title: Real time cancer prediction based on objective tissue compliance measurement in endoscopic surgery.
abstract: OBJECTIVE
  To investigate the feasibility of real time cancer tissue diagnosis intraoperatively based on in vivo tissue compliance measurements obtained by a recently developed laparoscopic smart device.
  
  
  BACKGROUND
  Cancer tissue is stiffer than its normal counterpart. Modern forms of remote surgery such as laparoscopic and robotic surgical techniques diminish direct assessment of this important tissue property. In vivo human tissue compliance of the normal and cancer gastrointestinal tissue is unknown. A Clinical Real Time Tissue Compliance Mapping System (CRTCMS) with a predictive power comparable to the human hand and useable in routine surgical practice has been recently developed.
  
  
  METHODS
  The CRTCMS is employed in the operating theater to collect data from 50 patients undergoing intra-abdominal surgical interventions [40 men, 10 women, aged between 32 and 89 (mean = 66.4, range = 57)]. This includes 10 esophageal and 27 gastric cancer patients. A total of 1212 compliance measurements of normal and cancerous in vivo gastrointestinal tissues were taken. The data were used to calibrate the CRTCMS to predict cancerous tissue in a further 12 patients (3 cancer esophagus and 9 cancer stomach) involving 175 measurements.
  
  
  RESULTS
  The system demonstrated a high prediction power to diagnose cancer tissue in real time during routine surgical procedures (sensitivity = 98.7%, specificity = 99%). An in vivo human tissue compliance data bank of the gastrointestinal tract was produced.
  
  
  CONCLUSIONS
  Real time cancer diagnosis based on in vivo tissue compliance measurements is feasible. The reported data open new avenues in cancer diagnostics, surgical robotics, and development of more realistic surgical simulators.
authors.affiliation: From the Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, Praed Street, London W2 1NY, UK.
authors.forename: Morkos
authors.initials: M
authors.lastname: Fakhry
authors.forename: Fernando
authors.initials: F
authors.lastname: Bello
authors.forename: George B
authors.initials: GB
authors.lastname: Hanna
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D003106:Colon / Q000502:physiology / Q000503:physiopathology; D003187:Compliance; D003661:Decision Support Techniques; D054459:Elasticity Imaging Techniques / Q000295:instrumentation* / Q000379:methods; D004938:Esophageal Neoplasms / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D004947:Esophagus / Q000502:physiology / Q000503:physiopathology; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007082:Ileum / Q000502:physiology / Q000503:physiopathology; D007090:Image Interpretation, Computer-Assisted; D007583:Jejunum / Q000502:physiology / Q000503:physiopathology; D010535:Laparoscopy / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D012044:Regression Analysis; D012680:Sensitivity and Specificity; D013270:Stomach / Q000502:physiology / Q000503:physiopathology; D013274:Stomach Neoplasms / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery