Abstract
We present a combination of optical coherence tomography (OCT) and Raman spectroscopy (RS) for improved diagnosis and discrimination of different stages and grades of bladder cancer ex vivo by linking the complementary information provided by these two techniques. Bladder samples were obtained from biopsies dissected via transurethral resection of the bladder tumor (TURBT). As OCT provides structural information rapidly, it was used as a red-flag technology to scan the bladder wall for suspicious lesions with the ability to discriminate malignant tissue from healthy urothelium. Upon identification of degenerated tissue via OCT, RS was implemented to determine the molecular characteristics via point measurements at suspicious sites. Combining the complementary information of both modalities allows not only for staging, but also for differentiation of low-grade and high-grade cancer based on a multivariate statistical analysis. OCT was able to clearly differentiate between healthy and malignant tissue by tomogram inspection and achieved an accuracy of 71% in the staging of the tumor, from pTa to pT2, through texture analysis followed by k-nearest neighbor classification. RS yielded an accuracy of 93% in discriminating low-grade from high-grade lesions via principal component analysis followed by k-nearest neighbor classification. In this study, we show the potential of a multi-modal approach with OCT for fast pre-screening and staging of cancerous lesions followed by RS for enhanced discrimination of low-grade and high-grade bladder cancer in a non-destructive, label-free and non-invasive way.
Highlights
Cancer is one of the leading causes of mortality worldwide [1,2,3]
Twelve Bladder biopsies originating from eight patients with suspicious lesions which were staged as five pTa, two pT1 and one pT2 and graded as four low-grade and four high-grade urothelial carcinomas by histopathology were studied with a multi-modal approach, starting with optical coherence tomography (OCT) and followed by Raman spectroscopy (RS)
OCT pre-screening was performed on all biopsies to determine the areas of interest of suspicious lesions
Summary
Cancer is one of the leading causes of mortality worldwide [1,2,3]. Bladder cancer has the highest recurrence rate amongst all cancer types, and ranks as thirteenth in the context of mortality [4,5]. Early diagnostic and full resection of suspicious lesions need to be improved to minimize the likelihood of recurrence. The gold standard for bladder cancer detection is white light-guided cystoscopy (WLC) with transurethral resection of the bladder tumor (TURBT). The resected bladder biopsies are examined by histopathologists. As this method heavily depends on the subjective interpretation of the surgeon and the histopathologist, it is time-consuming and associated with high costs, new strategies to overcome these limitations are of interest
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