Development and first in‐human use of a Raman spectroscopy guidance system integrated with a brain biopsy needle

Navigation-guided brain biopsies are the standard of care for diagnosis of several brain pathologies. However, imprecise targeting and tissue heterogeneity often hinder obtaining high-quality tissue samples, resulting in poor diagnostic yield. We report the development and first clinical testing of a navigation-guided fiberoptic Raman probe that allows surgeons to interrogate brain tissue in situ at the tip of the biopsy needle prior to tissue removal. The 900 μm diameter probe can detect high spectral quality Raman signals in both the fingerprint and high wavenumber spectral regions with minimal disruption to the neurosurgical workflow. The probe was tested in three brain tumor patients, and the acquired spectra in both normal brain and tumor tissue demonstrated the expected spectral features, indicating the quality of the data. As a proof-of-concept, we also demonstrate the consistency of the acquired Raman signal with different systems and experimental settings. Additional clinical development is planned to further evaluate the performance of the system and develop a statistical model for real-time tissue classification during the biopsy procedure.

[1]  Christoph Krafft,et al.  Characterization of lipid extracts from brain tissue and tumors using Raman spectroscopy and mass spectrometry , 2009, Analytical and bioanalytical chemistry.

[2]  W. Hall The safety and efficacy of stereotactic biopsy for intracranial lesions , 1998, Cancer.

[3]  Kevin Petrecca,et al.  A new method using Raman spectroscopy for in vivo targeted brain cancer tissue biopsy , 2018, Scientific Reports.

[4]  H. Abramczyk,et al.  Development of a new diagnostic Raman method for monitoring epigenetic modifications in the cancer cells of human breast tissue , 2016 .

[5]  Yin-Cheng Huang,et al.  Stereotactic brain biopsy: Single center retrospective analysis of complications , 2009, Clinical Neurology and Neurosurgery.

[6]  A. Belli,et al.  Image-guided frameless stereotactic biopsy without intraoperative neuropathological examination. , 2010, Journal of neurosurgery.

[7]  Renato Amaro Zângaro,et al.  Discriminating neoplastic and normal brain tissues in vitro through Raman spectroscopy: a principal components analysis classification model. , 2013, Photomedicine and laser surgery.

[8]  G. Puppels,et al.  Raman spectroscopic characterization of porcine brain tissue using a single fiber-optic probe. , 2007, Analytical chemistry.

[9]  D. Roberts,et al.  Frameless robotically targeted stereotactic brain biopsy: feasibility, diagnostic yield, and safety. , 2012, Journal of neurosurgery.

[10]  H. Abramczyk,et al.  The biochemical, nanomechanical and chemometric signatures of brain cancer. , 2018, Spectrochimica acta. Part A, Molecular and biomolecular spectroscopy.

[11]  M. Trippel,et al.  Intraindividual comparison of histopathological diagnosis obtained by stereotactic serial biopsy to open surgical resection specimen in patients with intracranial tumours , 2013, Clinical Neurology and Neurosurgery.

[12]  Neda Haj-Hosseini,et al.  405 nm versus 633 nm for protoporphyrin IX excitation in fluorescence‐guided stereotactic biopsy of brain tumors , 2016, Journal of biophotonics.

[13]  V. Seifert,et al.  “Two is not enough” – Impact of the number of tissue samples obtained from stereotactic brain biopsies in suspected glioblastoma , 2018, Journal of Clinical Neuroscience.

[14]  D. McLean,et al.  Automated Autofluorescence Background Subtraction Algorithm for Biomedical Raman Spectroscopy , 2007, Applied Spectroscopy.

[15]  Jason D. Wright,et al.  Complications Following Stereotactic Needle Biopsy of Intracranial Tumors. , 2015, World neurosurgery.

[16]  P. Konrad,et al.  Neuro-Oncological Applications of Optical Spectroscopy , 2006, Technology in cancer research & treatment.

[17]  T. B. Bakker Schut,et al.  Raman spectroscopy for cancer detection and cancer surgery guidance: translation to the clinics. , 2017, The Analyst.

[18]  Jochen Herms,et al.  Optical needle endoscope for safe and precise stereotactically guided biopsy sampling in neurosurgery. , 2012, Optics express.

[19]  F. Saad,et al.  Mesoscopic characterization of prostate cancer using Raman spectroscopy: potential for diagnostics and therapeutics , 2018, BJU international.

