Diagnostic power of diffuse reflectance spectroscopy for targeted detection of breast lesions with microcalcifications.

Microcalcifications geographically target the location of abnormalities within the breast and are of critical importance in breast cancer diagnosis. However, despite stereotactic guidance, core needle biopsy fails to retrieve microcalcifications in up to 15% of patients. Here, we introduce an approach based on diffuse reflectance spectroscopy for detection of microcalcifications that focuses on variations in optical absorption stemming from the calcified clusters and the associated cross-linking molecules. In this study, diffuse reflectance spectra are acquired ex vivo from 203 sites in fresh biopsy tissue cores from 23 patients undergoing stereotactic breast needle biopsies. By correlating the spectra with the corresponding radiographic and histologic assessment, we have developed a support vector machine-derived decision algorithm, which shows high diagnostic power (positive predictive value and negative predictive value of 97% and 88%, respectively) for diagnosis of lesions with microcalcifications. We further show that these results are robust and not due to any spurious correlations. We attribute our findings to the presence of proteins (such as elastin), and desmosine and isodesmosine cross-linkers in the microcalcifications. It is important to note that the performance of the diffuse reflectance decision algorithm is comparable to one derived from the corresponding Raman spectra, and the considerably higher intensity of the reflectance signal enables the detection of the targeted lesions in a fraction of the spectral acquisition time. Our findings create a unique landscape for spectroscopic validation of breast core needle biopsy for detection of microcalcifications that can substantially improve the likelihood of an adequate, diagnostic biopsy in the first attempt.

Emerging trends in optical sensing of glycemic markers for diabetes monitoring.

In the past decade, considerable attention has been focused on the measurement of glycemic markers, such as glycated hemoglobin and glycated albumin, that provide retrospective indices of average glucose levels in the bloodstream. While these biomarkers have been regularly used to monitor long-term glucose control in established diabetics, they have also gained traction in diabetic screening. Detection of such glycemic markers is challenging, especially in a point-of-care setting, due to the stringent requirements for sensitivity and robustness. A number of non-separation based measurement strategies were recently proposed, including photonic tools that are well suited to reagent-free marker quantitation. Here, we critically review these methods while focusing on vibrational spectroscopic methods, which offer highly specific molecular fingerprinting capability. We examine the underlying principles and the utility of these approaches as reagentless assays capable of multiplexed detection of glycemic markers and also the challenges in their eventual use in the clinic.

Incorporation of support vector machines in the LIBS toolbox for sensitive and robust classification amidst unexpected sample and system variability.

Despite the intrinsic elemental analysis capability and lack of sample preparation requirements, laser-induced breakdown spectroscopy (LIBS) has not been extensively used for real-world applications, e.g., quality assurance and process monitoring. Specifically, variability in sample, system, and experimental parameters in LIBS studies present a substantive hurdle for robust classification, even when standard multivariate chemometric techniques are used for analysis. Considering pharmaceutical sample investigation as an example, we propose the use of support vector machines (SVM) as a nonlinear classification method over conventional linear techniques such as soft independent modeling of class analogy (SIMCA) and partial least-squares discriminant analysis (PLS-DA) for discrimination based on LIBS measurements. Using over-the-counter pharmaceutical samples, we demonstrate that the application of SVM enables statistically significant improvements in prospective classification accuracy (sensitivity), because of its ability to address variability in LIBS sample ablation and plasma self-absorption behavior. Furthermore, our results reveal that SVM provides nearly 10% improvement in correct allocation rate and a concomitant reduction in misclassification rates of 75% (cf. PLS-DA) and 80% (cf. SIMCA)-when measurements from samples not included in the training set are incorporated in the test data-highlighting its robustness. While further studies on a wider matrix of sample types performed using different LIBS systems is needed to fully characterize the capability of SVM to provide superior predictions, we anticipate that the improved sensitivity and robustness observed here will facilitate application of the proposed LIBS-SVM toolbox for screening drugs and detecting counterfeit samples, as well as in related areas of forensic and biological sample analysis.

Raman spectroscopy-based sensitive and specific detection of glycated hemoglobin.

In recent years, glycated hemoglobin (HbA1c) has been increasingly accepted as a functional metric of mean blood glucose in the treatment of diabetic patients. Importantly, HbA1c provides an alternate measure of total glycemic exposure due to the representation of blood glucose throughout the day, including post-prandially. In this article, we propose and demonstrate the potential of Raman spectroscopy as a novel analytical method for quantitative detection of HbA1c, without using external dyes or reagents. Using the drop coating deposition Raman (DCDR) technique, we observe that the nonenzymatic glycosylation (glycation) of the hemoglobin molecule results in subtle but discernible and highly reproducible changes in the acquired spectra, which enable the accurate determination of glycated and nonglycated hemoglobin using standard chemometric methods. The acquired Raman spectra display excellent reproducibility of spectral characteristics at different locations in the drop and show a linear dependence of the spectral intensity on the analyte concentration. Furthermore, in hemolysate models, the developed multivariate calibration models for HbA1c show a high degree of prediction accuracy and precision--with a limit of detection that is a factor of ~15 smaller than the lowest physiological concentrations encountered in clinical practice. The excellent accuracy and reproducibility achieved in this proof-of-concept study opens substantive avenues for characterization and quantification of the glycosylation status of (therapeutic) proteins, which are widely used for biopharmaceutical development. We also envision that the proposed approach can provide a powerful tool for high-throughput HbA1c sensing in multicomponent mixtures and potentially in hemolysate and whole blood lysate samples.

Investigation of noise-induced instabilities in quantitative biological spectroscopy and its implications for noninvasive glucose monitoring.

Over the past decade, optical spectroscopy has been employed in combination with multivariate chemometric models to investigate a wide variety of diseases and pathological conditions, primarily due to its excellent chemical specificity and lack of sample preparation requirements. Despite promising results in several proof-of-concept studies, its translation to the clinical setting has often been hindered by inadequate accuracy of the conventional spectroscopic models. To address this issue and the possibility of curved (nonlinear) effects in the relationship between the concentrations of the analyte of interest and the mixture spectra (due to fluctuations in sample and environmental conditions), support vector machine-based least-squares nonlinear regression (LS-SVR) has been recently proposed. In this paper, we investigate the robustness of this methodology to noise-induced instabilities and present an analytical formula for estimating modeling precision as a function of measurement noise and model parameters. This formalism can be readily used to evaluate uncertainty in information extracted from spectroscopic measurements, particularly important for rapid-acquisition biomedical applications. Subsequently, using field data (Raman spectra) acquired from a glucose clamping study on an animal model subject, we perform the first systematic investigation of the relative effect of additive interference components (namely, noise in prediction spectra, calibration spectra, and calibration concentrations) on the prediction error of nonlinear spectroscopic models. Our results show that the LS-SVR method gives more accurate results and is substantially more robust to additive noise when compared with conventional regression methods such as partial least-squares regression (PLS), when careful selection of the LS-SVR model parameters are performed. We anticipate that these results will be useful for uncertainty estimation in similar biomedical applications where the precision of measurements and its response to noise in the data set is as important, if not more so, than the generic accuracy level.

Precision of Raman spectroscopy measurements in detection of microcalcifications in breast needle biopsies.

Microcalcifications are an early mammographic sign of breast cancer and a target for stereotactic breast needle biopsy. We developed Raman spectroscopy decision algorithms to detect breast microcalcifications, based on fit coefficients (FC) derived by modeling tissue Raman spectra as a linear combination of the Raman spectra of 9 chemical and morphologic components of breast tissue. However, little or no information is available on the precision of such measurements and its effect on the ability of Raman spectroscopy to make predictions for breast microcalcification detection. Here we report the precision, that is, the closeness of agreement between replicate Raman spectral measurements--and the model FC derived from them--obtained ex vivo from fresh breast biopsies from patients undergoing stereotactic breast needle biopsy, using a compact clinical Raman system. The coefficients of variation of the model FC averaged 0.03 for normal breast tissue sites, 0.12 for breast lesions without, and 0.22 for breast lesions with microcalcifications. Imprecision in the FC resulted in diagnostic discordance among replicates only for line-sitters, that is, tissue sites with FC values near the decision line or plane. The source of this imprecision and their implications for the use of Raman spectroscopy for guidance of stereotactic breast biopsies for microcalcifications are also discussed. In summary, we conclude that the precision of Raman spectroscopy measurements in breast tissue obtained using our compact clinical system is more than adequate to make accurate and repeatable predictions of microcalcifications in breast tissue using decision algorithms based on model FC. This provides strong evidence of the potential of Raman spectroscopy guidance of stereotactic breast needle biopsies for microcalcifications.

