title: Spectral sensing for tissue diagnosis during lung biopsy procedures: The importance of an adequate internal reference and real-time feedback.
abstract: Difficulties in obtaining a representative tissue sample are a major obstacle in timely selecting the optimal treatment for patients with lung cancer or other malignancies. Having a modality to provide needle guidance and confirm the biopsy site selection could be of great clinical benefit, especially when small masses are targeted. The objective of this study was to evaluate whether diffuse reflectance spectroscopy (DRS) at the tip of a core biopsy needle can be used for biopsy site confirmation in real time, thereby enabling optimized biopsy acquisition and improving diagnostic capability.
  
  
  
  We included a total of 23 patients undergoing a routine computed tomography (CT) guided transthoracic needle biopsy of a lesion suspected for lung cancer or metastatic disease. DRS measurements were acquired during needle insertion and clinically relevant parameters were extracted from the spectral data along the needle paths. Histopathology results were compared with the DRS data at the final measurement position.
  
  
  
  Analysis of the collective data acquired from all enrolled subjects showed significant differences (p<0.01) for blood content, stO2, water content, and scattering amplitude. The identified spectral contrast matched the final pathology in 20 out of 22 clinical cases that could be used for analysis, which corresponds with an overall diagnostic performance of 91%. Three cases underlined the importance of adequate reference measurements and the need for real time diagnostic feedback. Continuous real time DRS measurements performed during a biopsy procedure in one patient provided clear information with respect to the variation in tissue and allowed identification of the tumour boundary.
  
  
  
  The presented technology creates a basis for the design and clinical implementation of integrated fibre-optic tools for a variety of minimal invasive applications.
authors.affiliation: Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066CX, Amsterdam, Netherlands. Electronic address: j.spliethoff@nki.nl.
authors.forename: Jarich W
authors.initials: JW
authors.lastname: Spliethoff
authors.affiliation: Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066CX, Amsterdam, Netherlands.
authors.forename: Lisanne L
authors.initials: LL
authors.lastname: de Boer
authors.affiliation: Department of Radiology, Netherlands Cancer Institute, Plesmanlaan 121, 1066CX, Amsterdam, Netherlands.
authors.forename: Mark A J
authors.initials: MAJ
authors.lastname: Meier
authors.affiliation: Department of Radiology, Netherlands Cancer Institute, Plesmanlaan 121, 1066CX, Amsterdam, Netherlands.
authors.forename: Warner
authors.initials: W
authors.lastname: Prevoo
authors.affiliation: Department of Pathology, Netherlands Cancer Institute, Plesmanlaan 121, 1066CX, Amsterdam, Netherlands.
authors.forename: Jeroen
authors.initials: J
authors.lastname: de Jong
authors.affiliation: Minimally Invasive Healthcare Department, Philips Research, High Tech Campus 34, 5656AE, Eindhoven, Netherlands.
authors.forename: Torre M
authors.initials: TM
authors.lastname: Bydlon
authors.affiliation: Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066CX, Amsterdam, Netherlands; Department of Biomedical Engineering and Physics, Academic Medical Centre, Meibergdreef 9, 1105AZ, Amsterdam, Netherlands.
authors.forename: Henricus J C M
authors.initials: HJCM
authors.lastname: Sterenborg
authors.affiliation: Department of Thoracic Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066CX, Amsterdam, Netherlands.
authors.forename: Jacobus A
authors.initials: JA
authors.lastname: Burgers
authors.affiliation: Minimally Invasive Healthcare Department, Philips Research, High Tech Campus 34, 5656AE, Eindhoven, Netherlands.
authors.forename: Benno H W
authors.initials: BHW
authors.lastname: Hendriks
authors.affiliation: Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066CX, Amsterdam, Netherlands; MIRA Institute, University of Twente, Building Zuidhorst, Room ZH 116, Enschede, Netherlands.
authors.forename: Theodoor J M
authors.initials: TJM
authors.lastname: Ruers
mesh_terms: D038524:Diffusion Magnetic Resonance Imaging; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods / Q000592:standards; D008175:Lung Neoplasms / Q000175:diagnosis*; D061848:Optical Imaging; D014057:Tomography, X-Ray Computed; D047368:Tumor Burden
keywords: Biopsy; Lung cancer; Optical spectroscopy; Real-time guidance; Tissue diagnosis