A research group at VU University Amsterdam (The Netherlands) has shown that an ultrafast laser technique can reveal exactly where brain tumors are, producing images in less than a minute and enabling surgeons to remove tumors without compromising healthy tissue.
Related: OCT-based approach facilitates brain cancer surgery
Pathologists typically use staining methods, in which chemicals like hematoxylin and eosin turn different tissue components blue and red, revealing its structure and whether there are any tumor cells. But for a definitive diagnosis, this process can take up to 24 hours—which means surgeons may not realize some cancerous tissue has escaped from their attention until after surgery, requiring a second operation and more risk.
But the research team's new ultrafast laser technique is label-free—instead, they fire short, 20-fs-long laser pulses into the tissue, and when three photons converge at the same time and place, the photons interact with the nonlinear optical properties of the tissue. Through well-known phenomena in optics called second- and third-harmonic generation, these interactions produce a single photon.
The key is that the incoming and outgoing photons have different wavelengths. The incoming photons are at 1200 nm, long enough to penetrate deep into the tissue. The single photon that is produced, however, is at 600 or 400 nm, depending on if it's second- or third-harmonic generation. The shorter wavelengths mean the photon can scatter in the tissue. The scattered photon thus contains information about the tissue, and when it reaches a detector—in this case, a high-sensitivity gallium arsenide phosphide (GaAsP) photomultiplier tube—it reveals what the tissue looks like inside.
The research team used the technique to analyze glial brain tumors, which are particularly deadly because it's hard to get rid of tumor cells by surgery, irradiation, and chemotherapy without substantial collateral damage to the surrounding brain tissue. They tested their method on samples of glial brain tumors from humans, finding that the histological detail in these images was as good—if not better—than those made with conventional staining techniques. They were able to make most images in under a minute. The smaller ones took less than a second, while larger images of a few square millimeters took five minutes—making it possible to do it in real time in the operating room, according to Marloes Groot of VU University Amsterdam, who led the work.
Now that they've shown their approach works, the researchers are developing a handheld device that a surgeon can use to identify a tumor's border during surgery. The incoming laser pulses can only reach a depth of about 100 µm into the tissue. To reach farther, Groot envisions attaching a needle that can pierce the tissue and deliver photons deeper, allowing diagnosis during an operation and possibly before surgery begins.
Full details of the work appear in the journal Biomedical Optics Express; for more information, please visit http://dx.doi.org/10.1364/boe.7.001889.
