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Brenes D, Salcedo MP, Coole JB, Maker Y, Kortum A, Schwarz RA, Carns J, Vohra IS, Possati-Resende JC, Antoniazzi M, Fonseca BDO, Souza KCB, Santana IVV, Barbin FF, Kreitchmann R, Ramanujam N, Schmeler KM, Richards-Kortum R. Multiscale Optical Imaging Fusion for Cervical Precancer Diagnosis: Integrating Widefield Colposcopy and High-Resolution Endomicroscopy. IEEE Trans Biomed Eng 2024; PP:1-10. [PMID: 38507389 DOI: 10.1109/tbme.2024.3379898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
OBJECTIVE Early detection and treatment of cervical precancers can prevent disease progression. However, in low-resource communities with a high incidence of cervical cancer, high equipment costs and a shortage of specialists hinder preventative strategies. This manuscript presents a low-cost multiscale in vivo optical imaging system coupled with a computer-aided diagnostic system that could enable accurate, real-time diagnosis of high-grade cervical precancers. METHODS The system combines portable colposcopy and high-resolution endomicroscopy (HRME) to acquire spatially registered widefield and microscopy videos. A multiscale imaging fusion network (MSFN) was developed to identify cervical intraepithelial neoplasia grade 2 or more severe (CIN 2+). The MSFN automatically identifies and segments the ectocervix and lesions from colposcopy images, extracts nuclear morphology features from HRME videos, and integrates the colposcopy and HRME information. RESULTS With a threshold value set to achieve sensitivity equal to clinical impression (0.98 [p = 1.0]), the MSFN achieved a significantly higher specificity than clinical impression (0.75 vs. 0.43, p = 0.000006). CONCLUSION Our findings show that multiscale optical imaging of the cervix allows the highly sensitive and specific detection of high-grade precancers. SIGNIFICANCE The multiscale imaging system and MSFN could facilitate the accurate, real-time diagnosis of cervical precancers in low-resource settings.
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Hou H, Mitbander R, Tang Y, Azimuddin A, Carns J, Schwarz RA, Richards-Kortum RR. Optical imaging technologies for in vivo cancer detection in low-resource settings. Curr Opin Biomed Eng 2023; 28:100495. [PMID: 38406798 PMCID: PMC10883072 DOI: 10.1016/j.cobme.2023.100495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Cancer continues to affect underserved populations disproportionately. Novel optical imaging technologies, which can provide rapid, non-invasive, and accurate cancer detection at the point of care, have great potential to improve global cancer care. This article reviews the recent technical innovations and clinical translation of low-cost optical imaging technologies, highlighting the advances in both hardware and software, especially the integration of artificial intelligence, to improve in vivo cancer detection in low-resource settings. Additionally, this article provides an overview of existing challenges and future perspectives of adapting optical imaging technologies into clinical practice, which can potentially contribute to novel insights and programs that effectively improve cancer detection in low-resource settings.
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Affiliation(s)
- Huayu Hou
- Department of Bioengineering, Rice University, Houston, TX 77005, USA
| | - Ruchika Mitbander
- Department of Bioengineering, Rice University, Houston, TX 77005, USA
| | - Yubo Tang
- Department of Bioengineering, Rice University, Houston, TX 77005, USA
| | - Ahad Azimuddin
- School of Medicine, Texas A&M University, Houston, TX 77030, USA
| | - Jennifer Carns
- Department of Bioengineering, Rice University, Houston, TX 77005, USA
| | - Richard A Schwarz
- Department of Bioengineering, Rice University, Houston, TX 77005, USA
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Hou H, Tang Y, Coole JB, Kortum A, Schwarz RA, Carns J, Gillenwater AM, Ramalingam P, Milbourne A, Salcedo MP, Schmeler KM, Richards-Kortum RR. Scanning darkfield high-resolution microendoscope for label-free microvascular imaging. Biomed Opt Express 2023; 14:5097-5112. [PMID: 37854554 PMCID: PMC10581811 DOI: 10.1364/boe.498584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/31/2023] [Accepted: 09/01/2023] [Indexed: 10/20/2023]
Abstract
Characterization of microvascular changes during neoplastic progression has the potential to assist in discriminating precancer and early cancer from benign lesions. Here, we introduce a novel high-resolution microendoscope that leverages scanning darkfield reflectance imaging to characterize angiogenesis without exogenous contrast agents. Scanning darkfield imaging is achieved by coupling programmable illumination with a complementary metal-oxide semiconductor (CMOS) camera rolling shutter, eliminating the need for complex optomechanical components and making the system portable, low-cost (<$5,500) and simple to use. Imaging depth is extended by placing a gradient-index (GRIN) lens at the distal end of the imaging fiber to resolve subepithelial microvasculature. We validated the capability of the scanning darkfield microendoscope to visualize microvasculature at different anatomic sites in vivo by imaging the oral cavity of healthy volunteers. Images of cervical specimens resected for suspected neoplasia reveal distinct microvascular patterns in columnar and squamous epithelium with different grades of precancer, indicating the potential of scanning darkfield microendoscopy to aid in efforts to prevent cervical cancer through early diagnosis.
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Affiliation(s)
- Huayu Hou
- Department of Bioengineering, Rice University, Houston, TX 77005, USA
| | - Yubo Tang
- Department of Bioengineering, Rice University, Houston, TX 77005, USA
| | - Jackson B. Coole
- Department of Bioengineering, Rice University, Houston, TX 77005, USA
| | - Alex Kortum
- Department of Bioengineering, Rice University, Houston, TX 77005, USA
| | | | - Jennifer Carns
- Department of Bioengineering, Rice University, Houston, TX 77005, USA
| | - Ann M. Gillenwater
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Preetha Ramalingam
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Andrea Milbourne
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Mila P. Salcedo
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Department of Obstetrics and Gynecology, Federal University of Health Sciences of Porto Alegre (UFCSPA)/Santa Casa Hospital of Porto Alegre, Porto Alegre, Brazil
| | - Kathleen M. Schmeler
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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Coole JB, Brenes D, Mitbander R, Vohra I, Hou H, Kortum A, Tang Y, Maker Y, Schwarz RA, Carns J, Badaoui H, Williams M, Vigneswaran N, Gillenwater A, Richards-Kortum R. Multimodal optical imaging with real-time projection of cancer risk and biopsy guidance maps for early oral cancer diagnosis and treatment. J Biomed Opt 2023; 28:016002. [PMID: 36654656 PMCID: PMC9838568 DOI: 10.1117/1.jbo.28.1.016002] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 12/28/2022] [Indexed: 06/17/2023]
Abstract
SIGNIFICANCE Despite recent advances in multimodal optical imaging, oral imaging systems often do not provide real-time actionable guidance to the clinician who is making biopsy and treatment decisions. AIM We demonstrate a low-cost, portable active biopsy guidance system (ABGS) that uses multimodal optical imaging with deep learning to directly project cancer risk and biopsy guidance maps onto oral mucosa in real time. APPROACH Cancer risk maps are generated based on widefield autofluorescence images and projected onto the at-risk tissue using a digital light projector. Microendoscopy images are obtained from at-risk areas, and multimodal image data are used to calculate a biopsy guidance map, which is projected onto tissue. RESULTS Representative patient examples highlight clinically actionable visualizations provided in real time during an imaging procedure. Results show multimodal imaging with cancer risk and biopsy guidance map projection offers a versatile, quantitative, and precise tool to guide biopsy site selection and improve early detection of oral cancers. CONCLUSIONS The ABGS provides direct visible guidance to identify early lesions and locate appropriate sites to biopsy within those lesions. This represents an opportunity to translate multimodal imaging into real-time clinically actionable visualizations to help improve patient outcomes.
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Affiliation(s)
- Jackson B. Coole
- Rice University, Department of Bioengineering, Houston, Texas, United States
| | - David Brenes
- Rice University, Department of Bioengineering, Houston, Texas, United States
| | - Ruchika Mitbander
- Rice University, Department of Bioengineering, Houston, Texas, United States
| | - Imran Vohra
- Rice University, Department of Bioengineering, Houston, Texas, United States
| | - Huayu Hou
- Rice University, Department of Bioengineering, Houston, Texas, United States
| | - Alex Kortum
- Rice University, Department of Bioengineering, Houston, Texas, United States
| | - Yubo Tang
- Rice University, Department of Bioengineering, Houston, Texas, United States
| | - Yajur Maker
- Rice University, Department of Bioengineering, Houston, Texas, United States
| | - Richard A. Schwarz
- Rice University, Department of Bioengineering, Houston, Texas, United States
| | - Jennifer Carns
- Rice University, Department of Bioengineering, Houston, Texas, United States
| | - Hawraa Badaoui
- The University of Texas M. D. Anderson Cancer Center, Department of Head and Neck Surgery, Houston, Texas, United States
| | - Michelle Williams
- The University of Texas M. D. Anderson Cancer Center, Department of Pathology, Houston, Texas, United States
| | - Nadarajah Vigneswaran
- The University of Texas School of Dentistry, Department of Diagnostic and Biomedical Sciences, Houston, Texas, United States
| | - Ann Gillenwater
- The University of Texas M. D. Anderson Cancer Center, Department of Head and Neck Surgery, Houston, Texas, United States
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Brenes DR, Nipper AJ, Tan MT, Gleber-Netto FO, Schwarz RA, Pickering CR, Williams MD, Vigneswaran N, Gillenwater AM, Sikora AG, Richards-Kortum RR. Mildly dysplastic oral lesions with optically-detectable abnormalities share genetic similarities with severely dysplastic lesions. Oral Oncol 2022; 135:106232. [PMID: 36335817 PMCID: PMC9881670 DOI: 10.1016/j.oraloncology.2022.106232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 10/23/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Optical imaging studies of oral premalignant lesions have shown that optical markers, including loss of autofluorescence and altered morphology of epithelial cell nuclei, are predictive of high-grade pathology. While these optical markers are consistently positive in lesions with moderate/severe dysplasia or cancer, they are positive only in a subset of lesions with mild dysplasia. This study compared the gene expression profiles of lesions with mild dysplasia (stratified by optical marker status) to lesions with severe dysplasia and without dysplasia. MATERIALS AND METHODS Forty oral lesions imaged in patients undergoing oral surgery were analyzed: nine without dysplasia, nine with severe dysplasia, and 22 with mild dysplasia. Samples were submitted for high throughput gene expression analysis. RESULTS The analysis revealed 116 genes differentially expressed among sites without dysplasia and sites with severe dysplasia; 50 were correlated with an optical marker quantifying altered nuclear morphology. Ten of 11 sites with mild dysplasia and positive optical markers (91%) had gene expression similar to sites with severe dysplasia. Nine of 11 sites with mild dysplasia and negative optical markers (82%) had similar gene expression as sites without dysplasia. CONCLUSION This study suggests that optical imaging may help identify patients with mild dysplasia who require more intensive clinical follow-up. If validated, this would represent a significant advance in patient care for patients with oral premalignant lesions.
