Head and neck cancers are the 16th most prevalent globally, and survival relies on early detection. Widefield autofluorescence (WFAF) shows potential for identifying neoplastic sites but lacks specificity. We investigate multispectral WFAF imaging to identify spectral features from endogenous biomarkers in native and neoplastic oral mucosa, using a DMBA-treated hamster buccal pouch model, with the aim to increase specificity. Spatially resolved spectra revealed variations between nonneoplastic and neoplastic areas. Analyses will compare spectral features in benign, dysplastic, and carcinoma sites from preclinical animal model and human tissues. Refinements in the red/green WFAF approach, by analyzing spectral features, are considered.
This study explores the development of a multimodal imaging system for disease assessment. Various experiments were conducted to evaluate performance in terms of power density, illumination uniformity, and fluorescence emission properties, comparing the handheld setup to the benchtop system. Test samples included phantom gels and oral cancer samples. Preliminary results indicate that the compact LED ring illuminator provided sufficient power for detectable emission signals and improved emission distribution due to sample scattering. The presentation also discusses solutions for achieving a more uniform illumination field and provides insights into imaging in oral epithelial neoplasia with the compact widefield system, along with considerations for translating from a benchtop test system to a compact handheld multimodal system.
Multiphoton fluorescence imaging allows clinicians to identify early signs of oral cancer at its origin below the tissue surface. The high resolution required for adequate morphological assessment is only possible over a relatively small field of view, however, so an additional co-registered wide field of view, low resolution image is crucial for efficient device operation. To meet this need, we present the design of a handheld intraoral probe that includes a 0.50NA objective for multiphoton imaging and auxiliary cameras for region-of-interest identification. Because multiphoton image quality is most dependent on the high NA objective, we characterize its performance and correlate findings to expected system-level quality. Finally, we show concepts for the design and manufacturing strategy of a compact, monolithic, high NA freeform prism objective optimized for multiphoton imaging in the oral cavity.
There is increased interest in use of multiple optical imaging/sensing modalities together as a means to potentially improve diagnostic outcomes. This presentation will review aspects of analysis methods that have been employed when evaluating diagnostic potential of multimodal imaging. It will include discussion of our own current/previous approaches and a thorough commentary on the methods employed in the literature with literature review focusing on multimodal diagnostic imaging. This review includes investigational as well as clinical modalities, and beyond optical imaging to other modalities. Strategies and specific recommendations for consideration of analyses during the development of multimodal approaches will be presented.
The recognized need to develop better clinical approaches for detection of epithelial cancers and potentially malignant lesions than currently used has motivated work in development of noninvasive fluorescence imaging devices. While individual large area imaging and microscopic techniques are promising, recent trends have explored combinations that could merge strengths. The study will discuss a workflow to combine strengths of label-free nonlinear optical microscopy (NLOM) which has shown promise for optical biopsy but is limited in scannable area with widefield autofluorescence microscopy providing large surface area assessment, in studies conducted in both a hamster model for oral neoplasia and inflammation and in surgical oral cancer specimens.
A study evaluating the use of multimodal widefield fluorescence imaging with nonlinear optical microscopy for detection of oral neoplasia was carried out using human clinical samples alongside a preclinical model with the goal of optimizing the most relevant endpoint measures to facilitate development and translation. Samples (in vivo buccal mucosa and surgical samples of oral cancer) were imaged by WF imaging using filter selection of red and green spectral windows, multispectral WF imaging to obtain WF spectral characteristics, and multiphoton autofluorescence microscopy. Features between preclinical and human samples were compared. Similarities and relevant endpoints for pursuing further development of a multimodal workflow will be discussed.
Significance: Early detection of epithelial cancers and precancers/neoplasia in the presence of benign lesions is challenging due to the lack of robust in vivo imaging and biopsy guidance techniques. Label-free nonlinear optical microscopy (NLOM) has shown promise for optical biopsy through the detection of cellular and extracellular signatures of neoplasia. Although in vivo microscopy techniques continue to be developed, the surface area imaged in microscopy is limited by the field of view. FDA-approved widefield fluorescence (WF) imaging systems that capture autofluorescence signatures of neoplasia provide molecular information at large fields of view, which may complement the cytologic and architectural information provided by NLOM.
Aim: A multimodal imaging approach with high-sensitivity WF and high-resolution NLOM was investigated to identify and distinguish image-based features of neoplasia from normal and benign lesions.
Approach:In vivo label-free WF imaging and NLOM was performed in preclinical hamster models of oral neoplasia and inflammation. Analyses of WF imaging, NLOM imaging, and dual modality (WF combined with NLOM) were performed.
Results: WF imaging showed increased red-to-green autofluorescence ratio in neoplasia compared to inflammation and normal oral mucosa (p < 0.01). In vivo assessment of the mucosal tissue with NLOM revealed subsurface cytologic (nuclear pleomorphism) and architectural (remodeling of extracellular matrix) atypia in histologically confirmed neoplastic tissue, which were not observed in inflammation or normal mucosa. Univariate and multivariate statistical analysis of macroscopic and microscopic image-based features indicated improved performance (94% sensitivity and 97% specificity) of a multiscale approach over WF alone, even in the presence of benign lesions (inflammation), a common confounding factor in diagnostics.
Conclusions: A multimodal imaging approach integrating strengths from WF and NLOM may be beneficial in identifying oral neoplasia. Our study could guide future studies on human oral neoplasia to further evaluate merits and limitations of multimodal workflows and inform the development of multiscale clinical imaging systems.
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