Netherlands
| | - Theodoor J. M. Ruers
- Department of Surgery, Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, CX Amsterdam, The Netherlands
- MIRA Institute, University of Twente, AE Enschede, The Netherlands
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Langhout GC, Bydlon TM, van der Voort M, Müller M, Kortsmit J, Lucassen G, Balthasar AJ, van Geffen GJ, Steinfeldt T, Sterenborg HJ, Hendriks BH, Ruers TJ. Nerve detection using optical spectroscopy, an evaluation in four different models: In human and swine, in-vivo, and post mortem. Lasers Surg Med 2017; 50:253-261. [DOI: 10.1002/lsm.22755] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Gerrit C. Langhout
- Department of Surgery; The Netherlands Cancer Institute-Antoni van Leeuwenhoek; Plesmanlaan 121 1066 CX Amsterdam The Netherlands
| | - Torre M. Bydlon
- Philips Research, In-Body Systems Department; HTC 34 5656 AE Eindhoven The Netherlands
| | | | - Manfred Müller
- Philips Research, In-Body Systems Department; HTC 34 5656 AE Eindhoven The Netherlands
| | - Jeroen Kortsmit
- Philips HealthTech; Veenpluis 4 5684 PC, Best The Netherlands
| | - Gerald Lucassen
- Philips HealthTech; Veenpluis 4 5684 PC, Best The Netherlands
| | - Andrea J.R. Balthasar
- Department of Anesthesiology and Pain Medicine; Maastricht University Medical Center; P. Debyelaan 25 6229 HX, Maastricht The Netherlands
| | - Geert-Jan van Geffen
- Department of Anesthesiology; Radboud Medical Center; Radboud University; Geert Grooteplein Zuid 10 6525 GA, Nijmegen The Netherlands
| | - Thorsten Steinfeldt
- Diakonie-Klinikum Schwäbisch Hall; Department of Anesthesia; Diakoniestraße 10 74523 Schwäbisch Hall Germany
| | - Henricus J.C.M. Sterenborg
- Department of Biomedical Engineering and Physics; Amsterdam Medical Center; Meibergdreef 9 1105 AZ Amsterdam the Netherlands
| | - Benno H.W. Hendriks
- Philips Research, In-Body Systems Department; HTC 34 5656 AE Eindhoven The Netherlands
- Department of BioMechanical Engineering; Delft University of Technology; Mekelweg 2 2628 CD, Delft The Netherlands
| | - Theo J.M. Ruers
- Department of Surgery; The Netherlands Cancer Institute-Antoni van Leeuwenhoek; Plesmanlaan 121 1066 CX Amsterdam The Netherlands
- Nanobiophysics Group, MIRA Institute; University of Twente; Post Box 217 7500 AE Enschede The Netherlands
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Spliethoff JW, de Boer LL, Meier MAJ, Prevoo W, de Jong J, Kuhlmann K, Bydlon TM, Sterenborg HJCM, Hendriks BHW, Ruers TJM. In vivo characterization of colorectal metastases in human liver using diffuse reflectance spectroscopy: toward guidance in oncological procedures. J Biomed Opt 2016; 21:97004. [PMID: 27637008 PMCID: PMC8357329 DOI: 10.1117/1.jbo.21.9.097004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 08/30/2016] [Indexed: 05/15/2023]
Abstract
There is a strong need to develop clinical instruments that can perform rapid tissue assessment at the tip of smart clinical instruments for a variety of oncological applications. This study presents the first in vivo real-time tissue characterization during 24 liver biopsy procedures using diffuse reflectance (DR) spectroscopy at the tip of a core biopsy needle with integrated optical fibers. DR measurements were performed along each needle path, followed by biopsy of the target lesion using the same needle. Interventional imaging was coregistered with the DR spectra. Pathology results were compared with the DR spectroscopy data at the final measurement position. Bile was the primary discriminator between normal liver tissue and tumor tissue. Relative differences in bile content matched with the tissue diagnosis based on histopathological analysis in all 24 clinical cases. Continuous DR measurements during needle insertion in three patients showed that the method can also be applied for biopsy guidance or tumor recognition during surgery. This study provides an important validation step for DR spectroscopy-based tissue characterization in the liver. Given the feasibility of the outlined approach, it is also conceivable to make integrated fiber-optic tools for other clinical procedures that rely on accurate instrument positioning.
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Affiliation(s)
- Jarich W. Spliethoff
- Netherlands Cancer Institute, Department of Surgery, Plesmanlaan 121, 1066CX Amsterdam, The Netherlands
- Address all correspondence to: Jarich W. Spliethoff, E-mail:
| | - Lisanne L. de Boer
- Netherlands Cancer Institute, Department of Surgery, Plesmanlaan 121, 1066CX Amsterdam, The Netherlands
| | - Mark A. J. Meier
- Netherlands Cancer Institute, Department of Radiology, Plesmanlaan 121, 1066CX Amsterdam, The Netherlands
| | - Warner Prevoo
- Netherlands Cancer Institute, Department of Radiology, Plesmanlaan 121, 1066CX Amsterdam, The Netherlands
| | - Jeroen de Jong
- Netherlands Cancer Institute, Department of Pathology, Plesmanlaan 121, 1066CX Amsterdam, The Netherlands
| | - Koert Kuhlmann
- Netherlands Cancer Institute, Department of Surgery, Plesmanlaan 121, 1066CX Amsterdam, The Netherlands
| | - Torre M. Bydlon
- Philips Research, Department In-body Systems, High Tech Campus 34, 5656AE Eindhoven, The Netherlands
| | - Henricus J. C. M. Sterenborg
- Academic Medical Center, Department of Biomedical Engineering and Physics, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands
| | - Benno H. W. Hendriks
- Philips Research, Department In-body Systems, High Tech Campus 34, 5656AE Eindhoven, The Netherlands
| | - Theo J. M. Ruers
- Netherlands Cancer Institute, Department of Surgery, Plesmanlaan 121, 1066CX Amsterdam, The Netherlands
- University of Twente, MIRA Institute, Drienerlolaan 5, Zuidhorst ZH116, 7522 NB Enschede, The Netherlands
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Spliethoff JW, de Boer LL, Meier MA, Prevoo W, de Jong J, Bydlon TM, Sterenborg HJ, Burgers JA, Hendriks BH, Ruers TJ. Spectral sensing for tissue diagnosis during lung biopsy procedures: The importance of an adequate internal reference and real-time feedback. Lung Cancer 2016; 98:62-68. [DOI: 10.1016/j.lungcan.2016.05.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 05/17/2016] [Accepted: 05/25/2016] [Indexed: 01/10/2023]
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de Boer LL, Molenkamp BG, Bydlon TM, Hendriks BHW, Wesseling J, Sterenborg HJCM, Ruers TJM. Fat/water ratios measured with diffuse reflectance spectroscopy to detect breast tumor boundaries. Breast Cancer Res Treat 2015; 152:509-18. [PMID: 26141407 DOI: 10.1007/s10549-015-3487-z] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 06/15/2015] [Indexed: 12/16/2022]
Abstract
Recognition of the tumor during breast-conserving surgery (BCS) can be very difficult and currently a robust method of margin assessment for the surgical setting is not available. As a result, tumor-positive margins, which require additional treatment, are not found until histopathologic evaluation. With diffuse reflectance spectroscopy (DRS), tissue can be characterized during surgery based on optical parameters that are related to the tissue morphology and composition. Here we investigate which optical parameters are able to detect tumor in an area with a mixture of benign and tumor tissue and hence which parameters are most suitable for intra-operative margin assessment. DRS spectra (400-1600 nm) were obtained from 16 ex vivo lumpectomy specimens from benign, tumor border, and tumor tissue. One mastectomy specimen was used with a custom-made grid for validation purposes. The optical parameter related to the absorption of fat and water (F/W-ratio) in the extended near-infrared wavelength region (~1000-1600 nm) provided the best discrimination between benign and tumor sites resulting in a sensitivity and specificity of 100 % (excluding the border sites). Per patient, the scaled F/W-ratio gradually decreased from grossly benign tissue towards the tumor in 87.5 % of the specimens. In one test case, based on a predefined F/W-ratio for boundary tissue of 0.58, DRS produced a surgical resection plane that nearly overlapped with a 2-mm rim of benign tissue, 2 mm being the most widely accepted definition of a negative margin. The F/W-ratio provided excellent discrimination between sites clearly inside or outside the tumor and was able to detect the border of the tumor in one test case. This work shows the potential for DRS to guide the surgeon during BCS.
