Biomedical Engineering Reference
In-Depth Information
Designing Therapy and Guiding Tissue Biopsy
Tissue biopsies are usually obtained from lesions after localisation by radio-
logical imaging. However, as we have already pointed out, imaging cannot
reliably distinguish among normal, benign, and malignant tissue areas, and
hence, some tissue biopsies are not diagnostic due to sampling error, requir-
ing a second attempt at biopsy. This obviously results in patient discomfort,
distress, and anxiety, as well as a delay in diagnosis and initiation of treat-
ment. The diagnostic pathway can be shortened by precise localisation of
the disease process including malignancy and better yield of tissue biopsy,
where spectroscopy can help.
Evaluating Efficacy and Response to Treatment
In a significant number of conditions, including cancers, it is desirable to
assess response to treatment, which can be a prognostic factor in itself.
In some cancers, for example, oesophageal, breast, lung, rectal, ovarian, and
bladder cancers, chemotherapy and/or other treatments are administered
prior to surgery for various reasons. The response is determined radio-
logically, which may not be entirely accurate as it is difficult to distinguish
between viable residual cancer and tissue necrosis as a result of treatment
response. This differentiation can help in accurate planning of subsequent
surgical treatment.
Earlier Detection of Recurrence and Metastases
In adults with multiple brain lesions, the primary differential diagnosis is
that of metastases. In the presence of a single lesion, differentiating between
primary and secondary brain tumours is important but not often possible.
Unfortunately, proton MR spectroscopic findings are also nonspecific in this
sit uation [11,23].
It should be possible for vibrational spectroscopy to detect not only the dif-
ference between the primary and secondary brain tumours, due to its precise
nature, but also the tumour recurrence before MR images become abnormal.
Spectroscopy should be similarly able to distinguish among lung, liver,
bone, peritoneal, adrenal, and other metastases from various primary can-
cers with good precision, which would be particularly useful in cases where
these lesions are deep-seated and not easily amenable to biopsy.
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