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Affiliation(s)
- David R. Brenes
- Rice University, Department of Bioengineering MS-142, 6100 Main St., Houston, TX 77005, USA
| | - Allison J. Nipper
- The University of Texas MD Anderson Cancer Center, Department of Head & Neck Surgery, 1400 Pressler Street, Houston, TX 77030, USA
| | - Melody T. Tan
- Rice University, Department of Bioengineering MS-142, 6100 Main St., Houston, TX 77005, USA
| | - Frederico O. Gleber-Netto
- The University of Texas MD Anderson Cancer Center, Department of Head & Neck Surgery, 1400 Pressler Street, Houston, TX 77030, USA
| | - Richard A. Schwarz
- Rice University, Department of Bioengineering MS-142, 6100 Main St., Houston, TX 77005, USA
| | - Curtis R. Pickering
- The University of Texas MD Anderson Cancer Center, Department of Head & Neck Surgery, 1400 Pressler Street, Houston, TX 77030, USA
| | - Michelle D. Williams
- The University of Texas MD Anderson Cancer Center, Department of Anatomical Pathology, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Nadarajah Vigneswaran
- The University of Texas Health School of Dentistry, Department of Diagnostic and Biomedical Sciences, 7500 Cambridge St., Houston, TX 77054, USA
| | - Ann M. Gillenwater
- The University of Texas MD Anderson Cancer Center, Department of Head & Neck Surgery, 1400 Pressler Street, Houston, TX 77030, USA
| | - Andrew G. Sikora
- The University of Texas MD Anderson Cancer Center, Department of Head & Neck Surgery, 1400 Pressler Street, Houston, TX 77030, USA
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Coole JB, Brenes D, Possati-Resende JC, Antoniazzi M, Fonseca BDO, Maker Y, Kortum A, Vohra IS, Schwarz RA, Carns J, Borba Souza KC, Vidigal Santana IV, Kreitchmann R, Salcedo MP, Ramanujam N, Schmeler KM, Richards-Kortum R. Development of a multimodal mobile colposcope for real-time cervical cancer detection. Biomed Opt Express 2022; 13:5116-5130. [PMID: 36425643 PMCID: PMC9664871 DOI: 10.1364/boe.463253] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/19/2022] [Accepted: 08/23/2022] [Indexed: 06/16/2023]
Abstract
Cervical cancer remains a leading cause of cancer death among women in low-and middle-income countries. Globally, cervical cancer prevention programs are hampered by a lack of resources, infrastructure, and personnel. We describe a multimodal mobile colposcope (MMC) designed to diagnose precancerous cervical lesions at the point-of-care without the need for biopsy. The MMC integrates two complementary imaging systems: 1) a commercially available colposcope and 2) a high speed, high-resolution, fiber-optic microendoscope (HRME). Combining these two image modalities allows, for the first time, the ability to locate suspicious cervical lesions using widefield imaging and then to obtain co-registered high-resolution images across an entire lesion. The MMC overcomes limitations of high-resolution imaging alone; widefield imaging can be used to guide the placement of the high-resolution imaging probe at clinically suspicious regions and co-registered, mosaicked high-resolution images effectively increase the field of view of high-resolution imaging. Representative data collected from patients referred for colposcopy at Barretos Cancer Hospital in Brazil, including 22,800 high resolution images and 9,900 colposcope images, illustrate the ability of the MMC to identify abnormal cervical regions, image suspicious areas with subcellular resolution, and distinguish between high-grade and low-grade dysplasia.
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Affiliation(s)
- Jackson B. Coole
- Rice University, Department of Bioengineering, Houston, TX 77005, USA
| | - David Brenes
- Rice University, Department of Bioengineering, Houston, TX 77005, USA
| | | | - Márcio Antoniazzi
- Barretos Cancer Hospital, Department of Prevention, Barretos, Brazil
| | | | - Yajur Maker
- Rice University, Department of Bioengineering, Houston, TX 77005, USA
| | - Alex Kortum
- Rice University, Department of Bioengineering, Houston, TX 77005, USA
| | - Imran S. Vohra
- Rice University, Department of Bioengineering, Houston, TX 77005, USA
| | | | - Jennifer Carns
- Rice University, Department of Bioengineering, Houston, TX 77005, USA
| | | | | | - Regis Kreitchmann
- Federal University of Health Sciences of Porto Alegre (UFCSPA)/Santa Casa Hospital of Porto Alegre, Department of Obstetrics and Gynecology, Porto Alegre, Brazil
| | - Mila P. Salcedo
- Federal University of Health Sciences of Porto Alegre (UFCSPA)/Santa Casa Hospital of Porto Alegre, Department of Obstetrics and Gynecology, Porto Alegre, Brazil
- The University of Texas MD Anderson Cancer Center, Department of Gynecologic Oncology and Reproductive Medicine, Houston, TX 77005, USA
| | - Nirmala Ramanujam
- Duke University, Department of Biomedical Engineering, Durham, NC 27708, USA
| | - Kathleen M. Schmeler
- The University of Texas MD Anderson Cancer Center, Department of Gynecologic Oncology and Reproductive Medicine, Houston, TX 77005, USA
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7
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Hunt B, Fregnani JHTG, Brenes D, Schwarz RA, Salcedo MP, Possati-Resende JC, Antoniazzi M, de Oliveira Fonseca B, Santana IVV, de Macêdo Matsushita G, Castle PE, Schmeler KM, Richards-Kortum R. Cervical lesion assessment using real-time microendoscopy image analysis in Brazil: The CLARA study. Int J Cancer 2021; 149:431-441. [PMID: 33811763 PMCID: PMC8815862 DOI: 10.1002/ijc.33543] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/05/2021] [Accepted: 02/12/2021] [Indexed: 01/28/2023]
Abstract
We conducted a prospective evaluation of the diagnostic performance of high-resolution microendoscopy (HRME) to detect cervical intraepithelial neoplasia (CIN) in women with abnormal screening tests. Study participants underwent colposcopy, HRME and cervical biopsy. The prospective diagnostic performance of HRME using an automated morphologic image analysis algorithm was compared to that of colposcopy using histopathologic detection of CIN as the gold standard. To assess the potential to further improve performance of HRME image analysis, we also conducted a retrospective analysis assessing performance of a multi-task convolutional neural network to segment and classify HRME images. One thousand four hundred eighty-six subjects completed the study; 435 (29%) subjects had CIN Grade 2 or more severe (CIN2+) diagnosis. HRME with morphologic image analysis for detection of CIN Grade 3 or more severe diagnoses (CIN3+) was similarly sensitive (95.6% vs 96.2%, P = .81) and specific (56.6% vs 58.7%, P = .18) as colposcopy. HRME with morphologic image analysis for detection of CIN2+ was slightly less sensitive (91.7% vs 95.6%, P < .01) and specific (59.7% vs 63.4%, P = .02) than colposcopy. Images from 870 subjects were used to train a multi-task convolutional neural network-based algorithm and images from the remaining 616 were used to validate its performance. There were no significant differences in the sensitivity and specificity of HRME with neural network analysis vs colposcopy for detection of CIN2+ or CIN3+. Using a neural network-based algorithm, HRME has comparable sensitivity and specificity to colposcopy for detection of CIN2+. HRME could provide a low-cost, point-of-care alternative to colposcopy and biopsy in the prevention of cervical cancer.
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Affiliation(s)
- Brady Hunt
- Rice University, Department of Bioengineering, Houston, Texas
| | | | - David Brenes
- Rice University, Department of Bioengineering, Houston, Texas
| | | | - Mila P. Salcedo
- Federal University of Health Sciences of Porto Alegre (UFCSPA)/Santa Casa Hospital of Porto Alegre, Brazil
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD
| | | | | | | | | | | | - Philip E. Castle
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Rockville, MD
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD
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8
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Parra SG, López-Orellana LM, Molina Duque AR, Carns JL, Schwarz RA, Smith CA, Ortiz Silvestre M, Diaz Bazan S, Escobar PA, Felix JC, Ramalingam P, Castle PE, Cremer ML, Maza M, Schmeler KM, Richards-Kortum RR. Cervical cancer prevention in El Salvador: A prospective evaluation of screening and triage strategies incorporating high-resolution microendoscopy to detect cervical precancer. Int J Cancer 2021; 148:2571-2578. [PMID: 33368249 PMCID: PMC10568648 DOI: 10.1002/ijc.33454] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/16/2020] [Accepted: 11/27/2020] [Indexed: 01/28/2023]
Abstract
Cervical cancer remains a leading cause of cancer death for women in low- and middle-income countries. The goal of our study was to evaluate screening and triage strategies, including high-resolution microendoscopy (HRME), to detect cervical abnormalities concerning for precancer at the point of care. Women (n = 1824) were enrolled at the Instituto de Cáncer de El Salvador. All underwent screening by both human papillomavirus (HPV) testing using careHPV and visual inspection with acetic acid (VIA). Screen-positives, along with 10% of screen-negatives, were invited to return for a follow-up examination that included triage with VIA, colposcopy and HRME imaging. Biopsies were taken of any abnormalities identified. If no abnormalities were identified, then the worst scoring site by HRME was biopsied. The sensitivities of HPV testing and VIA to screen for cervical intraepithelial neoplasia Grade 2 or more severe diagnoses (CIN2+) were 82.1% and 75% (P = .77), while the specificities were 90.4% and 80.9% (P < .001), respectively. The sensitivities of VIA, colposcopy and HRME as triage tests for CIN2+ were 82.1%, 82.1% and 71.4%, respectively (P ≥ .38). HRME had a significantly higher specificity (66.7%) than VIA (51.9%) (P < .001) and colposcopy (53.3%) (P < .001). When evaluating different theoretical screening and triage strategies, screening with HPV testing followed by triage with HRME would result in more women receiving appropriate care (97%) compared to screening with VIA (75%) or HPV alone (90%). Our findings demonstrate that screening with HPV is superior to VIA, and that triage with HRME imaging increases the specificity of detecting CIN2+ at the point of care in a low-resource setting.
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Affiliation(s)
- Sonia G Parra
- Department of Bioengineering, Rice University, Houston, Texas, USA
| | | | | | - Jennifer L Carns
- Department of Bioengineering, Rice University, Houston, Texas, USA
| | | | - Chelsey A Smith
- Department of Bioengineering, Rice University, Houston, Texas, USA
| | | | | | - Pablo A Escobar
- Liga Contra el Cáncer de El Salvador, San Salvador, El Salvador
| | - Juan C Felix
- Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Preetha Ramalingam
- Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Philip E Castle
- Divisions of Cancer Prevention and Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
| | - Miriam L Cremer
- Basic Health International, San Salvador, El Salvador
- Women's Health Institute, Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mauricio Maza
- Basic Health International, San Salvador, El Salvador
| | - Kathleen M Schmeler
- Department of Gynecological Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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9
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Parra SG, López-Orellana LM, Molina Duque AR, Carns JL, Schwarz RA, Smith CA, Ortiz Silvestre M, Diaz Bazan S, Felix JC, Ramalingam P, Castle PE, Cremer ML, Maza M, Schmeler KM, Richards-Kortum RR. Reply to: Comments on Cervical cancer prevention in El Salvador: A prospective evaluation of screening and triage strategies incorporating high-resolution microendoscopy to detect cervical precancer. Int J Cancer 2021; 149:969-971. [PMID: 33817804 DOI: 10.1002/ijc.33586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 03/18/2021] [Indexed: 11/07/2022]
Affiliation(s)
- Sonia G Parra
- Department of Bioengineering, Rice University, Houston, Texas, USA
| | | | | | - Jennifer L Carns
- Department of Bioengineering, Rice University, Houston, Texas, USA
| | | | - Chelsey A Smith
- Department of Bioengineering, Rice University, Houston, Texas, USA
| | | | | | - Juan C Felix
- Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Preetha Ramalingam
- Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Philip E Castle
- Divisions of Cancer Prevention and Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
| | - Miriam L Cremer
- Basic Health International, San Salvador, El Salvador
- Department of Obstetrics and Gynecology, Women's Health Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mauricio Maza
- Basic Health International, San Salvador, El Salvador
| | - Kathleen M Schmeler
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Tang Y, Kortum A, Vohra I, Schwarz RA, Carns J, Kannady CR, Clavell-Hernandez J, Hu Z, Dhanani N, Richards-Kortum R. Initial Results of First In Vivo Imaging of Bladder Lesions Using a High-Resolution Confocal Microendoscope. J Endourol 2021; 35:1190-1197. [PMID: 33307957 DOI: 10.1089/end.2020.0757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Purpose: Conventional cystoscopy plays an important role in detection of bladder cancer; however, it is difficult to differentiate benign and neoplastic lesions based on cystoscopic appearance alone. Advanced microscopic modalities, such as confocal laser endomicroscopy and optical coherence tomography, have been shown to provide critical histopathologic information to help identify neoplastic bladder lesions in real time, but their availability and clinical adoption are limited due to a high cost. In this study, we present the first use of a novel and low-cost ($ <5000) confocal high-resolution microendoscope (confocal HRME) for in vivo imaging of bladder lesions. Materials and Methods: In a cohort of 15 patients undergoing white light cystoscopy as part of their standard of care, high-resolution images of proflavine-stained bladder lesions were acquired in vivo using the confocal HRME. Based on these images, we evaluated the ability of the confocal HRME to visualize uroepithelium with subcellular resolution and high contrast. Furthermore, we analyzed the cellular architecture and staining patterns of benign and neoplastic bladder lesions in confocal HRME images and compared results to that of standard cystoscopy and histopathology. Results: In vivo imaging in the pilot study demonstrates that the confocal HRME resolved subcellular structures of bladder uroepithelium with high contrast. In a wide range of clinical conditions from normal bladder wall to benign and neoplastic lesions, confocal HRME images revealed important diagnostic features that correlated to histopathology. Conclusions: The confocal HRME provides an affordable, portable, and easy-to-use tool to allow real-time and high-contrast subcellular characterization of bladder lesions, well suited for bladder cancer detection in community and resource-constrained settings. The ClinicalTrials.gov Identifier: NCT02340650.