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Affiliation(s)
- L L de Boer
- Department of Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands,
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Bydlon TM, Nachabé R, Ramanujam N, Sterenborg HJCM, Hendriks BHW. Chromophore based analyses of steady-state diffuse reflectance spectroscopy: current status and perspectives for clinical adoption. J Biophotonics 2015; 8:9-24. [PMID: 24760790 DOI: 10.1002/jbio.201300198] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 03/09/2014] [Accepted: 03/26/2014] [Indexed: 05/22/2023]
Abstract
Diffuse reflectance spectroscopy is a rapidly growing technology in the biophotonics community where it has shown promise in its ability to classify different tissues. In the steady-state domain a wide spectrum of clinical applications is supported with this technology ranging from diagnostic to guided interventions. Diffuse reflectance spectra provide a wealth of information about tissue composition; however, extracting biologically relevant information from the spectra in terms of chromophores may be more useful to gain acceptance into the clinical community. The chromophores that absorb light in the visible and near infrared wavelengths can provide information about tissue composition. The key characteristics of these chromophores and their relevance in different organs and clinical applications is the focus of this review, along with translating their use to the clinic.
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Affiliation(s)
- Torre M Bydlon
- Philips Research, Minimally Invasive Healthcare Department, HTC 34, The Netherlands.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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Affiliation(s)
- J Quincy Brown
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, United States of America.
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Bydlon TM, Barry WT, Kennedy SA, Brown JQ, Gallagher JE, Wilke LG, Geradts J, Ramanujam N. Advancing optical imaging for breast margin assessment: an analysis of excisional time, cautery, and patent blue dye on underlying sources of contrast. PLoS One 2012; 7:e51418. [PMID: 23251526 PMCID: PMC3519619 DOI: 10.1371/journal.pone.0051418] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Accepted: 11/01/2012] [Indexed: 11/30/2022] Open
Abstract
Breast conserving surgery (BCS) is a recommended treatment for breast cancer patients where the goal is to remove the tumor and a surrounding rim of normal tissue. Unfortunately, a high percentage of patients return for additional surgeries to remove all of the cancer. Post-operative pathology is the gold standard for evaluating BCS margins but is limited due to the amount of tissue that can be sampled. Frozen section analysis and touch-preparation cytology have been proposed to address the surgical needs but also have sampling limitations. These issues represent an unmet clinical need for guidance in resecting malignant tissue intra-operatively and for pathological sampling. We have developed a quantitative spectral imaging device to examine margins intra-operatively. The context in which this technology is applied (intra-operative or post-operative setting) is influenced by time after excision and surgical factors including cautery and the presence of patent blue dye (specifically Lymphazurin™, used for sentinel lymph node mapping). Optical endpoints of hemoglobin ([THb]), fat ([β-carotene]), and fibroglandular content via light scattering (<µs’>) measurements were quantified from diffuse reflectance spectra of lumpectomy and mastectomy specimens using a Monte Carlo model. A linear longitudinal mixed-effects model was used to fit the optical endpoints for the cautery and kinetics studies. Monte Carlo simulations and tissue mimicking phantoms were used for the patent blue dye experiments. [THb], [β-carotene], and <µs’> were affected by <3.3% error with <80 µM of patent blue dye. The percent change in [β-carotene], <µs’>, and [β-carotene]/<µs’> was <14% in 30 minutes, while percent change in [THb] was >40%. [β-carotene] and [β-carotene]/<µs’> were the only parameters not affected by cautery. This work demonstrates the importance of understanding the post-excision kinetics of ex-vivo tissue and the presence of cautery and patent blue dye for breast tumor margin assessment, to accurately interpret data and exploit underling sources of contrast.