Selective sampling using confocal Raman spectroscopy provides enhanced specificity for urinary bladder cancer diagnosis.

In recent years, Raman spectroscopy has shown substantive promise in diagnosing bladder cancer, especially due to its exquisite molecular specificity. The ability to reduce false detection rates in comparison to existing diagnostic tools such as photodynamic diagnosis makes Raman spectroscopy particularly attractive as a complementary diagnostic tool for real-time guidance of transurethral resection of bladder tumor (TURBT). Nevertheless, the state-of-the-art high-volume Raman spectroscopic probes have not reached the expected levels of specificity thereby impeding their clinical translation. To address this issue, we propose the use of a confocal Raman probe for bladder cancer diagnosis that can boost the specificity of the diagnostic algorithm based on its suppression of the out-of-focus non-analyte-specific signals emanating from the neighboring normal tissue. In this article, we engineer and apply such a probe, having depth of field of approximately 280 µm, for Raman spectral acquisition from ex vivo normal and cancerous TURBT samples. Using this clinical dataset, a diagnostic algorithm based on principal component analysis and logistic regression is developed. We demonstrate that this approach results in comparable sensitivity but significantly higher specificity in relation to high-volume Raman spectral data. The application of only two principal components is sufficient for the discrimination of the samples underlining the robustness of the algorithm. Further, no discordance between replicate spectra is observed emphasizing the reproducible nature of the current diagnostic assessment. The high levels of sensitivity and specificity achieved in this proof-of-concept study opens substantive avenues for application of a confocal Raman probe during endoscopic procedures related to diagnosis and treatment of bladder cancer.

Investigation of the specificity of Raman spectroscopy in non-invasive blood glucose measurements.

Although several in vivo blood glucose measurement studies have been performed by different research groups using near-infrared (NIR) absorption and Raman spectroscopic techniques, prospective prediction has proven to be a challenging problem. An important issue in this case is the demonstration of causality of glucose concentration to the spectral information, especially as the intrinsic glucose signal is smaller compared with that of the other analytes in the blood-tissue matrix. Furthermore, time-dependent physiological processes make the relation between glucose concentration and spectral data more complex. In this article, chance correlations in Raman spectroscopy-based calibration model for glucose measurements are investigated for both in vitro (physical tissue models) and in vivo (animal model and human subject) cases. Different spurious glucose concentration profiles are assigned to the Raman spectra acquired from physical tissue models, where the glucose concentration is intentionally held constant. Analogous concentration profiles, in addition to the true concentration profile, are also assigned to the datasets acquired from an animal model during a glucose clamping study as well as a human subject during an oral glucose tolerance test. We demonstrate that the spurious concentration profile-based calibration models are unable to provide prospective predictions, in contrast to those based on actual concentration profiles, especially for the physical tissue models. We also show that chance correlations incorporated by the calibration models are significantly less in Raman as compared to NIR absorption spectroscopy, even for the in vivo studies. Finally, our results suggest that the incorporation of chance correlations for in vivo cases can be largely attributed to the uncontrolled physiological sources of variations. Such uncontrolled physiological variations could either be intrinsic to the subject or stem from changes in the measurement conditions.

Development of robust calibration models using support vector machines for spectroscopic monitoring of blood glucose.

Sample-to-sample variability has proven to be a major challenge in achieving calibration transfer in quantitative biological Raman spectroscopy. Multiple morphological and optical parameters, such as tissue absorption and scattering, physiological glucose dynamics and skin heterogeneity, vary significantly in a human population introducing nonanalyte specific features into the calibration model. In this paper, we show that fluctuations of such parameters in human subjects introduce curved (nonlinear) effects in the relationship between the concentrations of the analyte of interest and the mixture Raman spectra. To account for these curved effects, we propose the use of support vector machines (SVM) as a nonlinear regression method over conventional linear regression techniques such as partial least-squares (PLS). Using transcutaneous blood glucose detection as an example, we demonstrate that application of SVM enables a significant improvement (at least 30%) in cross-validation accuracy over PLS when measurements from multiple human volunteers are employed in the calibration set. Furthermore, using physical tissue models with randomized analyte concentrations and varying turbidities, we show that the fluctuations in turbidity alone causes curved effects which can only be adequately modeled using nonlinear regression techniques. The enhanced levels of accuracy obtained with the SVM based calibration models opens up avenues for prospective prediction in humans and thus for clinical translation of the technology.