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Affiliation(s)
- Yubo Tang
- Department of Bioengineering, Rice University, Houston, Texas, USA
| | - Alex Kortum
- Department of Bioengineering, Rice University, Houston, Texas, USA
| | - Imran Vohra
- Department of Bioengineering, Rice University, Houston, Texas, USA
| | | | - Jennifer Carns
- Department of Bioengineering, Rice University, Houston, Texas, USA
| | - Christopher R Kannady
- Department of Surgery and University of Texas Health Science Center at Houston, Houston, Texas, USA
| | | | - Zhihong Hu
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Nadeem Dhanani
- Department of Surgery and University of Texas Health Science Center at Houston, Houston, Texas, USA
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11
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Yang EC, Brenes DR, Vohra IS, Schwarz RA, Williams MD, Vigneswaran N, Gillenwater AM, Richards-Kortum RR. Algorithm to quantify nuclear features and confidence intervals for classification of oral neoplasia from high-resolution optical images. J Med Imaging (Bellingham) 2020; 7:054502. [PMID: 32999894 PMCID: PMC7503985 DOI: 10.1117/1.jmi.7.5.054502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 01/05/2020] [Accepted: 09/02/2020] [Indexed: 11/14/2022] Open
Abstract
Purpose: In vivo optical imaging technologies like high-resolution microendoscopy (HRME) can image nuclei of the oral epithelium. In principle, automated algorithms can then calculate nuclear features to distinguish neoplastic from benign tissue. However, images frequently contain regions without visible nuclei, due to biological and technical factors, decreasing the data available to and accuracy of image analysis algorithms. Approach: We developed the nuclear density-confidence interval (ND-CI) algorithm to determine if an HRME image contains sufficient nuclei for classification, or if a better image is required. The algorithm uses a convolutional neural network to exclude image regions without visible nuclei. Then the remaining regions are used to estimate a confidence interval (CI) for the number of abnormal nuclei per mm 2 , a feature used by a previously developed algorithm (called the ND algorithm), to classify images as benign or neoplastic. The range of the CI determines whether the ND-CI algorithm can classify an image with confidence, and if so, the predicted category. The ND and ND-CI algorithm were compared by calculating their positive predictive value (PPV) and negative predictive value (NPV) on 82 oral biopsies with histopathologically confirmed diagnoses. Results: After excluding the images that could not be classified with confidence, the ND-CI algorithm had higher PPV (65% versus 59%) and NPV (78% versus 75%) than the ND algorithm. Conclusions: The ND-CI algorithm could improve the real-time classification of HRME images of the oral epithelium by informing the user if an improved image is required for diagnosis.
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Affiliation(s)
- Eric C Yang
- Baylor College of Medicine, Houston, Texas, United States
| | - David R Brenes
- Rice University, Department of Bioengineering, Houston, Texas, United States
| | - Imran S Vohra
- Rice University, Department of Bioengineering, Houston, Texas, United States
| | - Richard A Schwarz
- Rice University, Department of Bioengineering, Houston, Texas, United States
| | - Michelle D Williams
- The University of Texas, MD Anderson Cancer Center, Department of Pathology, Houston, Texas, United States
| | - Nadarajah Vigneswaran
- The University of Texas, School of Dentistry at Houston, Department of Diagnostic and Biomedical Sciences, Houston, Texas, United States
| | - Ann M Gillenwater
- The University of Texas, MD Anderson Cancer Center, Department of Head and Neck Surgery, Houston, Texas, United States
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12
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Tan MT, Wu JG, Callejas-Valera JL, Schwarz RA, Gillenwater AM, Richards-Kortum RR, Vigneswaran N. A PIK3CA transgenic mouse model with chemical carcinogen exposure mimics human oral tongue tumorigenesis. Int J Exp Pathol 2020; 101:45-54. [PMID: 32436348 DOI: 10.1111/iep.12347] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 11/08/2019] [Revised: 02/01/2020] [Accepted: 02/16/2020] [Indexed: 12/24/2022] Open
Abstract
Oral cancer causes significant global mortality and has a five-year survival rate of around 64%. Poor prognosis results from late-stage diagnosis, highlighting an important need to develop better approaches to detect oral premalignant lesions (OPLs) and identify which OPLs are at highest risk of progression to oral squamous cell carcinoma (OSCC). An appropriate animal model that reflects the genetic, histologic, immunologic, molecular and gross visual features of human OSCC would aid in the development and evaluation of early detection and risk assessment strategies. Here, we present an experimental PIK3CA + 4NQO transgenic mouse model of oral carcinogenesis that combines the PIK3CA oncogene mutation with oral exposure to the chemical carcinogen 4NQO, an alternate experimental transgenic mouse model with PIK3CA as well as E6 and E7 mutations, and an existing wild-type mouse model based on oral exposure to 4NQO alone. We compare changes in dorsal and ventral tongue gross visual appearance, histologic features and molecular biomarker expression over a time course of carcinogenesis. Both transgenic models exhibit cytological and architectural features of dysplasia that mimic human disease and exhibit slightly increased staining for Ki-67, a cell proliferation marker. The PIK3CA + 4NQO model additionally exhibits consistent lymphocytic infiltration, presents with prominent dorsal and ventral tongue tumours, and develops cancer quickly relative to the other models. Thus, the PIK3CA + 4NQO model recapitulates the multistep genetic model of human oral carcinogenesis and host immune response in carcinogen-induced tongue cancer, making it a useful resource for future OSCC studies.
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Affiliation(s)
- Melody T Tan
- Department of Bioengineering, Rice University, Houston, TX, USA
| | - Jean G Wu
- Department of Diagnostic and Biomedical Sciences, University of Texas School of Dentistry, Houston, TX, USA
| | | | | | - Ann M Gillenwater
- Department of Head and Neck Surgery, M.D. Anderson Cancer Center, University of Texas, Houston, TX, USA
| | | | - Nadarajah Vigneswaran
- Department of Diagnostic and Biomedical Sciences, University of Texas School of Dentistry, Houston, TX, USA
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13
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Yang EC, Vohra IS, Badaoui H, Schwarz RA, Cherry KD, Jacob J, Rodriguez J, Williams MD, Vigneswaran N, Gillenwater AM, Richards-Kortum RR. Prospective evaluation of oral premalignant lesions using a multimodal imaging system: a pilot study. Head Neck 2019; 42:171-179. [PMID: 31621979 PMCID: PMC7003735 DOI: 10.1002/hed.25978] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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] [Received: 07/15/2019] [Revised: 09/03/2019] [Accepted: 09/17/2019] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Multimodal optical imaging, incorporating reflectance and fluorescence modalities, is a promising tool to detect oral premalignant lesions in real-time. METHODS Images were acquired from 171 sites in 66 patient visits for clinical evaluation of oral lesions. An automated algorithm was used to classify lesions as high- or low-risk for neoplasia. Biopsies were acquired at clinically indicated sites and those classified as high-risk by imaging, at the surgeon's discretion. RESULTS Twenty sites were biopsied based on clinical examination or imaging. Of these, 12 were indicated clinically and by imaging; 58% were moderate dysplasia or worse. Four biopsies were indicated by imaging evaluation only; 75% were moderate dysplasia or worse. Finally, four biopsies were indicated by clinical evaluation only; 75% were moderate dysplasia or worse. CONCLUSION Multimodal imaging identified more cases of high-grade dysplasia than clinical evaluation, and can improve detection of high grade precancer in patients with oral lesions.
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Affiliation(s)
- Eric C Yang
- MD/PhD Medical Scientist Training Program, Baylor College of Medicine, Houston, Texas, USA
| | - Imran S Vohra
- Department of Bioengineering, Rice University, Houston, Texas, USA
| | - Hawraa Badaoui
- Department of Head and Neck Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | | | - Katelin D Cherry
- Department of Bioengineering, Rice University, Houston, Texas, USA
| | - Justin Jacob
- Department of Head and Neck Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Jessica Rodriguez
- Department of Head and Neck Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Michelle D Williams
- Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Nadarajah Vigneswaran
- Department of Diagnostic and Biomedical Sciences, The University of Texas Health Science Center at Houston School of Dentistry, Houston, Texas
| | - Ann M Gillenwater
- Department of Head and Neck Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
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14
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Cherry KD, Schwarz RA, Yang EC, Vohra IS, Badaoui H, Williams MD, Vigneswaran N, Gillenwater AM, Richards-Kortum R. Autofluorescence Imaging to Monitor the Progression of Oral Potentially Malignant Disorders. Cancer Prev Res (Phila) 2019; 12:791-800. [PMID: 31451520 DOI: 10.1158/1940-6207.capr-19-0321] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 08/19/2019] [Accepted: 08/21/2019] [Indexed: 12/26/2022]
Abstract
Patients with oral potentially malignant disorders (OPMD) must undergo regular clinical surveillance to ensure that any progression to malignancy is detected promptly. Autofluorescence imaging (AFI) is an optical modality that can assist clinicians in detecting early cancers and high-grade dysplasia. Patients with OPMD undergoing surveillance for the development of oral cancer were examined using AFI at successive clinic visits. Autofluorescence images acquired at 133 clinical visits from sites in 15 patients who met inclusion criteria were analyzed quantitatively using an algorithm to calculate the red-to-green pixel intensity (RG ratio). A quantitative AFI threshold for high risk of progression was defined based on the RG ratio and was compared with expert clinical impression and with histopathology when available. Patients were divided into two groups based on their endpoint: surveillance (n = 6) or surgery (n = 9). In the surveillance group, 0 of 6 (0%) of patients were clinically identified as high risk for progression prior to the study endpoint, whereas 1 of 6 (17%) of patients were deemed at high risk for progression based on AFI during the same time period. In the surgery group, 9 of 9 (100%) of patients were clinically identified as high risk prior to the study endpoint, whereas 8 of 9 (89%) of patients were at high risk for progression based on AFI during the same time period. AFI results tracked over time were comparable with expert clinical impression in these patient groups. AFI has the potential to aid clinicians in noninvasively monitoring oral precancer and evaluating OPMDs that require increased surveillance.
