Assessment of the Electrolyte Heterogeneity of Tissues in Mandibular Bone-Infiltrating Head and Neck Cancer Using Laser-Induced Breakdown Spectroscopy.

Laser-induced breakdown spectroscopy (LIBS) was recently introduced as a rapid bone analysis technique in bone-infiltrating head and neck cancers. Research efforts on laser surgery systems with controlled tissue feedback are currently limited to animal specimens and the use of nontumorous tissues. Accordingly, this study aimed to characterize the electrolyte composition of tissues in human mandibular bone-infiltrating head and neck cancer. Mandible cross-sections from 12 patients with bone-invasive head and neck cancers were natively investigated with LIBS. Representative LIBS spectra (n = 3049) of the inferior alveolar nerve, fibrosis, tumor stroma, and cell-rich tumor areas were acquired and histologically validated. Tissue-specific differences in the LIBS spectra were determined by receiver operating characteristics analysis and visualized by principal component analysis. The electrolyte emission values of calcium (Ca) and potassium (K) significantly (p < 0.0001) differed in fibrosis, nerve tissue, tumor stroma, and cell-rich tumor areas. Based on the intracellular detection of Ca and K, LIBS ensures the discrimination between the inferior alveolar nerve and cell-rich tumor tissue with a sensitivity of ≥95.2% and a specificity of ≥87.2%. The heterogeneity of electrolyte emission values within tumorous and nontumorous tissue areas enables LIBS-based tissue recognition in mandibular bone-infiltrating head and neck cancer.

The role of potassium in depth profiling of the tumor border in bone-invasive oral cancer using laser-induced breakdown spectroscopy (LIBS): a pilot study.

PURPOSE: Microscopic tumor spread beyond the macroscopically visible tumor mass in bone represents a major risk in surgical oncology, where the spatial complexity of bony resection margins cannot be countered with rapid bone analysis techniques. Laser-induced breakdown spectroscopy (LIBS) has recently been introduced as a promising option for rapid bone analysis. The present study aimed to use LIBS-based depth profiling based on electrolyte disturbance tracking to evaluate the detection of microscopic tumor spread in bone. METHODS: After en bloc resection, the tumor-infiltrated mandible section of a patient's segmental mandibulectomy specimen was natively investigated using LIBS. Spectral and electrolytic depth profiles were analyzed across 30 laser shots per laser spot position in healthy bone and at the tumor border. For the histological validation of the lasered positions, the mandibular section was marked with a thin separating disc. RESULTS: Solid calcium (Ca) from hydroxyapatite and soluble Ca from dissolved Ca can be reliably differentiated using LIBS and reflect the natural heterogeneity of healthy bone. Increased potassium (K) emission values in otherwise typically healthy bone spectra are the first spectral signs of tumorous bone invasion. LIBS-based depth profiles at the tumor border region can be used to track tumor-associated changes within the bone with shot accuracy based on the distribution of K. CONCLUSION: Depth profiling using LIBS might enable the detection of microscopic tumor spread in bone. In the future, direct electrolyte tracking using LIBS should be applied to other intraoperative challenges in surgical oncology to advance rapid bone analysis by spectroscopic-optical techniques.

Real-time detection of bone-invasive oral cancer with laser-induced breakdown spectroscopy: A proof-of-principle study.

OBJECTIVES: Intraoperative definition of resection margin status in bone-invasive oral cancer is a fundamental problem in oncologic surgery due to the lack of rapid bone analysis methods. Laser-induced breakdown spectroscopy (LIBS) provides direct measurement with real-time examination of a minimal tissue sample. This proof-of-principle study aimed to evaluate the possibility of distinguishing tumorous and healthy areas with LIBS. MATERIALS AND METHODS: LIBS experiments were executed on native segmental mandibulectomy specimens from 15 patients with bone-invasive oral cancer. Normalized and intensity-matched spectra were compared. Under biological derivation, peak area calculation and principal component analysis (PCA) were applied. The discriminatory power of the PCAs was correlated with the architectural and cytological characteristics of the lasered tumor tissue. Receiver operating characteristics analysis was used to evaluate the performance of LIBS in the real-time detection of bone-invasive cancer. RESULTS: Calcium (Ca), which is high in healthy bone, is replaced by potassium (K) and sodium (Na) in bone-invasive cancer. The degree of stromal induction is significantly correlated with the discriminatory power between healthy and tumorous spectra. In this study, LIBS ensured an overall sensitivity of 95.51% and a specificity of 98.64% via the intracellular detection of K and Na. CONCLUSION: This study demonstrated robust real-time detection of bone-invasive oral cancer with LIBS, which may lay the foundation for establishing LIBS as a rapid bone analysis method. Further development of a LIBS-guided assessment of bone tumor resection margins might reduce the extent of bony resection without compromising oncologic safety.

Evaluation of electrolyte element composition in human tissue by laser-induced breakdown spectroscopy (LIBS).

Laser-induced breakdown spectroscopy (LIBS) enables the direct measurement of cell electrolyte concentrations. The utility of LIBS spectra in biomarker studies is limited because these studies rarely consider basic physical principles. The aim of this study was to test the suitability of LIBS spectra as an analytical method for biomarker assays and to evaluate the composition of electrolyte elements in human biomaterial. LIBS as an analytical method was evaluated by establishing KCl calibration curves to demonstrate linearity, by the correct identification of emission lines with corresponding reference spectra, and by the feasibility to use LIBS in human biomaterial, analyzing striated muscle tissues from the oral regions of two patients. Lorentzian peak fit and peak area calculations resulted in better linearity and reduced shot-to-shot variance. Correct quantitative measurement allowed for differentiation of human biomaterial between patients, and determination of the concentration ratios of main electrolytes within human tissue. The clinical significance of LIBS spectra should be evaluated using peak area rather than peak intensity. LIBS might be a promising tool for analyzing a small group of living cells. Due to linearity, specificity and robustness of the proposed analytical method, LIBS could be a component of future biomarker studies.