Anatomy of noise in quantitative biological Raman spectroscopy.

Raman spectroscopy is a fundamental form of molecular spectroscopy that is widely used to investigate structures and properties of molecules using their vibrational transitions. It relies on inelastic scattering of monochromatic laser light irradiating the specimen. After appropriate filtering the scattered light is dispersed onto a detector to determine the shift from the excitation wavelength, which appears in the form of characteristic spectral patterns. The technique can investigate biological samples and provide real-time diagnosis of diseases. However, despite its intrinsic advantages of specificity and minimal perturbation, the Raman scattered light is typically very weak and limits applications of Raman spectroscopy due to measurement (im)precision, driven by inherent noise in the acquired spectra. In this article, we review the principal noise sources that impact quantitative biological Raman spectroscopy. Further, we discuss how such noise effects can be reduced by innovative changes in the constructed Raman system and appropriate signal processing methods.

Non-gated laser induced breakdown spectroscopy provides a powerful segmentation tool on concomitant treatment of characteristic and continuum emission.

We demonstrate the application of non-gated laser induced breakdown spectroscopy (LIBS) for characterization and classification of organic materials with similar chemical composition. While use of such a system introduces substantive continuum background in the spectral dataset, we show that appropriate treatment of the continuum and characteristic emission results in accurate discrimination of pharmaceutical formulations of similar stoichiometry. Specifically, our results suggest that near-perfect classification can be obtained by employing suitable multivariate analysis on the acquired spectra, without prior removal of the continuum background. Indeed, we conjecture that pre-processing in the form of background removal may introduce spurious features in the signal. Our findings in this report significantly advance the prior results in time-integrated LIBS application and suggest the possibility of a portable, non-gated LIBS system as a process analytical tool, given its simple instrumentation needs, real-time capability and lack of sample preparation requirements.

Spectroscopic approach for dynamic bioanalyte tracking with minimal concentration information.

Vibrational spectroscopy has emerged as a promising tool for non-invasive, multiplexed measurement of blood constituents - an outstanding problem in biophotonics. Here, we propose a novel analytical framework that enables spectroscopy-based longitudinal tracking of chemical concentration without necessitating extensive a priori concentration information. The principal idea is to employ a concentration space transformation acquired from the spectral information, where these estimates are used together with the concentration profiles generated from the system kinetic model. Using blood glucose monitoring by Raman spectroscopy as an illustrative example, we demonstrate the efficacy of the proposed approach as compared to conventional calibration methods. Specifically, our approach exhibits a 35% reduction in error over partial least squares regression when applied to a dataset acquired from human subjects undergoing glucose tolerance tests. This method offers a new route at screening gestational diabetes and opens doors for continuous process monitoring without sample perturbation at intermediate time points.

A facile and real-time spectroscopic method for biofluid analysis in point-of-care diagnostics.

BACKGROUND: Accurate and real-time information is critical for decision making, especially in medical applications, where any delay in diagnosis due to collection, transport and storage of biofluids can have substantial ramifications for disease management. RESULTS: We present a facile method for point-of-care biofluid diagnostics based on the spectroscopic analysis of cotton-swab contents using a Raman probe. A PCA algorithm was developed in order to understand the clustering behavior of different off-the-shelf pharmaceutical formulations based on the recorded spectral data. Furthermore, we employed the Raman probe to detect antibiotics in a human urine sample. Our observations suggest that it is possible to provide quantitative concentration determination of Raman-active analytes by using cotton swabs as a sampling probe, which offers a wealth of possibility for real-time measurement in clinical situations. CONCLUSION: We envision that the intrinsic simplicity of the proposed approach in conjunction with its capability for accurate analyte determination in biofluids will lead to its clinical translation and application in point-of-care settings in the near future.

Raman spectroscopy provides a powerful, rapid diagnostic tool for the detection of tuberculous meningitis in ex vivo cerebrospinal fluid samples.