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Affiliation(s)
| | | | - Eric C Yang
- Department of Bioengineering, Rice University, Houston, Texas.,Medical Scientist Training Program, Baylor College of Medicine, Houston, Texas
| | - Imran S Vohra
- Department of Bioengineering, Rice University, Houston, Texas
| | - Hawraa Badaoui
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Michelle D Williams
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Ann M Gillenwater
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
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15
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Kundrod KA, Smith CA, Hunt B, Schwarz RA, Schmeler K, Richards-Kortum R. Advances in technologies for cervical cancer detection in low-resource settings. Expert Rev Mol Diagn 2019; 19:695-714. [PMID: 31368827 DOI: 10.1080/14737159.2019.1648213] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Introduction: Cervical cancer mortality rates remain high in low- and middle-income countries (LMICs) and other medically underserved areas due to challenges with implementation and sustainability of routine screening, accurate diagnosis, and early treatment of preinvasive lesions. Areas covered: In this review, we first discuss the standard of care for cervical cancer screening and diagnosis in high- and low-resource settings, biomarkers that correlate to cervical precancer and cancer, and needs for new tests. We review technologies for screening and diagnosis with a focus on tests that are already in use in LMICs or have the potential to be adapted for use in LMICs. Finally, we provide perspectives on the next five years of technology development for improved cervical cancer screening and diagnosis in LMICs. Expert opinion: Innovation toward improved molecular and imaging tests is needed to enable effective, affordable see-and-treat approaches to detect and treat cervical precancer in a single visit. Current molecular tests remain too complex and/or costly for widespread use. Especially with imaging tests, decision support may improve performance of new technologies.
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Affiliation(s)
| | - Chelsey A Smith
- Department of Bioengineering, Rice University , Houston , TX , USA
| | - Brady Hunt
- Department of Bioengineering, Rice University , Houston , TX , USA
| | | | - Kathleen Schmeler
- Department of Gynecologic Oncology, The University of Texas MD Anderson Cancer Center , Houston , TX , USA
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16
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Parra SG, Rodriguez AM, Cherry KD, Schwarz RA, Gowen RM, Guerra LB, Milbourne AM, Toscano PA, Fisher-Hoch SP, Schmeler KM, Richards-Kortum RR. Low-cost, high-resolution imaging for detecting cervical precancer in medically-underserved areas of Texas. Gynecol Oncol 2019; 154:558-564. [PMID: 31288949 DOI: 10.1016/j.ygyno.2019.06.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 06/18/2019] [Accepted: 06/24/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Cervical cancer rates in the United States have declined since the 1940's, however, cervical cancer incidence remains elevated in medically-underserved areas, especially in the Rio Grande Valley (RGV) along the Texas-Mexico border. High-resolution microendoscopy (HRME) is a low-cost, in vivo imaging technique that can identify high-grade precancerous cervical lesions (CIN2+) at the point-of-care. The goal of this study was to evaluate the performance of HRME in medically-underserved areas in Texas, comparing results to a tertiary academic medical center. METHODS HRME was evaluated in five different outpatient clinical settings, two in Houston and three in the RGV, with medical providers of varying skill and training. Colposcopy, followed by HRME imaging, was performed on eligible women. The sensitivity and specificity of traditional colposcopy and colposcopy followed by HRME to detect CIN2+ were compared and HRME image quality was evaluated. RESULTS 174 women (227 cervical sites) were included in the final analysis, with 12% (11% of cervical sites) diagnosed with CIN2+ on histopathology. On a per-site basis, a colposcopic impression of low-grade precancer or greater had a sensitivity of 84% and a specificity of 45% to detect CIN2+. While there was no significant difference in sensitivity (76%, p = 0.62), the specificity when using HRME was significantly higher than that of traditional colposcopy (56%, p = 0.01). There was no significant difference in HRME image quality between clinical sites (p = 0.77) or medical providers (p = 0.33). CONCLUSIONS HRME imaging increased the specificity for detecting CIN2+ when compared to traditional colposcopy. HRME image quality remained consistent across different clinical settings.
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Affiliation(s)
- Sonia G Parra
- Rice University, Department of Bioengineering, Houston, TX 77005, USA
| | - Ana M Rodriguez
- The University of Texas Medical Branch, Department of Obstetrics & Gynecology, Galveston, TX 77555, USA
| | - Katelin D Cherry
- Rice University, Department of Bioengineering, Houston, TX 77005, USA
| | - Richard A Schwarz
- Rice University, Department of Bioengineering, Houston, TX 77005, USA
| | - Rose M Gowen
- Su Clinica Brownsville, Brownsville, TX 78526, USA
| | | | - Andrea M Milbourne
- The University of Texas MD Anderson Cancer Center, Department of Gynecologic Oncology and Reproductive Medicine, Houston, TX 77057, USA
| | - Paul A Toscano
- The University of Texas Health Science Center at Houston, School of Public Health, Brownsville, TX 78520, USA
| | - Susan P Fisher-Hoch
- The University of Texas Health Science Center at Houston, School of Public Health, Brownsville, TX 78520, USA
| | - Kathleen M Schmeler
- The University of Texas MD Anderson Cancer Center, Department of Gynecologic Oncology and Reproductive Medicine, Houston, TX 77057, USA
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17
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Yang EC, Vohra IS, Badaoui H, Schwarz RA, Cherry KD, Quang T, Jacob J, Lang A, Bass N, Rodriguez J, Williams MD, Vigneswaran N, Gillenwater AM, Richards-Kortum RR. Development of an integrated multimodal optical imaging system with real-time image analysis for the evaluation of oral premalignant lesions. J Biomed Opt 2019; 24:1-10. [PMID: 30793567 PMCID: PMC6383051 DOI: 10.1117/1.jbo.24.2.025003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 10/31/2018] [Accepted: 01/30/2019] [Indexed: 05/11/2023]
Abstract
Oral premalignant lesions (OPLs), such as leukoplakia, are at risk of malignant transformation to oral cancer. Clinicians can elect to biopsy OPLs and assess them for dysplasia, a marker of increased risk. However, it is challenging to decide which OPLs need a biopsy and to select a biopsy site. We developed a multimodal optical imaging system (MMIS) that fully integrates the acquisition, display, and analysis of macroscopic white-light (WL), autofluorescence (AF), and high-resolution microendoscopy (HRME) images to noninvasively evaluate OPLs. WL and AF images identify suspicious regions with high sensitivity, which are explored at higher resolution with the HRME to improve specificity. Key features include a heat map that delineates suspicious regions according to AF images, and real-time image analysis algorithms that predict pathologic diagnosis at imaged sites. Representative examples from ongoing studies of the MMIS demonstrate its ability to identify high-grade dysplasia in OPLs that are not clinically suspicious, and to avoid unnecessary biopsies of benign OPLs that are clinically suspicious. The MMIS successfully integrates optical imaging approaches (WL, AF, and HRME) at multiple scales for the noninvasive evaluation of OPLs.
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Affiliation(s)
- Eric C. Yang
- Rice University, Department of Bioengineering, Houston, Texas, United States
- Baylor College of Medicine, MD/PhD Medical Scientist Training Program, Houston, Texas, United States
| | - Imran S. Vohra
- Rice University, Department of Bioengineering, Houston, Texas, United States
| | - Hawraa Badaoui
- University of Texas M.D. Anderson Cancer Center, Department of Head and Neck Surgery, Houston, Texas, United States
| | - Richard A. Schwarz
- Rice University, Department of Bioengineering, Houston, Texas, United States
| | - Katelin D. Cherry
- Rice University, Department of Bioengineering, Houston, Texas, United States
| | - Timothy Quang
- Rice University, Department of Bioengineering, Houston, Texas, United States
| | - Justin Jacob
- University of Texas M.D. Anderson Cancer Center, Department of Head and Neck Surgery, Houston, Texas, United States
| | - Alex Lang
- University of Texas Health Science Center, School of Dentistry, Department of Diagnostic and Biomedical Sciences, Houston, Texas, United States
| | - Nancy Bass
- University of Texas Health Science Center, School of Dentistry, Department of Diagnostic and Biomedical Sciences, Houston, Texas, United States
| | - Jessica Rodriguez
- University of Texas M.D. Anderson Cancer Center, Department of Head and Neck Surgery, Houston, Texas, United States
| | - Michelle D. Williams
- University of Texas M.D. Anderson Cancer Center, Department of Pathology, Houston, Texas, United States
| | - Nadarajah Vigneswaran
- University of Texas Health Science Center, School of Dentistry, Department of Diagnostic and Biomedical Sciences, Houston, Texas, United States
| | - Ann M. Gillenwater
- University of Texas M.D. Anderson Cancer Center, Department of Head and Neck Surgery, Houston, Texas, United States
| | - Rebecca R. Richards-Kortum
- Rice University, Department of Bioengineering, Houston, Texas, United States
- Address all correspondence to Rebecca R. Richards-Kortum, E-mail:
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18
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Pantano N, Hunt B, Schwarz RA, Parra S, Cherry K, Possati-Resende JC, Longatto-Filho A, Fregnani JHTG, Castle PE, Schmeler K, Richards-Kortum R. Is Proflavine Exposure Associated with Disease Progression in Women with Cervical Dysplasia? A Brief Report. Photochem Photobiol 2018; 94:1308-1313. [PMID: 29981148 PMCID: PMC6282608 DOI: 10.1111/php.12976] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 06/27/2018] [Indexed: 12/13/2022]
Abstract
Proflavine is an acridine dye used with high-resolution microendoscopy for in vivo diagnostic evaluation of cervical epithelial cells. However, there are concerns that even short-term exposure of cervical tissue to dilute proflavine may increase cervical cancer risk. We performed a retrospective analysis of women referred for colposcopy to Barretos Cancer Hospital comparing the risk of cervical disease progression in those whose cervical tissue was (n = 232) or was not exposed (n = 160) to proflavine. Patients in both groups underwent treatment and follow-up based on histopathologic results and per the local standards of care. Progression of disease was evaluated by comparing histopathology from the initial visit to the worst subsequent histopathology result from all follow-up visits. Mean duration of follow-up was 18.7 and 20.1 months for the proflavine-exposed and controls groups, respectively. There were no significant differences in disease progression from normal/CIN1 to CIN2/3 or from any initial diagnosis to invasive cancer between the proflavine exposed and control groups overall. Risks of cervical dysplasia progression observed in this study are in agreement with those of the natural history of cervical cancer. Our results suggest that cervical exposure to dilute proflavine does not increase the risk of cervical precancer and cancer.
