Tissue Diagnosis During Colorectal Cancer Surgery Using Optical Sensing: an in Vivo Study

Overview

Journal J Transl Med

Publisher Biomed Central

Specialties Biomedical Engineering
General Medicine

Date 2019 Oct 4

PMID 31578153

Citations 9

Authors

E J M Baltussen

S G Brouwer de Koning

J Sanders

A G J Aalbers

N F M Kok

G L Beets

B H W Hendriks

H J C M Sterenborg

K F D Kuhlmann

T J M Ruers

Affiliations

Soon will be listed here.

Abstract

Background: In colorectal cancer surgery there is a delicate balance between complete removal of the tumor and sparing as much healthy tissue as possible. Especially in rectal cancer, intraoperative tissue recognition could be of great benefit in preventing positive resection margins and sparing as much healthy tissue as possible. To better guide the surgeon, we evaluated the accuracy of diffuse reflectance spectroscopy (DRS) for tissue characterization during colorectal cancer surgery and determined the added value of DRS when compared to clinical judgement.

Methods: DRS spectra were obtained from fat, healthy colorectal wall and tumor tissue during colorectal cancer surgery and results were compared to histopathology examination of the measurement locations. All spectra were first normalized at 800 nm, thereafter two support vector machines (SVM) were trained using a tenfold cross-validation. With the first SVM fat was separated from healthy colorectal wall and tumor tissue, the second SVM distinguished healthy colorectal wall from tumor tissue.

Results: Patients were included based on preoperative imaging, indicating advanced local stage colorectal cancer. Based on the measurement results of 32 patients, the classification resulted in a mean accuracy for fat, healthy colorectal wall and tumor of 0.92, 0.89 and 0.95 respectively. If the classification threshold was adjusted such that no false negatives were allowed, the percentage of false positive measurement locations by DRS was 25% compared to 69% by clinical judgement.

Conclusion: This study shows the potential of DRS for the use of tissue classification during colorectal cancer surgery. Especially the low false positive rate obtained for a false negative rate of zero shows the added value for the surgeons. Trail registration This trail was performed under approval from the internal review board committee (Dutch Trail Register NTR5315), registered on 04/13/2015, https://www.trialregister.nl/trial/5175 .

Citing Articles

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References

Park J, Huh J, Park Y, Cho Y, Yun S, Kim H . A circumferential resection margin of 1 mm is a negative prognostic factor in rectal cancer patients with and without neoadjuvant chemoradiotherapy. Dis Colon Rectum. 2014; 57(8):933-40. DOI: 10.1097/DCR.0000000000000171. View

Schols R, Dunias P, Wieringa F, Stassen L . Multispectral characterization of tissues encountered during laparoscopic colorectal surgery. Med Eng Phys. 2013; 35(7):1044-50. DOI: 10.1016/j.medengphy.2013.01.004. View

Miller K, Siegel R, Lin C, Mariotto A, Kramer J, Rowland J . Cancer treatment and survivorship statistics, 2016. CA Cancer J Clin. 2016; 66(4):271-89. DOI: 10.3322/caac.21349. View

de Koning S, Baltussen E, Karakullukcu M, Dashtbozorg B, Smit L, Dirven R . Toward complete oral cavity cancer resection using a handheld diffuse reflectance spectroscopy probe. J Biomed Opt. 2018; 23(12):1-8. DOI: 10.1117/1.JBO.23.12.121611. View

Tanis E, Evers D, Spliethoff J, Pully V, Kuhlmann K, Van Coevorden F . In vivo tumor identification of colorectal liver metastases with diffuse reflectance and fluorescence spectroscopy. Lasers Surg Med. 2016; 48(9):820-827. DOI: 10.1002/lsm.22581. View

Gomes A, Backman V . Algorithm for automated selection of application-specific fiber-optic reflectance probes. J Biomed Opt. 2013; 18(2):27012. PMC: 3585420. DOI: 10.1117/1.JBO.18.2.027012. View