[20]  Michael Jermyn,et al.  Combining high wavenumber and fingerprint Raman spectroscopy for the detection of prostate cancer during radical prostatectomy , 2018, Biomedical optics express.

[21]  A. A. Spector,et al.  The fatty acid composition of human gliomas differs from that found in nonmalignant brain tissue , 1996, Lipids.

[22]  Gerwin J Puppels,et al.  Fiber-optic probes for in vivo Raman spectroscopy in the high-wavenumber region. , 2005, Analytical chemistry.

[23]  A. Parau,et al.  Diagnosing clean margins through Raman spectroscopy in human and animal mammary tumour surgery: a short review , 2016, Interface Focus.

[24]  B. Wilson,et al.  A review of Raman spectroscopy advances with an emphasis on clinical translation challenges in oncology , 2016, Physics in medicine and biology.

[25]  J. Kros,et al.  Contemporary frameless intracranial biopsy techniques: Might variation in safety and efficacy be expected? , 2015, Acta Neurochirurgica.

[26]  A. Talari,et al.  Raman Spectroscopy of Biological Tissues , 2007 .

[27]  P. Woerdeman,et al.  Frameless image-guided stereotactic brain biopsies: emphasis on diagnostic yield , 2014, Acta Neurochirurgica.

[28]  Christoph Krafft,et al.  Near infrared Raman spectra of human brain lipids. , 2005, Spectrochimica acta. Part A, Molecular and biomolecular spectroscopy.

[29]  Kevin Petrecca,et al.  Raman spectroscopy detects distant invasive brain cancer cells centimeters beyond MRI capability in humans. , 2016, Biomedical optics express.

[30]  Johan M. Kros,et al.  Towards improving the safety and diagnostic yield of stereotactic biopsy in a single centre , 2010, Acta Neurochirurgica.

[31]  L. Bernstein,et al.  Intraoperative brain cancer detection with Raman spectroscopy in humans , 2015, Science Translational Medicine.

[32]  M. Hefti,et al.  5-Aminolevulinic acid-induced protoporphyrin IX fluorescence as immediate intraoperative indicator to improve the safety of malignant or high-grade brain tumor diagnosis in frameless stereotactic biopsies , 2012, Acta Neurochirurgica.

[33]  Kevin Petrecca,et al.  Raman spectroscopy in microsurgery: impact of operating microscope illumination sources on data quality and tissue classification. , 2017, The Analyst.

[34]  J. Peltier,et al.  Frameless robotic stereotactic biopsies: a consecutive series of 100 cases. , 2015, Journal of neurosurgery.

[35]  H. Abramczyk,et al.  The lipid-reactive oxygen species phenotype of breast cancer. Raman spectroscopy and mapping, PCA and PLSDA for invasive ductal carcinoma and invasive lobular carcinoma. Molecular tumorigenic mechanisms beyond Warburg effect. , 2015, The Analyst.

[36]  Ricardo J. Komotar,et al.  The role of 5-aminolevulinic acid in brain tumor surgery: a systematic review , 2016, Neurosurgical Review.

[37]  Kevin Petrecca,et al.  Highly Accurate Detection of Cancer In Situ with Intraoperative, Label-Free, Multimodal Optical Spectroscopy. , 2017, Cancer research.

[38]  Imiela Anna,et al.  Novel strategies of Raman imaging for brain tumor research , 2017, Oncotarget.

[39]  Brandy Broadbent,et al.  Intraoperative Raman Spectroscopy. , 2017, Neurosurgery clinics of North America.

[40]  Jacques Guyotat,et al.  Intraoperative Probe-Based Confocal Laser Endomicroscopy in Surgery and Stereotactic Biopsy of Low-Grade and High-Grade Gliomas: A Feasibility Study in Humans. , 2016, Neurosurgery.

[41]  Gregory W. Auner,et al.  Identification of Pediatric Brain Neoplasms Using Raman Spectroscopy , 2012, Pediatric Neurosurgery.

[42]  Matthias Kirsch,et al.  Raman spectroscopic grading of astrocytoma tissues: using soft reference information , 2011, Analytical and bioanalytical chemistry.

[43]  Wei Zheng,et al.  Classification of colonic tissues using near-infrared Raman spectroscopy and support vector machines. , 2008, International journal of oncology.