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Affiliation(s)
- Naitielle Pantano
- Institute of Education and Research, Barretos Cancer Hospital, Pio XII Foundation, Barretos, São Paulo, Brazil.,Molecular Oncology Center, Department of Cancer Prevention, Barretos Cancer Hospital, Pio XII Foundation, Barretos, São Paulo, Brazil
| | - Brady Hunt
- Department of Bioengineering, Rice University, Houston, TX
| | | | - Sonia Parra
- Department of Bioengineering, Rice University, Houston, TX
| | - Katelin Cherry
- Department of Bioengineering, Rice University, Houston, TX
| | - Júlio César Possati-Resende
- Institute of Education and Research, Barretos Cancer Hospital, Pio XII Foundation, Barretos, São Paulo, Brazil.,Molecular Oncology Center, Department of Cancer Prevention, Barretos Cancer Hospital, Pio XII Foundation, Barretos, São Paulo, Brazil
| | - Adhemar Longatto-Filho
- Molecular Oncology Center, Department of Cancer Prevention, Barretos Cancer Hospital, Pio XII Foundation, Barretos, São Paulo, Brazil.,Faculty of Medicine, Laboratory of Medical Investigation (LIM) 14, FMUSP, São Paulo University, São Paulo, Brazil.,School of Health Sciences, Life and Health Sciences Research Institute, ICVS, Uminho University, Braga, Portugal.,ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - José Humberto Tavares Guerreiro Fregnani
- Institute of Education and Research, Barretos Cancer Hospital, Pio XII Foundation, Barretos, São Paulo, Brazil.,Molecular Oncology Center, Department of Cancer Prevention, Barretos Cancer Hospital, Pio XII Foundation, Barretos, São Paulo, Brazil
| | - Philip E Castle
- Global Coalition against Cervical Cancer, New York, NY.,Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Kathleen Schmeler
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
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Yang EC, Schwarz RA, Lang AK, Bass N, Badaoui H, Vohra IS, Cherry KD, Williams MD, Gillenwater AM, Vigneswaran N, Richards-Kortum RR. In Vivo Multimodal Optical Imaging: Improved Detection of Oral Dysplasia in Low-Risk Oral Mucosal Lesions. Cancer Prev Res (Phila) 2018; 11:465-476. [PMID: 29903741 DOI: 10.1158/1940-6207.capr-18-0032] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 05/17/2018] [Accepted: 06/07/2018] [Indexed: 12/12/2022]
Abstract
Early detection of oral cancer and oral premalignant lesions (OPL) containing dysplasia could improve oral cancer outcomes. However, general dental practitioners have difficulty distinguishing dysplastic OPLs from confounder oral mucosal lesions in low-risk populations. We evaluated the ability of two optical imaging technologies, autofluorescence imaging (AFI) and high-resolution microendoscopy (HRME), to diagnose moderate dysplasia or worse (ModDys+) in 56 oral mucosal lesions in a low-risk patient population, using histopathology as the gold standard, and in 46 clinically normal sites. AFI correctly diagnosed 91% of ModDys+ lesions, 89% of clinically normal sites, and 33% of benign lesions. Benign lesions with severe inflammation were less likely to be correctly diagnosed by AFI (13%) than those without (42%). Multimodal imaging (AFI+HRME) had higher accuracy than either modality alone; 91% of ModDys+ lesions, 93% of clinically normal sites, and 64% of benign lesions were correctly diagnosed. Photos of the 56 lesions were evaluated by 28 dentists of varied training levels, including 26 dental residents. We compared the area under the receiver operator curve (AUC) of clinical impression alone to clinical impression plus AFI and clinical impression plus multimodal imaging using k-Nearest Neighbors models. The mean AUC of the dental residents was 0.71 (range: 0.45-0.86). The addition of AFI alone to clinical impression slightly lowered the mean AUC (0.68; range: 0.40-0.82), whereas the addition of multimodal imaging to clinical impression increased the mean AUC (0.79; range: 0.61-0.90). On the basis of these findings, multimodal imaging could improve the evaluation of oral mucosal lesions in community dental settings. Cancer Prev Res; 11(8); 465-76. ©2018 AACR.
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Affiliation(s)
- Eric C Yang
- Department of Bioengineering, Rice University, Houston, Texas.,Medical Scientist Training Program, Baylor College of Medicine, Houston, Texas
| | | | - Alexander K Lang
- The University of Texas School of Dentistry at Houston, Houston, Texas
| | - Nancy Bass
- The University of Texas School of Dentistry at Houston, Houston, Texas
| | - Hawraa Badaoui
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Imran S Vohra
- Department of Bioengineering, Rice University, Houston, Texas
| | | | - Michelle D Williams
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ann M Gillenwater
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
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20
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Hunt B, Fregnani JHTG, Schwarz RA, Pantano N, Tesoni S, Possati-Resende JC, Antoniazzi M, de Oliveira Fonseca B, de Macêdo Matsushita G, Scapulatempo-Neto C, Kerr L, Castle PE, Schmeler K, Richards-Kortum R. Diagnosing Cervical Neoplasia in Rural Brazil Using a Mobile Van Equipped with In Vivo Microscopy: A Cluster-Randomized Community Trial. Cancer Prev Res (Phila) 2018; 11:359-370. [PMID: 29618459 PMCID: PMC5984709 DOI: 10.1158/1940-6207.capr-17-0265] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 12/06/2017] [Accepted: 03/28/2018] [Indexed: 12/14/2022]
Abstract
Cervical cancer is a leading cause of death in underserved areas of Brazil. This prospective randomized trial involved 200 women in southern/central Brazil with abnormal Papanicolaou tests. Participants were randomized by geographic cluster and referred for diagnostic evaluation either at a mobile van upon its scheduled visit to their local community, or at a central hospital. Participants in both arms underwent colposcopy, in vivo microscopy, and cervical biopsies. We compared rates of diagnostic follow-up completion between study arms, and also evaluated the diagnostic performance of in vivo microscopy compared with colposcopy. There was a 23% absolute and 37% relative increase in diagnostic follow-up completion rates for patients referred to the mobile van (102/117, 87%) compared with the central hospital (53/83, 64%; P = 0.0001; risk ratio = 1.37, 95% CI, 1.14-1.63). In 229 cervical sites in 144 patients, colposcopic examination identified sites diagnosed as cervical intraepithelial neoplasia grade 2 or more severe (CIN2+; 85 sites) with a sensitivity of 94% (95% CI, 87%-98%) and specificity of 50% (95% CI, 42%-58%). In vivo microscopy with real-time automated image analysis identified CIN2+ with a sensitivity of 92% (95% CI, 84%-97%) and specificity of 48% (95% CI, 40%-56%). Women referred to the mobile van were more likely to complete their diagnostic follow-up compared with those referred to a central hospital, without compromise in clinical care. In vivo microscopy in a mobile van provides automated diagnostic imaging with sensitivity and specificity similar to colposcopy. Cancer Prev Res; 11(6); 359-70. ©2018 AACR.
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Affiliation(s)
- Brady Hunt
- Rice University, Department of Bioengineering, Houston, Texas
| | | | | | | | | | | | | | | | | | | | - Ligia Kerr
- Barretos Cancer Hospital, Barretos, SP, Brazil
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Yang EC, Tan MT, Schwarz RA, Richards-Kortum RR, Gillenwater AM, Vigneswaran N. Noninvasive diagnostic adjuncts for the evaluation of potentially premalignant oral epithelial lesions: current limitations and future directions. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 125:670-681. [PMID: 29631985 PMCID: PMC6083875 DOI: 10.1016/j.oooo.2018.02.020] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 02/13/2018] [Accepted: 02/23/2018] [Indexed: 12/15/2022]
Abstract
Potentially premalignant oral epithelial lesions (PPOELs) are a group of clinically suspicious conditions, of which a small percentage will undergo malignant transformation. PPOELs are suboptimally diagnosed and managed under the current standard of care. Dysplasia is the most well-established marker to distinguish high-risk PPOELs from low-risk PPOELs, and performing a biopsy to establish dysplasia is the diagnostic gold standard. However, a biopsy is limited by morbidity, resource requirements, and the potential for underdiagnosis. Diagnostic adjuncts may help clinicians better evaluate PPOELs before definitive biopsy, but existing adjuncts, such as toluidine blue, acetowhitening, and autofluorescence imaging, have poor accuracy and are not generally recommended. Recently, in vivo microscopy technologies, such as high-resolution microendoscopy, optical coherence tomography, reflectance confocal microscopy, and multiphoton imaging, have shown promise for improving PPOEL patient care. These technologies allow clinicians to visualize many of the same microscopic features used for histopathologic assessment at the point of care.
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Affiliation(s)
- Eric C Yang
- Department of Bioengineering, Rice University, Houston, TX, USA; Medical Scientist Training Program, Baylor College of Medicine, Houston, TX, USA
| | - Melody T Tan
- Department of Bioengineering, Rice University, Houston, TX, USA
| | | | | | - Ann M Gillenwater
- Department of Head and Neck Surgery, M.D. Anderson Cancer Center, University of Texas, Houston, TX, USA
| | - Nadarajah Vigneswaran
- Department of Diagnostic and Biomedical Sciences, University of Texas School of Dentistry, Houston, TX, USA.
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Quang T, Tran EQ, Schwarz RA, Williams MD, Vigneswaran N, Gillenwater AM, Richards-Kortum R. Prospective Evaluation of Multimodal Optical Imaging with Automated Image Analysis to Detect Oral Neoplasia In Vivo. Cancer Prev Res (Phila) 2017; 10:563-570. [PMID: 28765195 DOI: 10.1158/1940-6207.capr-17-0054] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 06/07/2017] [Accepted: 07/26/2017] [Indexed: 12/16/2022]
Abstract
The 5-year survival rate for patients with oral cancer remains low, in part because diagnosis often occurs at a late stage. Early and accurate identification of oral high-grade dysplasia and cancer can help improve patient outcomes. Multimodal optical imaging is an adjunctive diagnostic technique in which autofluorescence imaging is used to identify high-risk regions within the oral cavity, followed by high-resolution microendoscopy to confirm or rule out the presence of neoplasia. Multimodal optical images were obtained from 206 sites in 100 patients. Histologic diagnosis, either from a punch biopsy or an excised surgical specimen, was used as the gold standard for all sites. Histopathologic diagnoses of moderate dysplasia or worse were considered neoplastic. Images from 92 sites in the first 30 patients were used as a training set to develop automated image analysis methods for identification of neoplasia. Diagnostic performance was evaluated prospectively using images from 114 sites in the remaining 70 patients as a test set. In the training set, multimodal optical imaging with automated image analysis correctly classified 95% of nonneoplastic sites and 94% of neoplastic sites. Among the 56 sites in the test set that were biopsied, multimodal optical imaging correctly classified 100% of nonneoplastic sites and 85% of neoplastic sites. Among the 58 sites in the test set that corresponded to a surgical specimen, multimodal imaging correctly classified 100% of nonneoplastic sites and 61% of neoplastic sites. These findings support the potential of multimodal optical imaging to aid in the early detection of oral cancer. Cancer Prev Res; 10(10); 563-70. ©2017 AACR.
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Affiliation(s)
- Timothy Quang
- Department of Bioengineering, Rice University, Houston, Texas
| | - Emily Q Tran
- Department of Bioengineering, Rice University, Houston, Texas
| | | | - Michelle D Williams
- Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Nadarajah Vigneswaran
- Department of Diagnostic and Biomedical Sciences, University of Texas School of Dentistry, Houston, Texas
| | - Ann M Gillenwater
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
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Quang T, Schwarz RA, Dawsey SM, Tan MC, Patel K, Yu X, Wang G, Zhang F, Xu H, Anandasabapathy S, Richards-Kortum R. A tablet-interfaced high-resolution microendoscope with automated image interpretation for real-time evaluation of esophageal squamous cell neoplasia. Gastrointest Endosc 2016; 84:834-841. [PMID: 27036635 PMCID: PMC5045314 DOI: 10.1016/j.gie.2016.03.1472] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 03/17/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS In recent years high-resolution microendoscopy (HRME) has shown potential to improve screening for esophageal squamous cell neoplasia. Furthering its utility in a clinical setting, especially in lower-resource settings, could be accomplished by reducing the size and cost of the system as well as incorporating the ability of real-time, objective feedback. This article describes a tablet-interfaced HRME with fully automated, real-time image analysis. METHODS The performance of the tablet-interfaced HRME was assessed by acquiring images from the oral mucosa in a normal volunteer. An automated, real-time analysis algorithm was developed and evaluated using training, test, and validation images from a previous in vivo study of 177 patients referred for screening or surveillance endoscopy in China. The algorithm was then implemented in a tablet HRME that was used to obtain and analyze images from esophageal tissue in 3 patients. Images were displayed alongside the probability that the imaged region was neoplastic. RESULTS The tablet-interfaced HRME demonstrated comparable imaging performance at a lower cost compared with first-generation laptop-interfaced HRME systems. In a post-hoc quantitative analysis, the algorithm identified neoplasia with a sensitivity and specificity of 95% and 91%, respectively, in the validation set compared with 84% and 95% achieved in the original study. CONCLUSIONS The tablet-based HRME is a low-cost tool that provides quantitative diagnostic information to the endoscopist in real time. This could be especially beneficial in lower-resource settings for operators with less experience interpreting HRME images.