In this letter, we propose a novel method for diagnosis of tuberculous meningitis using Raman spectroscopy. The silicate Raman signature obtained from Mycobacterium tuberculosis positive cases enables specific and sensitive detection of tuberculous meningitis from acquired cerebrospinal fluid samples. The association of silicates with the tuberculosis mycobacterium is discussed. We envision that this new method will facilitate rapid diagnosis of tuberculous meningitis without application of exogenous reagents or dyes and can be aptly used as a complementary screening tool to the existing gold standard methods.

Development and comparative assessment of Raman spectroscopic classification algorithms for lesion discrimination in stereotactic breast biopsies with microcalcifications.

Microcalcifications are an early mammographic sign of breast cancer and a target for stereotactic breast needle biopsy. Here, we develop and compare different approaches for developing Raman classification algorithms to diagnose invasive and in situ breast cancer, fibrocystic change and fibroadenoma that can be associated with microcalcifications. In this study, Raman spectra were acquired from tissue cores obtained from fresh breast biopsies and analyzed using a constituent-based breast model. Diagnostic algorithms based on the breast model fit coefficients were devised using logistic regression, C4.5 decision tree classification, k-nearest neighbor (k -NN) and support vector machine (SVM) analysis, and subjected to leave-one-out cross validation. The best performing algorithm was based on SVM analysis (with radial basis function), which yielded a positive predictive value of 100% and negative predictive value of 96% for cancer diagnosis. Importantly, these results demonstrate that Raman spectroscopy provides adequate diagnostic information for lesion discrimination even in the presence of microcalcifications, which to the best of our knowledge has not been previously reported.

Label-free route to rapid, nanoscale characterization of cellular structure and dynamics through opaque media.

We report a novel technique for label-free, rapid visualization of structure and dynamics of live cells with nanoscale sensitivity through traditionally opaque media. Specifically, by combining principles of near-infrared (NIR) spectroscopy and quantitative phase imaging, functional characterization of cellular structure and dynamics through silicon substrates is realized in our study. We demonstrate the efficacy of the new approach by full-field imaging of erythrocyte morphology in their native states with a nm path length sensitivity. Additionally, we observe dynamic variations of human embryonic kidney cells, through a silicon substrate, in response to hypotonic stimulation with ms temporal resolution that also provides unique insight into the underlying biophysical changes. The proposed technology is fundamentally suited for high-performance investigations of biological specimens and significantly expands the options for visualization in complex microfluidic devices fabricated on silicon.

Application of Raman spectroscopy to identify microcalcifications and underlying breast lesions at stereotactic core needle biopsy.

Microcalcifications are a feature of diagnostic significance on a mammogram and a target for stereotactic breast needle biopsy. Here, we report development of a Raman spectroscopy technique to simultaneously identify microcalcification status and diagnose the underlying breast lesion, in real-time, during stereotactic core needle biopsy procedures. Raman spectra were obtained ex vivo from 146 tissue sites from fresh stereotactic breast needle biopsy tissue cores from 33 patients, including 50 normal tissue sites, 77 lesions with microcalcifications, and 19 lesions without microcalcifications, using a compact clinical system. The Raman spectra were modeled on the basis of the breast tissue components, and a support vector machine framework was used to develop a single-step diagnostic algorithm to distinguish normal tissue, fibrocystic change (FCC), fibroadenoma, and breast cancer, in the absence and presence of microcalcifications. This algorithm was subjected to leave-one-site-out cross-validation, yielding a positive predictive value, negative predictive value, sensitivity, and specificity of 100%, 95.6%, 62.5%, and 100% for diagnosis of breast cancer (with or without microcalcifications) and an overall accuracy of 82.2% for classification into specific categories of normal tissue, FCC, fibroadenoma, or breast cancer (with and without microcalcifications). Notably, the majority of breast cancers diagnosed are ductal carcinoma in situ (DCIS), the most common lesion associated with microcalcifications, which could not be diagnosed using previous Raman algorithm(s). Our study shows the potential of Raman spectroscopy to concomitantly detect microcalcifications and diagnose associated lesions, including DCIS, and thus provide real-time feedback to radiologists during such biopsy procedures, reducing nondiagnostic and false-negative biopsies.

