Pellionisz Peter A, Namiri Nikan K, Suematsu Gregory, Hu Yong, Braganza Ameet, Rangwalla Khuzaima, Denson Daniel J, Badran Karam, Francis Nathan C, Maccabi Ashkan, Saddik George, Taylor Zachary, St John Maie A, Grundfest Warren S
Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA.
UCLA Head and Neck Cancer Program, David Geffen School of Medicine at UCLA, Los Angeles, CA.
Yale J Biol Med. 2018 Sep 21;91(3):215-223. eCollection 2018 Sep.
Oral and head and neck squamous cell carcinoma (OSCC) is the sixth most common cancer worldwide. The primary management of OSCC relies on complete surgical resection of the tumor. Margin-free resection, however, is difficult given the devastating effects of aggressive surgery. Currently, surgeons determine where cuts are made by palpating edges of the tumor. Accuracy varies based on the surgeon's experience, the location and type of tumor, and the risk of damage to adjacent structures limiting resection margins. To fulfill this surgical need, we contrast tissue regions by identifying disparities in viscoelasticity by mixing two ultrasonic beams to produce a beat frequency, a technique termed vibroacoustography (VA). In our system, an extended focal length of the acoustic stress field yields surgeons' high resolution to detect focal lesions in deep tissue. VA offers 3D imaging by focusing its imaging plane at multiple axial cross-sections within tissue. Our efforts culminate in production of a mobile VA system generating image contrast between normal and abnormal tissue in minutes. We model the spatial direction of the generated acoustic field and generate images from tissue-mimicking phantoms and specimens with squamous cell carcinoma of the tongue to qualitatively demonstrate the functionality of our system. These preliminary results warrant additional validation as we continue clinical trials of tissue. This tool may prove especially useful for finding tumors that are deep within tissue and often missed by surgeons. The complete primary resection of tumors may reduce recurrence and ultimately improve patient outcomes.
口腔和头颈部鳞状细胞癌(OSCC)是全球第六大常见癌症。OSCC的主要治疗方法依赖于对肿瘤进行完整的手术切除。然而,由于根治性手术的破坏性影响,无边缘切除很困难。目前,外科医生通过触诊肿瘤边缘来确定切口位置。准确性因外科医生的经验、肿瘤的位置和类型以及对相邻结构造成损伤从而限制切除边缘的风险而有所不同。为满足这一手术需求,我们通过混合两束超声波以产生拍频来识别粘弹性差异,以此对比组织区域,这种技术称为振动声成像(VA)。在我们的系统中,声应力场的延长焦距使外科医生能够高分辨率地检测深部组织中的局灶性病变。VA通过将其成像平面聚焦在组织内的多个轴向横截面上提供三维成像。我们的努力最终成果是生产出一种移动VA系统,该系统能在几分钟内生成正常组织与异常组织之间的图像对比度。我们对所产生声场的空间方向进行建模,并从组织模拟体模和舌鳞状细胞癌标本生成图像,以定性地展示我们系统的功能。随着我们继续进行组织的临床试验,这些初步结果需要进一步验证。这个工具可能对发现深藏于组织中且外科医生常常遗漏的肿瘤特别有用。肿瘤的完整初次切除可能会降低复发率并最终改善患者预后。