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Affiliation(s)
- Timothy Quang
- Department of Bioengineering, Rice University, Houston, Texas
| | | | - Sanford M. Dawsey
- Department of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Mimi C. Tan
- Department of Gastroenterology, Baylor College of Medicine, Houston, Texas
| | - Kalpesh Patel
- Department of Gastroenterology, Baylor College of Medicine, Houston, Texas
| | - Xinying Yu
- Department of Endoscopy, Cancer Institute and Hospital, The Chinese Academy of Medical Sciences, Beijing, China
| | - Guiqi Wang
- Department of Endoscopy, Cancer Institute and Hospital, The Chinese Academy of Medical Sciences, Beijing, China
| | - Fan Zhang
- Department of Gastrointestinal Medicine, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Hong Xu
- Department of Gastrointestinal Medicine, The First Hospital of Jilin University, Changchun, Jilin, China
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Protano MA, Xu H, Wang G, Polydorides AD, Dawsey SM, Cui J, Xue L, Zhang F, Quang T, Pierce MC, Shin D, Schwarz RA, Bhutani MS, Lee M, Parikh N, Hur C, Xu W, Moshier E, Godbold J, Mitcham J, Hudson C, Richards-Kortum RR, Anandasabapathy S. Low-Cost High-Resolution Microendoscopy for the Detection of Esophageal Squamous Cell Neoplasia: An International Trial. Gastroenterology 2015; 149:321-329. [PMID: 25980753 PMCID: PMC4547689 DOI: 10.1053/j.gastro.2015.04.055] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 04/27/2015] [Accepted: 04/28/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND & AIMS Esophageal squamous cell neoplasia has a high mortality rate as a result of late detection. In high-risk regions such as China, screening is performed by Lugol's chromoendoscopy (LCE). LCE has low specificity, resulting in unnecessary tissue biopsy with a subsequent increase in procedure cost and risk. The purpose of this study was to evaluate the accuracy of a novel, low-cost, high-resolution microendoscope (HRME) as an adjunct to LCE. METHODS In this prospective trial, 147 consecutive high-risk patients were enrolled from 2 US and 2 Chinese tertiary centers. Three expert and 4 novice endoscopists performed white-light endoscopy followed by LCE and HRME. All optical images were compared with the gold standard of histopathology. RESULTS By using a per-biopsy analysis, the sensitivity of LCE vs LCE + HRME was 96% vs 91% (P = .0832), specificity was 48% vs 88% (P < .001), positive predictive value was 22% vs 45% (P < .0001), negative predictive value was 98% vs 98% (P = .3551), and overall accuracy was 57% vs 90% (P < .001), respectively. By using a per-patient analysis, the sensitivity of LCE vs LCE + HRME was 100% vs 95% (P = .16), specificity was 29% vs 79% (P < .001), positive predictive value was 32% vs 60%, 100% vs 98%, and accuracy was 47% vs 83% (P < .001). With the use of HRME, 136 biopsies (60%; 95% confidence interval, 53%-66%) could have been spared, and 55 patients (48%; 95% confidence interval, 38%-57%) could have been spared any biopsy. CONCLUSIONS In this trial, HRME improved the accuracy of LCE for esophageal squamous cell neoplasia screening and surveillance. HRME may be a cost-effective optical biopsy adjunct to LCE, potentially reducing unnecessary biopsies and facilitating real-time decision making in globally underserved regions. ClinicalTrials.gov, NCT 01384708.
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Affiliation(s)
| | - Hong Xu
- Department of Endoscopy, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Guiqi Wang
- Department of Endoscopy, Cancer Institute and Hospital, The Chinese Academy of Medical Sciences, Beijing, China
| | | | - Sanford M. Dawsey
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Junsheng Cui
- Department of Pathology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Liyan Xue
- Department of Pathology, Cancer Institute and Hospital, The Chinese Academy of Medical Sciences, Beijing, China
| | - Fan Zhang
- Department of Endoscopy, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Timothy Quang
- Department of Bioengineering, Rice University, Houston, TX
| | - Mark C. Pierce
- Biomedical Engineering, Rutgers University, Piscataway, NJ
| | - Dongsuk Shin
- Department of Bioengineering, Rice University, Houston, TX
| | | | - Manoop S. Bhutani
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Michelle Lee
- Division of Gastroenterology, The Mount Sinai Medical Center, New York, NY
| | - Neil Parikh
- Division of Digestive Diseases, Yale University, New Haven, CT
| | - Chin Hur
- GI Unit & Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA
| | - Weiran Xu
- Department of Endoscopy, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Erin Moshier
- Department of Preventative Medicine, The Mount Sinai Medical Center, New York, NY
| | - James Godbold
- Department of Preventative Medicine, The Mount Sinai Medical Center, New York, NY
| | - Josephine Mitcham
- Division of Gastroenterology, The Mount Sinai Medical Center, New York, NY
| | - Courtney Hudson
- Division of Gastroenterology, The Mount Sinai Medical Center, New York, NY
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Ishijima A, Schwarz RA, Shin D, Mondrik S, Vigneswaran N, Gillenwater AM, Anandasabapathy S, Richards-Kortum R. Automated frame selection process for high-resolution microendoscopy. J Biomed Opt 2015; 20:46014. [PMID: 25919426 PMCID: PMC4412137 DOI: 10.1117/1.jbo.20.4.046014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [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: 08/27/2014] [Accepted: 04/09/2015] [Indexed: 05/21/2023]
Abstract
We developed an automated frame selection algorithm for high-resolution microendoscopy video sequences. The algorithm rapidly selects a representative frame with minimal motion artifact from a short video sequence, enabling fully automated image analysis at the point-of-care. The algorithm was evaluated by quantitative comparison of diagnostically relevant image features and diagnostic classification results obtained using automated frame selection versus manual frame selection. A data set consisting of video sequences collected in vivo from 100 oral sites and 167 esophageal sites was used in the analysis. The area under the receiver operating characteristic curve was 0.78 (automated selection) versus 0.82 (manual selection) for oral sites, and 0.93 (automated selection) versus 0.92 (manual selection) for esophageal sites. The implementation of fully automated high-resolution microendoscopy at the point-of-care has the potential to reduce the number of biopsies needed for accurate diagnosis of precancer and cancer in low-resource settings where there may be limited infrastructure and personnel for standard histologic analysis.
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Affiliation(s)
- Ayumu Ishijima
- Rice University, Department of Bioengineering MS 142, 6100 Main Street, Houston, Texas 77005, United States
- University of Tokyo, Department of Precision Engineering, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Richard A. Schwarz
- Rice University, Department of Bioengineering MS 142, 6100 Main Street, Houston, Texas 77005, United States
| | - Dongsuk Shin
- Rice University, Department of Bioengineering MS 142, 6100 Main Street, Houston, Texas 77005, United States
| | - Sharon Mondrik
- Rice University, Department of Bioengineering MS 142, 6100 Main Street, Houston, Texas 77005, United States
| | - Nadarajah Vigneswaran
- University of Texas School of Dentistry, 7500 Cambridge Street, Houston, Texas 77054, United States
| | - Ann M. Gillenwater
- University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas 77030, United States
| | - Sharmila Anandasabapathy
- Mount Sinai Medical Center, Division of Gastroenterology, One Gustave L. Levy Place, New York, New York 10029, United States
| | - Rebecca Richards-Kortum
- Rice University, Department of Bioengineering MS 142, 6100 Main Street, Houston, Texas 77005, United States
- Address all correspondence to: Rebecca Richards-Kortum, E-mail:
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Shin D, Protano MA, Polydorides AD, Dawsey SM, Pierce MC, Kim MK, Schwarz RA, Quang T, Parikh N, Bhutani MS, Zhang F, Wang G, Xue L, Wang X, Xu H, Anandasabapathy S, Richards-Kortum RR. Quantitative analysis of high-resolution microendoscopic images for diagnosis of esophageal squamous cell carcinoma. Clin Gastroenterol Hepatol 2015; 13:272-279.e2. [PMID: 25066838 PMCID: PMC4305504 DOI: 10.1016/j.cgh.2014.07.030] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 06/06/2014] [Accepted: 07/17/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS High-resolution microendoscopy is an optical imaging technique with the potential to improve the accuracy of endoscopic screening for esophageal squamous neoplasia. Although these microscopic images can be interpreted readily by trained personnel, quantitative image analysis software could facilitate the use of this technology in low-resource settings. In this study, we developed and evaluated quantitative image analysis criteria for the evaluation of neoplastic and non-neoplastic squamous esophageal mucosa. METHODS We performed an image analysis of 177 patients undergoing standard upper endoscopy for screening or surveillance of esophageal squamous neoplasia, using high-resolution microendoscopy, at 2 hospitals in China and at 1 hospital in the United States from May 2010 to October 2012. Biopsy specimens were collected from imaged sites (n = 375), and a consensus diagnosis was provided by 2 expert gastrointestinal pathologists and used as the standard. RESULTS Quantitative information from the high-resolution images was used to develop an algorithm to identify high-grade squamous dysplasia or invasive squamous cell cancer, based on histopathology findings. Optimal performance was obtained using the mean nuclear area as the basis for classification, resulting in sensitivities and specificities of 93% and 92% in the training set, 87% and 97% in the test set, and 84% and 95% in an independent validation set, respectively. CONCLUSIONS High-resolution microendoscopy with quantitative image analysis can aid in the identification of esophageal squamous neoplasia. Use of software-based image guides may overcome issues of training and expertise in low-resource settings, allowing for widespread use of these optical biopsy technologies.
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Affiliation(s)
- Dongsuk Shin
- Department of Bioengineering, Rice University, Houston, Texas
| | - Marion-Anna Protano
- Division of Gastroenterology, The Mount Sinai Medical Center, New York, New York
| | | | - Sanford M Dawsey
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Mark C Pierce
- Department of Biomedical Engineering, Rutgers, The State University of New Jersey, Piscataway, New Jersey
| | - Michelle Kang Kim
- Division of Gastroenterology, The Mount Sinai Medical Center, New York, New York
| | | | - Timothy Quang
- Department of Bioengineering, Rice University, Houston, Texas
| | - Neil Parikh
- Division of Gastroenterology, The Mount Sinai Medical Center, New York, New York
| | - Manoop S Bhutani
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Fan Zhang
- Department of Gastrointestinal Medicine, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Guiqi Wang
- Department of Endoscopy, Cancer Institute and Hospital, The Chinese Academy of Medical Sciences, Beijing, China
| | - Liyan Xue
- Department of Pathology, Cancer Institute and Hospital, The Chinese Academy of Medical Sciences, Beijing, China
| | - Xueshan Wang
- Department of Gastrointestinal Medicine, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Hong Xu
- Department of Gastrointestinal Medicine, The First Hospital of Jilin University, Changchun, Jilin, China
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Gillenwater AM, Howe JM, Mondrik S, Schwarz RA, King TJ, Bhattar V, Richards-Kortum R. Observation of Patients with Oral Potentially Malignant Disorders Using Autofluorescence Imaging and Spectroscopy. Otolaryngol Head Neck Surg 2013. [DOI: 10.1177/0194599813495815a115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: 1) Describe 2 noninvasive optical techniques, widefield autofluorescence imaging (AFI) and optical spectroscopy, that may be used in conjunction with conventional oral examination (COE) for long-term surveillance of patients with oral potentially malignant disorders (OPMD). 2) Present images and spectra collected from patients with OPMD using AFI and spectroscopy over a 33-month surveillance period, and compare results to clinical observations and patient outcomes over that time period. Methods: Patients undergoing routine follow-up surveillance for OPMD were enrolled in a longitudinal optical imaging study. The patients were monitored over time with COE, AFI, and spectroscopy. AFI was used to observe natural tissue fluorescence over a 4-5 cm field of view. Spectroscopy was used to obtain reflectance and fluorescence spectra from selected sites within the oral cavity. The images and spectra collected from these patients were evaluated for changes over time and compared to clinical observations and (where available) histopathology results. Results: During the 33-month period from May 2010 to February 2013, more than 140 patients were enrolled in the study. To date, more than 1,000 optical measurements have been performed during more than 400 clinical surveillance visits. During the surveillance period 26 patients were judged clinically to have progressed from OPMD to cancer. Representative images and spectra from some of these patients will be presented. Conclusions: These results indicate the potential for simple optical techniques, when used in combination with COE, to assist clinicians in monitoring patients with OPMD for early detection of cancer.
