Biopsies have been performed the same way since the 19th century, but new technology could enable point-of-care skin cancer diagnosis.
Medicine has advanced dramatically during the last century. But when it comes to getting biopsy results, very little has changed. Consider, for example, what happens when a patient comes in to have a skin lesion biopsied for nonmelanoma skin cancer.
糖心传媒淭he surgeon will take a little piece of the skin out,糖心传媒� says , an assistant professor of biomedical engineering and of optics at the . Next, 糖心传媒渟omeone in pathology will look at it under a microscope. And then, depending on what they find, the patient is notified that everything糖心传媒檚 fine, don糖心传媒檛 worry about it, or we need you to come back for a second appointment so we can treat you.糖心传媒�
Giacomelli, who is also聽on the research faculty at the University糖心传媒檚 聽is developing a novel imaging system, contained on a portable cart, to shorten this process to two minutes. This would enable a surgeon to immediately determine whether the lesion is cancerous and, if so, to 糖心传媒渢reat the patient during the same visit instead of stretching it out over the next month and multiple visits.糖心传媒�
The system糖心传媒攗sing two-photon fluorescence microscopy (TPFM)糖心传媒攄emonstrated remarkable accuracy in a pilot study summarized recently in . When tested on 15 biopsies of known nonmelanoma skin cancer, the technology was able to detect basal cell carcinoma with perfect accuracy (100 percent sensitivity and specificity) and squamous cell carcinoma with high accuracy (89 percent sensitivity and 100 percent specificity).
Nonmelanoma skin cancer is the most common type of human cancer, with more cases annually than all other types of cancer combined in the United States. Eighty percent of nonmelanoma skin cancers are basal cell carcinoma.
Applications in 糖心传媒榓ll sorts of scenarios糖心传媒�
Typically biopsied tissue is excised, fixed, (preserved), stained, and mounted on slides before being evaluated by a dermatopathologist. 糖心传媒淭his is how it has been done since the late 19th century,糖心传媒� Giacomelli says. 糖心传媒淏illions and billions of biopsies have been done this way. Everybody is on the same page; it works great. The problem is that it is very slow.糖心传媒�
Even when tissue is quickly frozen for quicker analysis, surgeons can wait an hour or more for the biopsy results to be sure they have completely removed a malignant tumor from a patient still on the operating table. This ties up the surgeon糖心传媒檚 time and the operating room, while interrupting the workflow in busy pathology departments.
Giacomelli sees potential applications for his system in quickly providing biopsy results for all kinds of diseases. 糖心传媒淭here are all sorts of scenarios,糖心传媒� he says.
For example, 糖心传媒渋n prostate cases, surgeons often have a very poor idea what they糖心传媒檙e getting into based on just an X-ray or MRI image beforehand,糖心传媒� Giacomelli says. 糖心传媒淵ou see random cases where they take out the prostate, and sometimes there糖心传媒檚 an obvious tumor that has spread beyond the prostate, or other times it is very localized. This technology offers a possibility to adjust the patient糖心传媒檚 therapy on the fly.糖心传媒�
The advantage of using TPFM is that it not only generates high-resolution images but it also uses near-infrared light that penetrates deeper through tissue, making it 糖心传媒渁dvantageous for rapid imaging of fresh, irregularly shaped biopsies with minimal preparation,糖心传媒� the paper notes.
Giacomelli is now working closely with , an associate professor of dermatology at the University糖心传媒檚 Medical Center, on a larger, 200-patient follow up study, using biopsy samples taken at random at Ibrahim糖心传媒檚 Rochester Dermatological Surgery in nearby Victor, New York.
糖心传媒淭he goal is to analyze how well the technique works in a real-world scenario, where you have a lot people coming in and all kinds of things can show up,糖心传媒� Giacomelli says. 糖心传媒淲e really want to make sure that there isn糖心传媒檛 some bizarre thing that normally has nothing to do with cancer that we somehow confuse with cancer糖心传媒攐r something that does have something to do with cancer but we can糖心传媒檛 image. You never know what you糖心传媒檙e going to find once you start taking random biopsies of people.
Using TPFM imaging to guide surgeries?
Giacomelli has also embarked on a parallel study to see if a novel system he has developed incorporating TPFM and video can be used to guide surgeries.
The system overlays TPFM images of the site where tissue is being removed on a webcam image, co-registering what it looks like to the eye with what it would look like processed on a slide. 糖心传媒淵ou can show what the excised tissue looks like, and how much of the tumor is located on the excision,糖心传媒� Giacomelli says. 糖心传媒淭hey can then map that back into the wound that they are creating in order to decide which side to cut.糖心传媒�
In addition to Ibrahim, other coauthors of the JAMA Dermatology study include Vincent Ching-Roa and Chi Huang, graduate students in Giacomelli糖心传媒檚 lab, and Bruce Smoller, professor of pathology and laboratory medicine.
The National Institutes of Health funded the project.