Baltussen E, Snaebjornsson P, de Koning S, Sterenborg H, Aalbers A, Kok N . Diffuse reflectance spectroscopy as a tool for real-time tissue assessment during colorectal cancer surgery. J Biomed Opt. 2017; 22(10):1-6. DOI: 10.1117/1.JBO.22.10.106014. View

Nagtegaal I, Quirke P . What is the role for the circumferential margin in the modern treatment of rectal cancer?. J Clin Oncol. 2008; 26(2):303-12. DOI: 10.1200/JCO.2007.12.7027. View

Langhout G, Spliethoff J, Schmitz S, Aalbers A, van Velthuysen M, Hendriks B . Differentiation of healthy and malignant tissue in colon cancer patients using optical spectroscopy: A tool for image-guided surgery. Lasers Surg Med. 2015; 47(7):559-565. DOI: 10.1002/lsm.22388. View

10.

Zonios G, Perelman L, Backman V, Manoharan R, Fitzmaurice M, van Dam J . Diffuse reflectance spectroscopy of human adenomatous colon polyps in vivo. Appl Opt. 2008; 38(31):6628-37. DOI: 10.1364/ao.38.006628. View

11.

Nachabe R, Hendriks B, Desjardins A, van der Voort M, van der Mark M, Sterenborg H . Estimation of lipid and water concentrations in scattering media with diffuse optical spectroscopy from 900 to 1,600 nm. J Biomed Opt. 2010; 15(3):037015. DOI: 10.1117/1.3454392. View

12.

Spliethoff J, Evers D, Klomp H, van Sandick J, Wouters M, Nachabe R . Improved identification of peripheral lung tumors by using diffuse reflectance and fluorescence spectroscopy. Lung Cancer. 2013; 80(2):165-71. DOI: 10.1016/j.lungcan.2013.01.016. View

13.

de Boer L, Molenkamp B, Bydlon T, Hendriks B, Wesseling J, Sterenborg H . Fat/water ratios measured with diffuse reflectance spectroscopy to detect breast tumor boundaries. Breast Cancer Res Treat. 2015; 152(3):509-18. DOI: 10.1007/s10549-015-3487-z. View

14.

Delacroix Jr S, Winters J . Voiding dysfunction after pelvic colorectal surgery. Clin Colon Rectal Surg. 2011; 23(2):119-27. PMC: 2967332. DOI: 10.1055/s-0030-1254299. View

15.

Hennessy R, Goth W, Sharma M, Markey M, Tunnell J . Effect of probe geometry and optical properties on the sampling depth for diffuse reflectance spectroscopy. J Biomed Opt. 2014; 19(10):107002. PMC: 4210466. DOI: 10.1117/1.JBO.19.10.107002. View

16.

Siegel R, Miller K, Fedewa S, Ahnen D, Meester R, Barzi A . Colorectal cancer statistics, 2017. CA Cancer J Clin. 2017; 67(3):177-193. DOI: 10.3322/caac.21395. View

17.

Dhar A, Johnson K, Novelli M, Bown S, Bigio I, Lovat L . Elastic scattering spectroscopy for the diagnosis of colonic lesions: initial results of a novel optical biopsy technique. Gastrointest Endosc. 2006; 63(2):257-61. DOI: 10.1016/j.gie.2005.07.026. View

18.

Evers D, Nachabe R, Hompes D, van Coevorden F, Lucassen G, Hendriks B . Optical sensing for tumor detection in the liver. Eur J Surg Oncol. 2012; 39(1):68-75. DOI: 10.1016/j.ejso.2012.08.005. View

19.

Soares J, Barman I, Dingari N, Volynskaya Z, Liu W, Klein N . Diagnostic power of diffuse reflectance spectroscopy for targeted detection of breast lesions with microcalcifications. Proc Natl Acad Sci U S A. 2012; 110(2):471-6. PMC: 3545788. DOI: 10.1073/pnas.1215473110. View

20.

Wang H, Jiang J, Lin C, Lin J, Huang G, Yu J . Diffuse reflectance spectroscopy detects increased hemoglobin concentration and decreased oxygenation during colon carcinogenesis from normal to malignant tumors. Opt Express. 2009; 17(4):2805-17. DOI: 10.1364/oe.17.002805. View