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Bedard N, Schwarz RA, Hu A, Bhattar V, Howe J, Williams MD, Gillenwater AM, Richards-Kortum R, Tkaczyk TS. Multimodal snapshot spectral imaging for oral cancer diagnostics: a pilot study. Biomed Opt Express 2013; 4:938-49. [PMID: 23760882 PMCID: PMC3675872 DOI: 10.1364/boe.4.000938] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Revised: 05/22/2013] [Accepted: 05/22/2013] [Indexed: 05/19/2023]
Abstract
Optical imaging and spectroscopy have emerged as effective tools for detecting malignant changes associated with oral cancer. While clinical studies have demonstrated high sensitivity and specificity for detection, current devices either interrogate a small region or can have reduced performance for some benign lesions. We describe a snapshot imaging spectrometer that combines the large field-of-view of widefield imaging with the diagnostic strength of spectroscopy. The portable device can stream RGB images at 7.2 frames per second and record both autofluorescence and reflectance spectral datacubes in < 1 second. We report initial data from normal volunteers and oral cancer patients.
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Affiliation(s)
- Noah Bedard
- Department of Bioengineering, Rice University, 6100 Main Street, Houston, TX 77005, USA
| | - Richard A. Schwarz
- Department of Bioengineering, Rice University, 6100 Main Street, Houston, TX 77005, USA
| | - Aaron Hu
- Department of Bioengineering, Rice University, 6100 Main Street, Houston, TX 77005, USA
| | - Vijayashree Bhattar
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Jana Howe
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Michelle D. Williams
- Department of Pathology, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Ann M. Gillenwater
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Rebecca Richards-Kortum
- Department of Bioengineering, Rice University, 6100 Main Street, Houston, TX 77005, USA
- Department of Electrical and Computer Engineering, Rice University, 6100 Main Street, Houston, TX 77005, USA
| | - Tomasz S. Tkaczyk
- Department of Bioengineering, Rice University, 6100 Main Street, Houston, TX 77005, USA
- Department of Electrical and Computer Engineering, Rice University, 6100 Main Street, Houston, TX 77005, USA
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Pierce MC, Schwarz RA, Bhattar VS, Mondrik S, Williams MD, Lee JJ, Richards-Kortum R, Gillenwater AM. Accuracy of in vivo multimodal optical imaging for detection of oral neoplasia. Cancer Prev Res (Phila) 2012; 5:801-9. [PMID: 22551901 DOI: 10.1158/1940-6207.capr-11-0555] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
If detected early, oral cancer is eminently curable. However, survival rates for oral cancer patients remain low, largely due to late-stage diagnosis and subsequent difficulty of treatment. To improve clinicians' ability to detect early disease and to treat advanced cancers, we developed a multimodal optical imaging system (MMIS) to evaluate tissue in situ, at macroscopic and microscopic scales. The MMIS was used to measure 100 anatomic sites in 30 patients, correctly classifying 98% of pathologically confirmed normal tissue sites, and 95% of sites graded as moderate dysplasia, severe dysplasia, or cancer. When used alone, MMIS classification accuracy was 35% for sites determined by pathology as mild dysplasia. However, MMIS measurements correlated with expression of candidate molecular markers in 87% of sites with mild dysplasia. These findings support the ability of noninvasive multimodal optical imaging to accurately identify neoplastic tissue and premalignant lesions. This in turn may have considerable impact on detection and treatment of patients with oral cancer and other epithelial malignancies.
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Affiliation(s)
- Mark C Pierce
- Department of Bioengineering, Rice University, Houston, TX 77030, USA
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Schwarz RA, Pierce MC, Bhattar VS, Mondrik S, Williams MD, Gillenwater AM, Richards-Kortum R. Abstract 3566: Multimodal optical imaging for detection of oral neoplasia. Cancer Res 2012. [DOI: 10.1158/1538-7445.am2012-3566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Despite advances in treatment methods the 5-year survival rate for patients with oral cancer in the United States is still only 61%, in part due to late stage diagnosis and subsequent difficulty of surgical treatment for advanced disease. To improve the ability of clinicians to detect early stage disease and to treat advanced cancers, we developed a multimodal optical imaging system (MMIS) to evaluate tissue structure in vivo at macroscopic and microscopic scales. The MMIS noninvasively measures changes associated with the development of precancer and cancer, including alterations in tissue autofluorescence properties (due to loss of collagen integrity, epithelial thickening, metabolic changes, and microvascularization) and alterations in tissue morphology (nuclear enlargement and crowding within the epithelium). The macroscopic imaging component of the MMIS acquires autofluorescence images of tissue with an excitation wavelength of 405 nm, a field of view of 45 mm, and spatial resolution of 0.1 mm. Loss of autofluorescence intensity is quantified by calculating the normalized red-to-green ratio in widefield autofluorescence images. Regions of tissue that display reduced blue-green autofluorescence are examined further using the high-resolution imaging component of the MMIS, which is a compact fluorescence microscope coupled to a fiber-optic imaging probe with a 720 μm diameter field-of-view and 4.4 μm spatial resolution. High-resolution imaging is performed at an excitation wavelength of 455 nm following topical application of proflavine, a fluorescent contrast agent which predominantly stains cell nuclei. Alterations in nuclear size and crowding are quantified by calculating the mean nuclear-to-cytoplasm ratio in high-resolution images. The MMIS was used to measure 100 sites in 30 patients undergoing surgery for oral cancer or precancer. Histopathology results from tissue specimens collected from the measured sites were used as the gold standard. Tissue specimens with a histopathologic diagnosis of dysplasia (mild, moderate, or severe) were further evaluated for molecular alterations by immunohistochemical staining for the markers Ki-67, p63 and PHH3. The MMIS correctly classified 98% of pathologically confirmed normal tissue sites and 95% of sites graded as moderate dysplasia, severe dysplasia, or cancer. MMIS measurements also correlated with molecular markers in 87% of sites with mild dysplasia. Following stratification of mild dysplasia sites by biomarker status, multimodal optical imaging classified all 100 measured sites with 93% sensitivity and 96% specificity. These findings support the ability of MMIS to guide the clinician in identifying neoplastic tissue, and potentially those sites with elevated risk of malignant transformation. This would have considerable impact on the detection and treatment of oral cancer and other epithelial malignancies.
Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 3566. doi:1538-7445.AM2012-3566
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Schwarz RA, Gao W, Stepanek VMT, Le TT, Bhattar VS, Williams MD, Wu JK, Vigneswaran N, Adler-Storthz K, Gillenwater AM, Richards-Kortum R. Prospective evaluation of a portable depth-sensitive optical spectroscopy device to identify oral neoplasia. Biomed Opt Express 2010; 2:89-99. [PMID: 21326639 PMCID: PMC3028502 DOI: 10.1364/boe.2.000089] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2010] [Revised: 12/03/2010] [Accepted: 12/06/2010] [Indexed: 05/14/2023]
Abstract
A portable, depth-sensitive clinical spectroscopy device for noninvasive early diagnosis of oral cancer is described. We carried out a pilot study to evaluate the ability of the device to identify oral neoplasia using a previously developed diagnostic algorithm. A total of 79 oral sites in 33 subjects, including 28 patients with oral lesions and 5 healthy volunteers, were measured and analyzed. Measurements of 54 nonkeratinized oral sites yielded an area under the receiver operating characteristic curve of 0.90. Measurements of 25 keratinized oral sites yielded an area under the receiver operating characteristic curve of 0.83.
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Affiliation(s)
- Richard A. Schwarz
- Department of Bioengineering, Rice University, 6100 Main Street, Houston, TX 77005, USA
| | - Wen Gao
- Department of Bioengineering, Rice University, 6100 Main Street, Houston, TX 77005, USA
| | - Vanda M. T. Stepanek
- Department of Head and Neck Surgery, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Tao T. Le
- Department of Head and Neck Surgery, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Vijayashree S. Bhattar
- Department of Head and Neck Surgery, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Michelle D. Williams
- Department of Pathology, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Jessica K. Wu
- University of Texas Dental Branch at Houston, 6516 M. D. Anderson Boulevard, Houston, TX 77030, USA
| | - Nadarajah Vigneswaran
- University of Texas Dental Branch at Houston, 6516 M. D. Anderson Boulevard, Houston, TX 77030, USA
| | - Karen Adler-Storthz
- University of Texas Dental Branch at Houston, 6516 M. D. Anderson Boulevard, Houston, TX 77030, USA
| | - Ann M. Gillenwater
- Department of Head and Neck Surgery, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
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Roblyer D, Kurachi C, Stepanek V, Schwarz RA, Williams MD, El-Naggar AK, Lee JJ, Gillenwater AM, Richards-Kortum R. Comparison of multispectral wide-field optical imaging modalities to maximize image contrast for objective discrimination of oral neoplasia. J Biomed Opt 2010; 15:066017. [PMID: 21198191 PMCID: PMC3013151 DOI: 10.1117/1.3516593] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [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: 03/29/2010] [Revised: 09/28/2010] [Accepted: 09/30/2010] [Indexed: 05/21/2023]
Abstract
Multispectral widefield optical imaging has the potential to improve early detection of oral cancer. The appropriate selection of illumination and collection conditions is required to maximize diagnostic ability. The goals of this study were to (i) evaluate image contrast between oral cancer∕precancer and non-neoplastic mucosa for a variety of imaging modalities and illumination∕collection conditions, and (ii) use classification algorithms to evaluate and compare the diagnostic utility of these modalities to discriminate cancers and precancers from normal tissue. Narrowband reflectance, autofluorescence, and polarized reflectance images were obtained from 61 patients and 11 normal volunteers. Image contrast was compared to identify modalities and conditions yielding greatest contrast. Image features were extracted and used to train and evaluate classification algorithms to discriminate tissue as non-neoplastic, dysplastic, or cancer; results were compared to histologic diagnosis. Autofluorescence imaging at 405-nm excitation provided the greatest image contrast, and the ratio of red-to-green fluorescence intensity computed from these images provided the best classification of dysplasia∕cancer versus non-neoplastic tissue. A sensitivity of 100% and a specificity of 85% were achieved in the validation set. Multispectral widefield images can accurately distinguish neoplastic and non-neoplastic tissue; however, the ability to separate precancerous lesions from cancers with this technique was limited.
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Affiliation(s)
- Darren Roblyer
- Rice University, Department of Bioengineering, Houston, TX 77251-1892, USA
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Schwarz RA, Gao W, Redden Weber C, Kurachi C, Lee JJ, El-Naggar AK, Richards-Kortum R, Gillenwater AM. Noninvasive evaluation of oral lesions using depth-sensitive optical spectroscopy. Cancer 2009; 115:1669-79. [PMID: 19170229 DOI: 10.1002/cncr.24177] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Optical spectroscopy is a noninvasive technique with potential applications for diagnosis of oral dysplasia and early cancer. In this study, we evaluated the diagnostic performance of a depth-sensitive optical spectroscopy (DSOS) system for distinguishing dysplasia and carcinoma from non-neoplastic oral mucosa. METHODS Patients with oral lesions and volunteers without any oral abnormalities were recruited to participate. Autofluorescence and diffuse reflectance spectra of selected oral sites were measured using the DSOS system. A total of 424 oral sites in 124 subjects were measured and analyzed, including 154 sites in 60 patients with oral lesions and 270 sites in 64 normal volunteers. Measured optical spectra were used to develop computer-based algorithms to identify the presence of dysplasia or cancer. Sensitivity and specificity were calculated using a gold standard of histopathology for patient sites and clinical impression for normal volunteer sites. RESULTS Differences in oral spectra were observed in: (1) neoplastic versus nonneoplastic sites, (2) keratinized versus nonkeratinized tissue, and (3) shallow versus deep depths within oral tissue. Algorithms based on spectra from 310 nonkeratinized anatomic sites (buccal, tongue, floor of mouth, and lip) yielded an area under the receiver operating characteristic curve of 0.96 in the training set and 0.93 in the validation set. CONCLUSIONS The ability to selectively target epithelial and shallow stromal depth regions appeared to be diagnostically useful. For nonkeratinized oral sites, the sensitivity and specificity of this objective diagnostic technique were comparable to that of clinical diagnosis by expert observers. Thus, DSOS has potential to augment oral cancer screening efforts in community settings.
