Diagnosis of tumours during tissue conserving surgery by multimodal spectral imaging

在英国，每三个人中就有一个会在一生中患上癌症。癌症的发病率在全球范围内持续增加，医疗保健提供者在管理这一不断扩大的患者群体方面面临着越来越多的挑战。然而，新的成像技术允许在早期阶段检测肿瘤，现在比以往任何时候都有更多的癌症患者可以通过手术成功治疗。组织保存手术是一种先进的外科手术，它试图只切除癌组织，而将健康组织留在原位。在皮肤保护手术（也称为莫氏显微手术）中，一层又一层的组织被切除，并在显微镜下检查，以确保所有的癌症都被切除。当只剩下健康组织时，该过程停止。成功去除所有癌细胞是降低癌症复发率的关键。在确保所有的癌症都被切除和尽可能多地保留健康组织以减少疤痕和毁容之间总是要取得平衡。然而，真实的挑战是在手术过程中观察肿瘤时要知道肿瘤的起始和终止位置，以便外科医生知道何时停止切割。尽管莫氏手术对基底细胞癌的治愈率最高，基底细胞癌是人类最常见的癌症类型，在英国每年约有60，000名新患者，但在显微镜下每层大约需要1-2小时的准备和诊断。高成本和高度专业化的外科医生的需要，限制了莫氏手术在英国的可用性，并导致“邮政编码”治疗的变化。与莫氏手术相比，保乳手术（每年超过10，000例手术）要复杂得多，并且由于实际原因，通过制备薄组织标本进行诊断的传统方法不能在手术期间进行。因此，在英国，每年有2,000多名患者需要进行第二次手术，通常是完全切除乳房。最近，我的研究小组开发了一种新的方法来诊断手术中切除的组织层中的癌细胞。该技术的主要优点是消除了耗时的组织固定、染色和切片步骤。这种新的诊断方法使用了两种技术的组合，称为自体荧光成像和拉曼散射，可以测量组织的分子组成，并提供癌症的客观诊断。然而，这一突破仅仅是一个开始，需要进一步的工作来推动这些成功并改善患者护理。在短期和中期内，我将致力于通过开发一种同时测量组织十八个区域的拉曼光谱的方法，将皮肤癌的诊断时间缩短到几分钟。我们将与癌症外科医生合作，将这项新技术扩展到其他癌症的诊断，如乳腺癌和肺癌。这将通过优化自发荧光成像和拉曼散射来实现，以考虑这些组织的化学组成。从长远来看，我计划开发基于多模态光谱成像的新型手持式医疗设备，外科医生可以使用它来直接诊断身体上的组织，只有在检测到癌细胞时才能切除组织。这些肿瘤诊断方法可以彻底改变癌症的手术治疗，为外科医生提供一种快速客观的方法，以确保所有癌细胞都被切除，同时尽可能多地保留健康组织。为了实现这些雄心勃勃的目标，我将与其他科学家、工程师、医生、外科医生和工业界密切合作。这种合作将确保利用尖端科学和工程来开发领先的医疗保健技术，以造福患者。

One in three people in the UK population will develop cancer during their life time. The incidence of cancer continues to increase world-wide and healthcare providers are facing increasing challenges in the management of this expanding group of patients. However, new imaging technologies allow detection of tumours at earlier stages and now more cancer patients than ever can be successfully treated by surgery. Tissue conserving surgery is an advanced surgical procedure that tries to only remove cancerous tissue and leave healthy tissue in place. In skin conserving surgery (also known as Mohs micrographic surgery), one layer after another of tissue is cut away and examined under the microscope to make sure that all the cancer is out. This process is stopped when only healthy tissue is left. Successful removal of all cancer cells is the key to achieving lower rates of the cancer returning. There is always a balance to be struck between making sure that all the cancer is removed and preserving as much healthy tissue as possible in order to reduce scarring and disfigurement. The real challenge however is to know where the cancer starts and ends when looking at it during an operation so that the surgeon knows when to stop cutting.Although Mohs surgery provides the highest cure rates for basal cell carcinoma, the most common type of cancer in humans with ~60,000 new patients each year in the UK, it takes around 1-2 hours per layer to prepare and diagnose under the microscope. The high costs and the need for highly specialized surgeons, has limited the availability of Mohs surgery in the UK and led to "post-code" treatment variability. Compared to Mohs surgery, breast conserving surgery (more than 10,000 procedures per year) is considerably more complex and for practical reasons, the traditional methods of diagnosis by preparing thin tissue specimens cannot be performed during surgery. As a consequence, in England more than 2,000 patients per year require a second operation, usually complete removal of the breast.Recently, my research group has developed a new method to diagnose cancer cells in tissue layers removed during surgery. The main advantage of this technique is that the time consuming steps of tissue fixation, staining, and sectioning are eliminated. This new diagnosis method uses a combination of two techniques called auto-fluorescence imaging and Raman scattering, that can measure the molecular composition of tissue and provide objective diagnosis of cancer. However, this breakthrough is just the beginning and further work is required to take these successes forward and improve patient care. In the short and medium term, I will focus on reducing the diagnosis time for skin cancers to only a few minutes by developing a method to measure Raman spectra from eighteen regions of the tissue simultaneously. In collaboration with cancer surgeons, we will expand this new technology to diagnosis of other cancers, such as breast and lung. This will be achieved by optimizing the auto-fluorescence imaging and Raman scattering to take into consideration the chemical make up of these tissues. In the longer term, I plan to develop novel hand-held medical devices based on multimodal spectral imaging that could be used by the surgeons to diagnose the tissues directly on the body and remove tissue only if cancerous cells are detected. These methods for tumour diagnosis can revolutionise the surgical treatment of cancers, by providing a fast and objective way for surgeons to make sure that all cancer cells have been removed whilst at the same time preserving as much healthy tissue as possible. To achieve these ambitious objectives I will work in close partnership with other scientists, engineers, doctors, surgeons and industry. Such collaborations will ensure that cutting-edge science and engineering is exploited to develop leading healthcare technologies for the benefit of patients.