Clinical integration of fast Raman spectroscopy for Mohs micrographic surgery of basal cell carcinoma

Abstract

We present the first clinical integration of a prototype device based on integrated auto-fluorescence imaging and Raman spectroscopy (Fast Raman device) for intra-operative assessment of surgical margins during Mohs micrographic surgery of basal cell carcinoma (BCC). Fresh skin specimens from 112 patients were used to optimise the tissue pre-processing and the Fast Raman algorithms to enable an analysis of complete Mohs layers within 30 minutes. The optimisation allowed >95% of the resection surface area to be investigated (including the deep and epidermal margins). The Fast Raman device was then used to analyse skin layers excised from the most relevant anatomical sites (nose, temple, eyelid, cheek, forehead, eyebrow and lip) and to detect the three main types of BCC (nodular, superficial and infiltrative). These results suggest that the Fast Raman technique is a promising tool to provide an objective diagnosis “tumour clear yes/no” during Mohs surgery of BCC. This clinical integration study is a key step towards a larger scale diagnosis test accuracy study to reliably determine the sensitivity and specificity in a clinical setting.

The complementary value of intraoperative fluorescence imaging and Raman spectroscopy for cancer surgery: combining the incompatibles

“…The combination of other imaging modalities with selective sampling of suspicious areas by RS as a powerful labelfree analytical technique has also been explored [128,129]. Such approaches include MRI, second harmonic generation, OCT, AFI, total internal reflection fluorescence, or quantitative phase microscopy [130][131][132][133][134][135][136][137][138]. In general, the basic concept behind these multimodal approaches is to combine the high sensitivity of an imaging modality (i.e.…”

Emerging Minimally Invasive Technologies for the Detection of Skin Cancer

“…The system had a sensitivity of 90% and a specificity of >32% for determining benignity [118]. Recently, RS was suggested to be a promising tool to assess surgical margins during Mohs micrographic surgery of BCC [119].…”

Time-gated Raman spectroscopy for biomedical application under ambient or strong background light conditions

“…As an example, we selected BCC, which is the most common type of cancers in humans [32]. While Raman spectroscopy has been widely used for discrimination between normal tissue and cancer [2], including BCC [14,16], we are not aware of any reports using TG Raman spectroscopy. Previous studies showed that Raman spectra of BCC are characterised by higher signals assigned to nucleic acids and lower intensity bands of collagen compared to Raman spectra of dermis in normal skin [33].…”

“…Any further distribution of this work must maintain attribution to the author(s) and the title of the work, journal citation and DOI. and treatment: hand-held Raman probes for in-vivo cancer diagnosis [3,4], detection of residual tumour during cancer surgery [5], bone disease [6], Raman endoscopes [7][8][9], or ex-vivo Raman needle-probes [10][11][12] and multimodal Raman-autofluorescence (AF) [13][14][15] to assess completeness of tumour excision during cancer surgery. When acquiring Raman spectra of biological samples, it is important to block any stray or ambient light from reaching the detector as this background signal can swamp the tissue specific Raman bands.…”