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Pavlova I, Weber CR, Schwarz RA, Williams MD, Gillenwater AM, Richards-Kortum R. Fluorescence spectroscopy of oral tissue: Monte Carlo modeling with site-specific tissue properties. J Biomed Opt 2009; 14:014009. [PMID: 19256697 PMCID: PMC2722954 DOI: 10.1117/1.3065544] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [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] [Indexed: 05/20/2023]
Abstract
A Monte Carlo model with site-specific input is used to predict depth-resolved fluorescence spectra from individual normal, inflammatory, and neoplastic oral sites. Our goal in developing this model is to provide a computational tool to study how the morphological characteristics of the tissue affect clinically measured spectra. Tissue samples from the measured sites are imaged using fluorescence confocal microscopy; autofluorescence patterns are measured as a function of depth and tissue sublayer for each individual site. These fluorescence distributions are used as input to the Monte Carlo model to generate predictions of fluorescence spectra, which are compared to clinically measured spectra on a site-by-site basis. A lower fluorescence intensity and longer peak emission wavelength observed in clinical spectra from dysplastic and cancerous sites are found to be associated with a decrease in measured fluorescence originating from the stroma or deeper fibrous regions, and an increase in the measured fraction of photons originating from the epithelium or superficial tissue layers. The simulation approach described here can be used to suggest an optical probe design that samples fluorescence at a depth that gives optimal separation in the spectral signal measured for benign, dysplastic, and cancerous oral mucosa.
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Affiliation(s)
- Ina Pavlova
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, Texas 78712
| | | | | | - Michelle D. Williams
- Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030
| | - Ann M. Gillenwater
- Department of Head and Neck Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030
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Pavlova I, Weber CR, Schwarz RA, Williams M, El-Naggar A, Gillenwater A, Richards-Kortum R. Monte Carlo model to describe depth selective fluorescence spectra of epithelial tissue: applications for diagnosis of oral precancer. J Biomed Opt 2008; 13:064012. [PMID: 19123659 PMCID: PMC2615394 DOI: 10.1117/1.3006066] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [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] [Indexed: 05/04/2023]
Abstract
We present a Monte Carlo model to predict fluorescence spectra of the oral mucosa obtained with a depth-selective fiber optic probe as a function of tissue optical properties. A model sensitivity analysis determines how variations in optical parameters associated with neoplastic development influence the intensity and shape of spectra, and elucidates the biological basis for differences in spectra from normal and premalignant oral sites. Predictions indicate that spectra of oral mucosa collected with a depth-selective probe are affected by variations in epithelial optical properties, and to a lesser extent, by changes in superficial stromal parameters, but not by changes in the optical properties of deeper stroma. The depth selective probe offers enhanced detection of epithelial fluorescence, with 90% of the detected signal originating from the epithelium and superficial stroma. Predicted depth-selective spectra are in good agreement with measured average spectra from normal and dysplastic oral sites. Changes in parameters associated with dysplastic progression lead to a decreased fluorescence intensity and a shift of the spectra to longer emission wavelengths. Decreased fluorescence is due to a drop in detected stromal photons, whereas the shift of spectral shape is attributed to an increased fraction of detected photons arising in the epithelium.
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Affiliation(s)
- Ina Pavlova
- Cornell University, School of Applied and Engineering Physics, Ithaca, New York 14853, USA
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Redden Weber C, Schwarz RA, Atkinson EN, Cox DD, Macaulay C, Follen M, Richards-Kortum R. Model-based analysis of reflectance and fluorescence spectra for in vivo detection of cervical dysplasia and cancer. J Biomed Opt 2008; 13:064016. [PMID: 19123662 PMCID: PMC2701358 DOI: 10.1117/1.3013307] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [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] [Indexed: 05/20/2023]
Abstract
Development, validation, and implementation of an analytical model to extract biologically and diagnostically relevant parameters from measured cervical tissue reflectance and fluorescence spectra are presented. Monte Carlo simulations of tissue reflectance are used to determine the relative contribution of the signal from the epithelium and stroma. The results indicate that the clinical probe used collects a majority of its reflectance signal from the stroma; therefore, a one-layer analytical model of reflectance is used. Two analytical approaches to calculate reflectance spectra are compared to Monte Carlo simulations, and a diffusion theory-based model is implemented. The model is validated by fitting spectra generated from Monte Carlo simulations and comparing the input and output parameters. Median agreement between extracted optical properties and input parameters is 10.6%. The reflectance model is used together with an analytical model of tissue fluorescence to extract optical properties and fluorophore concentrations from 748 clinical measurements of cervical tissue. A diagnostic algorithm based on these extracted parameters is developed and evaluated using cross-validation. The sensitivity/specificity of this algorithm relative to the gold standard of histopathology per measurement are 8551%; this is comparable to accuracy reported in other studies of optical technologies for detection of cervical cancer and its precursors.
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Schwarz RA, Gao W, Daye D, Williams MD, Richards-Kortum R, Gillenwater AM. Autofluorescence and diffuse reflectance spectroscopy of oral epithelial tissue using a depth-sensitive fiber-optic probe. Appl Opt 2008; 47:825-34. [PMID: 18288232 PMCID: PMC2773166 DOI: 10.1364/ao.47.000825] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Optical spectroscopy can provide useful diagnostic information about the morphological and biochemical changes related to the progression of precancer in epithelial tissue. As precancerous lesions develop, the optical properties of both the superficial epithelium and underlying stroma are altered; measuring spectral data as a function of depth has the potential to improve diagnostic performance. We describe a clinical spectroscopy system with a depth-sensitive, ball lens coupled fiber-optic probe for noninvasive in vivo measurement of oral autofluorescence and diffuse reflectance spectra. We report results of spectroscopic measurements from oral sites in normal volunteers and in patients with neoplastic lesions of the oral mucosa; results indicate that the addition of depth selectivity can enhance the detection of optical changes associated with precancer.
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Affiliation(s)
- Richard A Schwarz
- Department of Bioengineering MS 142, Rice University, 6100 Main Street, Keck Hall Suite 116, Houston, Texas 77005, USA.
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Richards-Kortum R, Buckley D, Schwarz RA, Atkinson EN, Follen M. A Translational Bioengineering Course Provides Substantial Gains in Civic Scientific Literacy. Ann Biomed Eng 2007; 35:1324-32. [PMID: 17458698 DOI: 10.1007/s10439-007-9319-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2006] [Accepted: 04/17/2007] [Indexed: 10/23/2022]
Abstract
A growing number of essential consumer choices and public policy issues require a basic level of scientific literacy. Recent studies suggest as many as three-quarters of adults are unable to read and understand news accounts of scientific advances and controversies. In response to this challenge, a new course for non-science majors, Bioengineering and World Health, was designed to improve biomedical literacy. The goal of this study was to compare scientific literacy of students enrolled in the course to that of two groups of students who had not taken the course; the first control group included students majoring in Biomedical Engineering (BME), the second included those majoring in Liberal Arts or Natural Sciences. Small group interviews in which students discussed science news accounts from the popular press were used to assess scientific literacy. Students in Bioengineering and World Health showed increasing scientific literacy throughout the course. At the conclusion of Bioengineering and World Health, the mean scientific literacy of students in the course was significantly higher than that in both control groups. Students were stratified by the number of semester credit hours completed in science, math, engineering and technology (SME&T) courses. Regardless of number of SME&T hours completed, the mean scientific literacy of students completing Bioengineering and World Health was equivalent to that of BME majors who had completed more than 60 semester credit hours of SME&T coursework, suggesting that a single introductory course can significantly influence scientific literacy as measured by participant's ability to discuss medical innovations from a common news source.
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Affiliation(s)
- Rebecca Richards-Kortum
- Department of Bioengineering, Rice University, Keck Hall Suite 116, 6100 Main St, Houston, TX 77005, USA.
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Carraher CE, Schwarz RA, Schroeder JA, Schwarz M. Organotitanium Polydyes Derived from Phenylsulfonphthalein Dyes, and Congo Red, Eriochrome Black T, Nigrosine and Indigo Carmine-Synthesis and Doping Characteristics. ACTA ACUST UNITED AC 2006. [DOI: 10.1080/00222338108056766] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Arifler D, Schwarz RA, Chang SK, Richards-Kortum R. Reflectance spectroscopy for diagnosis of epithelial precancer: model-based analysis of fiber-optic probe designs to resolve spectral information from epithelium and stroma. Appl Opt 2005; 44:4291-305. [PMID: 16045217 PMCID: PMC2773164 DOI: 10.1364/ao.44.004291] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Reflectance spectroscopy is a promising technology for detection of epithelial precancer. Fiber-optic probes that selectively collect scattered light from both the epithelium and the underlying stroma are likely to improve diagnostic performance of in vivo reflectance spectroscopy by revealing diagnostic features unique to each layer. We present Monte Carlo models with which to evaluate fiber-optic probe geometries with respect to sampling depth and depth resolution. We propose a probe design that utilizes half-ball lens coupled source and detector fibers to isolate epithelial scattering from stromal scattering and hence to resolve spectral information from the two layers. The probe is extremely compact and can provide easy access to different organ sites.
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Schwarz RA, Arifler D, Chang SK, Pavlova I, Hussain IA, Mack V, Knight B, Richards-Kortum R, Gillenwater AM. Ball lens coupled fiber-optic probe for depth-resolved spectroscopy of epithelial tissue. Opt Lett 2005; 30:1159-61. [PMID: 15945140 PMCID: PMC2773162 DOI: 10.1364/ol.30.001159] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
A ball lens coupled fiber-optic probe design is described for depth-resolved measurements of the fluorescence and reflectance properties of epithelial tissue. A reflectance target, fluorescence targets, and a two-layer tissue phantom consisting of fluorescent microspheres suspended in collagen are used to characterize the performance of the probe. Localization of the signal to within 300 microm of the probe tip is observed by use of reflectance and fluorescence targets in air. Differential enhancement of the fluorescence signal from the top layer of the two-layer tissue phantom is observed.
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Affiliation(s)
- Richard A Schwarz
- Department of Biomedical Engineering, University of Texas at Austin, 1 University Station, C0800, Austin, Texas 78712, USA
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Beam CF, Dyer MCD, Schwarz RA, Hauser CR. New synthesis of isoxazoles from 1,4-dianions of oximes having an .alpha. hydrogen. Mass spectrometry. J Org Chem 2002. [DOI: 10.1021/jo00831a020] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kaiser EM, Solter LE, Schwarz RA, Beard RD, Hauser CR. gem-Dialkali derivatives of certain functionally substituted organic compounds. J Am Chem Soc 2002. [DOI: 10.1021/ja00746a025] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Watanabe H, Schwarz RA, Hauser CR, Lewis J, Slocum DW. Ortho lithiation of N,N-dimethylbenzenesulfonamide by n-butyllithium. Condensation with electrophilic compounds. CAN J CHEM 1969. [DOI: 10.1139/v69-254] [Citation(s) in RCA: 43] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
N,N-Dimethylbenzenesulfonamide was converted by n-butyllithium to the ortho-lithiosulfonamide, which was condensed with benzophenone, benzonitrile, phenylisocyanate, and carbon dioxide to form a carbinol, an imine, an amide, and an acid, respectively. The carbinol was cyclized thermally to give a sultone. The imine was converted to the corresponding ketone, oxime, and phenylhydrazone. The oxime underwent a Beckmann rearrangement to afford the same amide that was obtained in the reaction of the ortho-lithiosulfonamide with phenylisocyanate.
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