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      A new method using Raman spectroscopy for in vivo targeted brain cancer tissue biopsy

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          Abstract

          Modern cancer diagnosis requires histological, molecular, and genomic tumor analyses. Tumor sampling is often achieved using a targeted needle biopsy approach. Targeting errors and cancer heterogeneity causing inaccurate sampling are important limitations of this blind technique leading to non-diagnostic or poor quality samples, and the need for repeated biopsies pose elevated patient risk. An optical technology that can analyze the molecular nature of the tissue prior to harvesting could improve cancer targeting and mitigate patient risk. Here we report on the design, development, and validation of an in situ intraoperative, label-free, cancer detection system based on high wavenumber Raman spectroscopy. This optical detection device was engineered into a commercially available biopsy system allowing tumor analysis prior to tissue harvesting without disrupting workflow. Using a dual validation approach we show that high wavenumber Raman spectroscopy can detect human dense cancer with >60% cancer cells in situ during surgery with a sensitivity and specificity of 80% and 90%, respectively. We also demonstrate for the first time the use of this system in a swine brain biopsy model. These studies set the stage for the clinical translation of this optical molecular imaging method for high yield and safe targeted biopsy.

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          Intraoperative brain cancer detection with Raman spectroscopy in humans.

          Cancers are often impossible to visually distinguish from normal tissue. This is critical for brain cancer where residual invasive cancer cells frequently remain after surgery, leading to disease recurrence and a negative impact on overall survival. No preoperative or intraoperative technology exists to identify all cancer cells that have invaded normal brain. To address this problem, we developed a handheld contact Raman spectroscopy probe technique for live, local detection of cancer cells in the human brain. Using this probe intraoperatively, we were able to accurately differentiate normal brain from dense cancer and normal brain invaded by cancer cells, with a sensitivity of 93% and a specificity of 91%. This Raman-based probe enabled detection of the previously undetectable diffusely invasive brain cancer cells at cellular resolution in patients with grade 2 to 4 gliomas. This intraoperative technology may therefore be able to classify cell populations in real time, making it an ideal guide for surgical resection and decision-making.
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            Rapid, label-free detection of brain tumors with stimulated Raman scattering microscopy.

            Surgery is an essential component in the treatment of brain tumors. However, delineating tumor from normal brain remains a major challenge. We describe the use of stimulated Raman scattering (SRS) microscopy for differentiating healthy human and mouse brain tissue from tumor-infiltrated brain based on histoarchitectural and biochemical differences. Unlike traditional histopathology, SRS is a label-free technique that can be rapidly performed in situ. SRS microscopy was able to differentiate tumor from nonneoplastic tissue in an infiltrative human glioblastoma xenograft mouse model based on their different Raman spectra. We further demonstrated a correlation between SRS and hematoxylin and eosin microscopy for detection of glioma infiltration (κ = 0.98). Finally, we applied SRS microscopy in vivo in mice during surgery to reveal tumor margins that were undetectable under standard operative conditions. By providing rapid intraoperative assessment of brain tissue, SRS microscopy may ultimately improve the safety and accuracy of surgeries where tumor boundaries are visually indistinct.
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              Population-based risk for complications after transthoracic needle lung biopsy of a pulmonary nodule: an analysis of discharge records.

