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Light scattering spectroscopy identifies the malignant potential of pancreatic cysts during endoscopy

Nature Biomedical Engineering volume 1, Article number: 0040 (2017) Cite this article

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Abstract

Pancreatic cancers are usually detected at an advanced stage and have poor prognosis. About one-fifth of these arise from pancreatic cystic lesions. Yet not all lesions are precancerous, and imaging tools lack adequate accuracy for distinguishing precancerous from benign cysts. Therefore, decisions on surgical resection usually rely on endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). Unfortunately, cyst fluid often contains few cells, and fluid chemical analysis lacks accuracy—which has dire consequences, including unnecessary pancreatic surgery for benign cysts and the development of cancer. Here, we report an optical spectroscopic technique, based on a spatial gating fibre-optic probe, that predicts the malignant potential of pancreatic cystic lesions during routine diagnostic EUS-FNA procedures. In a double-blind prospective study in 25 patients, with 14 cysts measured in vivo and 13 postoperatively, the technique achieved an overall accuracy of 95%, with a 95% confidence interval of 78–99%, in cysts with definitive diagnosis.

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Figure 1: Ex vivo optical spectroscopic differentiation of cystic neoplasms.
Figure 2: In vivo spatial gating fibre optic probe for use with EUS-FNA.
Figure 3: In vivo measurements during the endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) procedure.
Figure 4: In vivo optical spectroscopic differentiation of cystic neoplasms in 14 subjects.

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Acknowledgements

We thank Y. Li for help in data acquisition. This work was supported by US National Institutes of Health grants R01 EB003472 and R01 CA205431 and US National Science Foundation grants CBET-1402926 and CBET-1605116.

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Author notes

  1. Lei Zhang and Douglas K. Pleskow: These authors contributed equally to this work.

Authors and Affiliations

  1. Department of Medicine and Department of Obstetrics, Center for Advanced Biomedical Imaging and Photonics, Gynecology and Reproductive Biology, Beth Israel Deaconess Medical Center, Harvard University, Massachusetts, 02215, Boston, USA

    Lei Zhang, Vladimir Turzhitsky, Edward Vitkin, Yuri Zakharov, Umar Khan, Irving Itzkan, Le Qiu & Lev T. Perelman

  2. Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard University, Massachusetts, 02215, Boston, USA

    Douglas K. Pleskow, Tyler M. Berzin, Mandeep Sawhney, Fen Wang, Ram Chuttani & Lev T. Perelman

  3. Department of Pathology, Beth Israel Deaconess Medical Center, Harvard University, Massachusetts, 02215, Boston, USA

    Eric U. Yee, Shweta Shinagare & Jeffrey D. Goldsmith

  4. Division of Biostatistics and Biomathematics, Massachusetts General Hospital, Harvard University, Massachusetts, 02114, Boston, USA

    Saveli Goldberg

  5. Biological and Biomedical Sciences Program, Harvard University, Massachusetts, 02115, Boston, USA

    Lev T. Perelman

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Contributions

L.Q., D.K.P. and L.T.P. conceived the method and initiated the project; L.Q. and L.T.P. supervised the project; L.Q., L.Z., U.K. and Y.Z. constructed the system; D.K.P., R.C., M.S. and T.M.B. performed clinical procedures; L.Z., Y.Z., U.K. and L.Q. performed measurements; E.U.Y., S.S. and J.D.G. evaluated the histology specimens; E.V. performed the data analysis; L.Z., E.U.Y., V.T., J.D.G., F.W., L.Q. and L.T.P. evaluated the method; S.G. performed statistical analysis; V.T., I.I., T.M.B., L.Z. and L.Q. contributed to the writing of the manuscript; L.T.P. wrote the manuscript.

Corresponding authors

Correspondence to Le Qiu or Lev T. Perelman.

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The authors declare no competing financial interests.

Supplementary information

Supplementary Information

Supplementary figure. (PDF 246 kb)

Supplementary Video 1

Video recording of an endoscopic ultrasound-guided fine-needle-aspiration procedure in a pancreatic cyst, combined with light scattering spectroscopic (LSS) measurements. The overall duration of the LSS data collection is less than 1.5 minutes. (AVI 16649 kb)

Supplementary Video 2

Same video recording as in Supplementary Video 1, with captions explaining the procedural steps, and with the video speed adjusted. (AVI 15042 kb)

Supplementary Video 3

Operation of the probe-latching mechanism, extending the probe tip from the needle and retracting it into the needle. The position-locking button is also shown. (AVI 7221 kb)

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Zhang, L., Pleskow, D., Turzhitsky, V. et al. Light scattering spectroscopy identifies the malignant potential of pancreatic cysts during endoscopy. Nat Biomed Eng 1, 0040 (2017). https://doi.org/10.1038/s41551-017-0040

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