Abstract
We evaluated terahertz reflectance imaging and a combination of terahertz and optical techniques for delineating nonmelanoma skin cancers. After imaging, each terahertz pixel of each specimen was classified as cancerous or normal using a previously determined threshold. Subsequently, cancerous terahertz pixels were re-evaluated with polarization-sensitive optical technique. This additional information enabled us to re-classify each cancerous terahertz pixel using morphological appearance of the structures in the optical images. If the structures in the terahertz pixel appeared normal, the pixel was considered normal. The generalized linear mixture model was implemented to determine the sensitivity and specificity of each method. The model tested the probability of each terahertz pixel being diagnosed as a match with histology. For terahertz imaging alone, the sensitivity and specificity were 82% and 94%, respectively. For multimodal imaging, the sensitivity and specificity increased to 96 % and 99%, respectively. Multimodal terahertz-optical imaging has potential for the intraoperative assessment of tumor margins.
Highlights
More people are diagnosed with nonmelanoma skin cancer (NMSC) in the United States yearly than with all other cancers combined
In this paper we presented experimental evaluation and statistical comparison of two methods, i.e., crosspolarized continuous-wave terahertz imaging and multimodal polarization-sensitive optical and terahertz approach, which can be termed on-demand optical-overterahertz imaging, for the intraoperative ex vivo delineation of NMSC
We have tested our approach to combining diagnostic information yielded by the terahertz and optical imaging, where terahertz image is used to reveal potential tumor sites, while morphological analysis of the optical images is confined to the areas highlighted by the terahertz approach
Summary
More people are diagnosed with nonmelanoma skin cancer (NMSC) in the United States yearly than with all other cancers combined. Most of these patients undergo traditional excisional surgery, which is performed without objective intraoperative tumor margin evaluation. A minority of the patients (~25%) are treated using Mohs Micrographic Surgery (MMS), which uses histopathological frozen sections and evaluates 100% of the margins during the surgical procedure. MMS is not available at all dermatology facilities It is not considered appropriate for treating 75% of non-melanoma skin cancers. Terahertz pulsed imaging has been investigated for skin cancer treatment [12,13,14,15]
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