              Because pulmonary nodules are found in up to 25% of patients undergoing computed tomography of the chest, the question of whether to perform biopsy is becoming increasingly common. Data on complications after transthoracic needle lung biopsy are limited to case series from selected institutions. To determine population-based estimates of risks for complications after transthoracic needle biopsy of a pulmonary nodule. Cross-sectional analysis. The 2006 State Ambulatory Surgery Databases and State Inpatient Databases for California, Florida, Michigan, and New York from the Healthcare Cost and Utilization Project. 15 865 adults who had transthoracic needle biopsy of a pulmonary nodule. Percentage of biopsies complicated by hemorrhage, any pneumothorax, or pneumothorax requiring a chest tube, and adjusted odds ratios for these complications associated with various biopsy characteristics, calculated by using multivariate, population-averaged generalized estimating equations. Although hemorrhage was rare, complicating 1.0% (95% CI, 0.9% to 1.2%) of biopsies, 17.8% (CI, 11.8% to 23.8%) of patients with hemorrhage required a blood transfusion. In contrast, the risk for any pneumothorax was 15.0% (CI, 14.0% to 16.0%), and 6.6% (CI, 6.0% to 7.2%) of all biopsies resulted in pneumothorax requiring a chest tube. Compared with patients without complications, those who experienced hemorrhage or pneumothorax requiring a chest tube had longer lengths of stay (P < 0.001) and were more likely to develop respiratory failure requiring mechanical ventilation (P = 0.020). Patients aged 60 to 69 years (as opposed to younger or older patients), smokers, and those with chronic obstructive pulmonary disease had higher risk for complications. Estimated risks may be inaccurate if coding of complications is incomplete. The analyzed databases contain little clinical detail (such as information on nodule characteristics or biopsy pathology) and cannot indicate whether performing the biopsy produced useful information. Whereas hemorrhage is an infrequent complication of transthoracic needle lung biopsy, pneumothorax is common and often necessitates chest tube placement. These population-based data should help patients and physicians make more informed choices about whether to perform biopsy of a pulmonary nodule. Department of Veterans Affairs and National Cancer Institute.
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                Author and article information

                Contributors
                Kevin.petrecca@mcgill.ca
                Frederic.leblond@polymtl.ca
                Journal
                Sci Rep
                Sci Rep
                Scientific Reports
                Nature Publishing Group UK (London )
                2045-2322
                29 January 2018
                29 January 2018
                2018
                : 8
                : 1792
                Affiliations
                [1 ]Dept. of Engineering Physics, Polytechnique Montreal, CP 6079, Succ. Centre-Ville, Montreal, QC H3C 3A7 Canada
                [2 ]ISNI 0000 0001 0743 2111, GRID grid.410559.c, Centre de Recherche du Centre Hospitalier de l’Université de Montréal, 900 rue, ; Saint-Denis, H2X 0A9 QC Canada
                [3 ]ISNI 0000 0001 2179 2404, GRID grid.254880.3, Thayer School of Engineering, , Dartmouth College, 14 Engineering Dr, ; Hanover, NH 03755 USA
                [4 ]ISNI 0000 0004 1936 8649, GRID grid.14709.3b, Brain Tumour Research Centre, Montreal Neurological Institute and Hospital, Dept. of Neurology and Neurosurgery, , McGill University, ; 3801 University St., Montreal, QC H3A 2B4 Canada
                [5 ]ISNI 0000 0001 2292 3357, GRID grid.14848.31, Division of Neurosurgery, Hôpital Notre-Dame du CHUM, , University of Montreal, Montreal, ; 1560 Sherbrooke E, Montreal, QC H2L 4M1 Canada
                [6 ]EMVision LLC, 1471 F Road, Loxahatchee, Florida 33470 United States
                [7 ]ISNI 0000 0001 0743 2111, GRID grid.410559.c, Department of Pathology, , Centre Hospitalier Universitaire de Montréal, 1058 Rue Saint-Denis, Montreal, ; Québec, H2X 3J4 Canada
                [8 ]ISNI 0000 0001 0743 2111, GRID grid.410559.c, Centre hospitalier de L’Université de Montréal, Hôpital Notre-Dame-Pavillon Lachapelle, ; Montréal, QC H2L 4M1 Canada
                [9 ]ISNI 0000 0004 1936 8649, GRID grid.14709.3b, Division of Neuropathology, Department of Pathology, Montreal Neurological Institute and Hospital, , McGill University, 3801 University St, ; Montreal, QC H3A 2B4 Canada
                [10 ]University Health Network/University of Toronto, TMDT 15-314, 101 College St., Toronto, ON M5G 1L7 Canada
                Article
                20233
                10.1038/s41598-018-20233-3
                5788981
                29379121
                4ec317d2-16eb-40a4-a58d-2b338ad1f860
                © The Author(s) 2018

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 11 October 2017
                : 11 January 2018
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