Discrimination between benign, primary and secondary malignancies in lymph nodes from the head and neck utilising Raman spectroscopy and multivariate analysis.

BACKGROUND: The potential use of Raman spectroscopy (RS) for the detection of malignancy within lymph nodes of the head and neck was evaluated. RS measures the presence of biomolecules by the inelastic scattering of light within cells and tissues. This can be performed in vivo in real-time. METHODS: 103 lymph nodes were collected from 23 patients undergoing surgery for suspicious lymph nodes. Five pathologies, defined by consensus histopathology, were collected including reactive nodes (benign), Hodgkin's and non-Hodgkin's lymphomas, metastases from both squamous cell carcinomas and adenocarcinomas. Raman spectra were measured with 830 nm excitation from numerous positions on each biopsy. Spectral diagnostic models were constructed using principal component analysis followed by linear discriminant analysis (PCA-LDA), and by partial least squares discriminant analysis (PLS-DA) for comparison. Two-group models were constructed to distinguish between reactive and malignant nodes, and three-group models to distinguish between the benign, primary and secondary conditions. RESULTS: Results were validated using a repeated subsampling procedure. Sensitivities and specificities of 90% and 86% were obtained using PCA-LDA, and 89% and 88% using PLS-DA, for the two-group models. Both PCA-LDA and PLS-DA models were also found to be very successful at discriminating between pathologies in the three-group models achieving sensitivities and specificities of over 78% and 89% for PCA-LDA, and over 81% and 89% for PLS-DA for all three pathology groups. CONCLUSION: Raman spectroscopy and chemometric techniques can be successfully utilised in combination for discriminating between different cancerous conditions of lymph nodes from the head and neck.

Raman spectroscopy--a potential new method for the intra-operative assessment of axillary lymph nodes.

Sentinel Lymph Node Biopsy has become the standard surgical procedure for the sampling of axillary lymph nodes in breast cancer. Intra-operative node assessment of these nodes would allow definitive axillary surgery to take place immediately with associated benefits for patient management. Our experimental study aims to demonstrate that a Raman spectroscopy probe system could overcome many of the disadvantages of current intra-operative methods. 59 axillary lymph nodes, 43 negative and 16 positive from 58 patients undergoing breast surgery at our district general hospital were mapped using Raman micro-spectroscopy. These maps were then used to model the effect of using a Raman spectroscopic probe by selecting 5 and 10 probe points across the mapped images and evaluating the impact on disease detection. Results demonstrated sensitivities of up to 81% and specificities of up to 97% when differentiating between positive and negative lymph nodes, dependent on the number of probe points included. The results would have concurred with histopathology assessment in 89% and 91% of cases in the 5 and 10 point models respectively. Using Raman spectroscopy in this way could allow lymph node assessment within a time-frame suitable for intra-operative use.

Raman spectroscopy--a new method for the intra-operative assessment of axillary lymph nodes.

Sentinel Lymph Node Biopsy has become the standard surgical procedure for the sampling of axillary lymph nodes in breast cancer. Intra operative node assessment is currently not offered to the majority of patients but would allow definitive axillary surgery to take place immediately. This would confer benefits both to the patient and to the healthcare system. Our experimental study aims to demonstrate that a Raman spectroscopy probe device could overcome many of the disadvantages of current intra-operative analysis techniques. 38 axillary lymph nodes, 25 negative and 13 positive from 20 patients undergoing breast surgery for invasive breast cancer were assessed using a commercially available Raman spectroscopy probe. Spectra were assessed using principal component fed linear discriminant analysis trained by the histopathology results. Leave one node out cross validation achieved a sensitivity of up to 92% and a specificity of up to 100% in differentiating between normal and metastatic lymph nodes.

Breast metastases from colorectal carcinoma.

A case history is presented of a 53-year-old woman with an incidental finding of a breast lump, identified after having had chemotherapy for lung metastases from a rectal carcinoma. Clinical examination, ultrasound, mammography, fine needle aspiration and core biopsies could not prove definitively whether the breast lump represented a metastasis from colorectal carcinoma. Following local excision, the final diagnosis of metastatic colorectal carcinoma to the breast was based on the absence of any site of origin within the breast (i.e. no surrounding DCIS) and on the expression of cytokeratin CK7 and CK20 on immunohistochemistry. Postoperative chemotherapy was initiated. Four months later, although without local recurrence in the breast, the patient developed cutaneous metastatic deposits and active treatment was stopped. A review of other cases of breast metastases from extramammary sources is presented. Possible mechanisms for this rare and unusual phenomenon are discussed.