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Affiliation(s)
- Torre M. Bydlon
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, United States of America
| | - William T. Barry
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts, United States of America
| | - Stephanie A. Kennedy
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, United States of America
| | - J. Quincy Brown
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, United States of America
- Zenalux, Research Triangle Park, North Carolina, United States of America
| | - Jennifer E. Gallagher
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Lee G. Wilke
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States of America
| | - Joseph Geradts
- Department of Pathology, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Nimmi Ramanujam
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, United States of America
- Zenalux, Research Triangle Park, North Carolina, United States of America
- * E-mail:
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Bydlon TM, Kennedy SA, Richards LM, Brown JQ, Yu B, Junker MK, Gallagher J, Geradts J, Wilke LG, Ramanujam N. Performance metrics of an optical spectral imaging system for intra-operative assessment of breast tumor margins. Opt Express 2010; 18:8058-76. [PMID: 20588651 PMCID: PMC2939901 DOI: 10.1364/oe.18.008058] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2009] [Revised: 03/19/2010] [Accepted: 03/20/2010] [Indexed: 05/20/2023]
Abstract
As many as 20-70% of patients undergoing breast conserving surgery require repeat surgeries due to a close or positive surgical margin diagnosed post-operatively [1]. Currently there are no widely accepted tools for intra-operative margin assessment which is a significant unmet clinical need. Our group has developed a first-generation optical visible spectral imaging platform to image the molecular composition of breast tumor margins and has tested it clinically in 48 patients in a previously published study [2]. The goal of this paper is to report on the performance metrics of the system and compare it to clinical criteria for intra-operative tumor margin assessment. The system was found to have an average signal to noise ratio (SNR) >100 and <15% error in the extraction of optical properties indicating that there is sufficient SNR to leverage the differences in optical properties between negative and close/positive margins. The probe had a sensing depth of 0.5-2.2 mm over the wavelength range of 450-600 nm which is consistent with the pathologic criterion for clear margins of 0-2 mm. There was <1% cross-talk between adjacent channels of the multi-channel probe which shows that multiple sites can be measured simultaneously with negligible cross-talk between adjacent sites. Lastly, the system and measurement procedure were found to be reproducible when evaluated with repeated measures, with a low coefficient of variation (<0.11). The only aspect of the system not optimized for intra-operative use was the imaging time. The manuscript includes a discussion of how the speed of the system can be improved to work within the time constraints of an intra-operative setting.
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Affiliation(s)
- Torre M Bydlon
- Department of Biomedical Engineering, Duke University, 136 Hudson Hall, Box 90281, Durham, NC, 27708, USA.
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Ramanujam N, Brown J, Bydlon TM, Kennedy SA, Richards LM, Junker MK, Gallagher J, Barry WT, Wilke LG, Geradts J. Quantitative spectral reflectance imaging device for intraoperative breast tumor margin assessment. Annu Int Conf IEEE Eng Med Biol Soc 2010; 2009:6554-6. [PMID: 19964903 DOI: 10.1109/iembs.2009.5334501] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Diffuse reflectance spectroscopy of tissue allows quantification of underlying physiological and morphological changes associated with cancer, provided that the absorption and scattering properties of the tissue can be effectively decoupled. A particular application of interest for tissue reflectance spectroscopy in the UV-VIS is intraoperative detection of residual cancer at the margins of excised breast tumors, which could prevent costly and unnecessary repeat surgeries. Our multi-disciplinary group has developed an optical imaging device, which employs a model-based algorithm for quantification of tissue optical properties, and is capable of surveying the entire specimen surface down to a depth of 1-2 mm, all within a short time as required for intraoperative use. In an ongoing IRB-approved study, reflectance spectral images were acquired from 55 margins in 48 patients. Conversion of the spectral images to quantitative tissue parameter maps was facilitated by a fast scalable inverse Monte-Carlo model. Data from margin parameter images were reduced to image-descriptive scalar values and compared to gold-standard margin pathology. Use of a decision-tree based classification algorithm on the two most significant optical parameters resulted in a sensitivity of 79% and specificity of 67% for detection of residual tumor of all pathologic variants, with an 89% sensitivity for ductal carcinoma in situ alone. Preliminary data from this ongoing clinical study suggest that this technology could significantly reduce the number of unnecessary repeat breast conserving surgeries annually.
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Brown JQ, Bydlon TM, Richards LM, Yu B, Kennedy SA, Geradts J, Wilke LG, Junker M, Gallagher J, Barry W, Ramanujam N. Optical assessment of tumor resection margins in the breast. IEEE J Sel Top Quantum Electron 2010; 16:530-544. [PMID: 21544237 PMCID: PMC3085495 DOI: 10.1109/jstqe.2009.2033257] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Breast conserving surgery, in which the breast tumor and surrounding normal tissue are removed, is the primary mode of treatment for invasive and in situ carcinomas of the breast, conditions that affect nearly 200,000 women annually. Of these nearly 200,000 patients who undergo this surgical procedure, between 20-70% of them may undergo additional surgeries to remove tumor that was left behind in the first surgery, due to the lack of intra-operative tools which can detect whether the boundaries of the excised specimens are free from residual cancer. Optical techniques have many attractive attributes which may make them useful tools for intra-operative assessment of breast tumor resection margins. In this manuscript, we discuss clinical design criteria for intra-operative breast tumor margin assessment, and review optical techniques appied to this problem. In addition, we report on the development and clinical testing of quantitative diffuse reflectance imaging (Q-DRI) as a potential solution to this clinical need. Q-DRI is a spectral imaging tool which has been applied to 56 resection margins in 48 patients at Duke University Medical Center. Clear sources of contrast between cancerous and cancer-free resection margins were identified with the device, and resulted in an overall accuracy of 75% in detecting positive margins.
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Affiliation(s)
- J. Quincy Brown
- Dept. of Biomedical Engineering, Duke University, Durham, NC 27708 USA
| | - Torre M. Bydlon
- Dept. of Biomedical Engineering, Duke University, Durham, NC 27708
| | - Lisa M. Richards
- Dept. of Biomedical Engineering, Duke University, Durham, NC 27708
| | - Bing Yu
- Dept. of Biomedical Engineering, Duke University, Durham, NC 27708
| | | | - Joseph Geradts
- Depts. of Surgery, Pathology, and Biostatistics, respectively; Duke University Medical Center, Durham, NC 27708 USA
| | - Lee G. Wilke
- Depts. of Surgery, Pathology, and Biostatistics, respectively; Duke University Medical Center, Durham, NC 27708 USA
| | - Marlee Junker
- Dept. of Biomedical Engineering, Duke University, Durham, NC 27708
| | - Jennifer Gallagher
- Depts. of Surgery, Pathology, and Biostatistics, respectively; Duke University Medical Center, Durham, NC 27708 USA
| | - William Barry
- Depts. of Surgery, Pathology, and Biostatistics, respectively; Duke University Medical Center, Durham, NC 27708 USA
| | - Nimmi Ramanujam
- Dept. of Biomedical Engineering, Duke University, Durham, NC 27708
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