Raman spectroscopy provides a powerful diagnostic tool for accurate determination of albumin glycation.

We present the first demonstration of glycated albumin detection and quantification using Raman spectroscopy without the addition of reagents. Glycated albumin is an important marker for monitoring the long-term glycemic history of diabetics, especially as its concentrations, in contrast to glycated hemoglobin levels, are unaffected by changes in erythrocyte life times. Clinically, glycated albumin concentrations show a strong correlation with the development of serious diabetes complications including nephropathy and retinopathy. In this article, we propose and evaluate the efficacy of Raman spectroscopy for determination of this important analyte. By utilizing the pre-concentration obtained through drop-coating deposition, we show that glycation of albumin leads to subtle, but consistent, changes in vibrational features, which with the help of multivariate classification techniques can be used to discriminate glycated albumin from the unglycated variant with 100% accuracy. Moreover, we demonstrate that the calibration model developed on the glycated albumin spectral dataset shows high predictive power, even at substantially lower concentrations than those typically encountered in clinical practice. In fact, the limit of detection for glycated albumin measurements is calculated to be approximately four times lower than its minimum physiological concentration. Importantly, in relation to the existing detection methods for glycated albumin, the proposed method is also completely reagent-free, requires barely any sample preparation and has the potential for simultaneous determination of glycated hemoglobin levels as well. Given these key advantages, we believe that the proposed approach can provide a uniquely powerful tool for quantification of glycation status of proteins in biopharmaceutical development as well as for glycemic marker determination in routine clinical diagnostics in the future.

Portable optical fiber probe-based spectroscopic scanner for rapid cancer diagnosis: a new tool for intraoperative margin assessment.

There continues to be a significant clinical need for rapid and reliable intraoperative margin assessment during cancer surgery. Here we describe a portable, quantitative, optical fiber probe-based, spectroscopic tissue scanner designed for intraoperative diagnostic imaging of surgical margins, which we tested in a proof of concept study in human tissue for breast cancer diagnosis. The tissue scanner combines both diffuse reflectance spectroscopy (DRS) and intrinsic fluorescence spectroscopy (IFS), and has hyperspectral imaging capability, acquiring full DRS and IFS spectra for each scanned image pixel. Modeling of the DRS and IFS spectra yields quantitative parameters that reflect the metabolic, biochemical and morphological state of tissue, which are translated into disease diagnosis. The tissue scanner has high spatial resolution (0.25 mm) over a wide field of view (10 cm × 10 cm), and both high spectral resolution (2 nm) and high spectral contrast, readily distinguishing tissues with widely varying optical properties (bone, skeletal muscle, fat and connective tissue). Tissue-simulating phantom experiments confirm that the tissue scanner can quantitatively measure spectral parameters, such as hemoglobin concentration, in a physiologically relevant range with a high degree of accuracy (<5% error). Finally, studies using human breast tissues showed that the tissue scanner can detect small foci of breast cancer in a background of normal breast tissue. This tissue scanner is simpler in design, images a larger field of view at higher resolution and provides a more physically meaningful tissue diagnosis than other spectroscopic imaging systems currently reported in literatures. We believe this spectroscopic tissue scanner can provide real-time, comprehensive diagnostic imaging of surgical margins in excised tissues, overcoming the sampling limitation in current histopathology margin assessment. As such it is a significant step in the development of a platform technology for intraoperative management of cancer, a clinical problem that has been inadequately addressed to date.

Rapid and accurate determination of tissue optical properties using least-squares support vector machines.

Diffuse reflectance spectroscopy (DRS) has been extensively applied for the characterization of biological tissue, especially for dysplasia and cancer detection, by determination of the tissue optical properties. A major challenge in performing routine clinical diagnosis lies in the extraction of the relevant parameters, especially at high absorption levels typically observed in cancerous tissue. Here, we present a new least-squares support vector machine (LS-SVM) based regression algorithm for rapid and accurate determination of the absorption and scattering properties. Using physical tissue models, we demonstrate that the proposed method can be implemented more than two orders of magnitude faster than the state-of-the-art approaches while providing better prediction accuracy. Our results show that the proposed regression method has great potential for clinical applications including in tissue scanners for cancer margin assessment, where rapid quantification of optical properties is critical to the performance.