Fluorescence imaging techniques for detection of oral cancer

Need for better oral cancer imaging techniques

Societal problem

Despite the general accessibility of the oral cavity, multiple screening and detection techniques during physical examination, many malignancies are not diagnosed until late stages of disease. Occurrence of oral cancer in 2012 resulted in 372,000 new cases and over 150,000 deaths. 5 year mortality is approx. 50%. 8th most common cancer for men; Total market is 12,500 practices, total value of market is > 150 M€/yr.

Oral cancer is difficult to diagnose

Often no visible lesions or discolorations in early stage (local).

Risk factors for oral cancer

Risk factors include tobacco, alcohol and HPV 16. Sufferers are 20 times higher risk of developing a second cancer.

Benefit if early diagnosis

Early diagnosis results in >80% survival.

Target Users – primary screeners

Otolaryngologists,
Oral Maxillofacial Surgeons,
Dentists,
Radiation Oncologists,
Nurse Practitioners.

Current Test Methods

History, COE, Adjunctive tools (Blue light, Dye, Brush Biopsy).
These test methods only result in a referral or Biopsy. No Diagnosis is made as the current test methods are not accurate enough.

Our solution – The EDOCAL system

Early Cancer Detection Using Photonic Crystal Lasers

Fast & reliable oral cancer detection

2M created the EDOCAL system based on fluorescence imaging techniques for early detection of oral cancer. The underlying knowhow and expertise is also applicable for other cancer types. The technology platform can be integrated in other tools and medical devices.

Current status

2M has build up the fundamental technical and medical knowhow to enable discrimination of cancerous cells from non-cancerous cells. This has resulted in a prototype that has tested in a number of patient studies. The technology and knowhow is ready for further commercialization.

In the meanwhile 2M is venturing in a number of new projects on early cancer detection and diagnostics further expanding our knowhow base.

Key features

Fewer biopsies – improved interpretation of oral mucosal abnormalities leading to fewer referrals/biopsies

Real-time imaging during surgery

Identify lesion type – Cross references to lesion database to help identify the lesion type

Superior differential diagnosis – Indicates optimum biopsy sites

Superior sensitivity and specificity

Patented technologies

Specifications of the EDOCAL system

System

Setup for multi-wavelength tissue illumination and integrade sensing
Technology: multi-wavelength fluorescence imaging
Application: mouth and throat cancer
Clinical trial completed
Complete technical optical, hardware, signal processing & application development by 2M
Portable

Main unit

Wavelengths: 6 laser sources and 4 LEDs from 365nm to 625nm
Spectrometer based signal processing

Senso probe

Light directed via optical fiber to human tissue
Fluorescence “return” emission collected via same fiber

Signal processing & algorithms

Light information is analyzed with computer with signal processing software

Combining fluorescence & conventional imaging techniques

Improved fluorescence using multi-wavelength laser technology

Technological solution based on the combination of a multi-laser sensor, image reference database and analytical software/algorithms. This solution provides effective diagnostic indications of tissue under investigation.

Conventional camera based imaging

An oral imaging system that helps to visualize and track progress of certain problems over time and provides fact based information about the problem area. The solution is affordable and can easily be added to any dentist practice.

System integrator, miniaturization and application

2M supports all development steps from early research to functional prototypes to final product.

FROM

First functional model

Focus: narrow band light sources, enough output power, clarify exact requirements with clinicians.

TO

Fully portable device for clinical tests

Miniaturization, downsizing, cost-down engineering, clinical use and approval requirements.

Practical side tools for mouth and throat cancer

Patient management software application
Spot & log progression of ulcers over time
Image morphing to allow easy comparison between images
Stores all edocal measurement data providing single interface

Earlier H2020 projects on cancer detection using laser photonics

EDOCAL Demonstrator

The project is funded under the FP7 program. Project name: EDOCALD (FP7 project number 605254)

In cancer, tissue cells tend to create many additional blood vessels to support their growth. The molecule protoporphyrin (PpIX) is generally present in blood vessels and exhibits red fluorescence when excited with UV or blue light in the 360-425 nm range. Cancer cells and pre-cancer cells are detected by observing the red fluorescence at a matching excitation wavelength. The wavelength of the laser has to be tunable as the matching wavelength depends on the person, type of illness and presence of other chemicals. Baselines are created using surrounding healthy tissue.

Advanced Bladder cancer LAser Diagnostics and thErapy (ABLADE)

Seventh Framework Programme, Grant Agreement No: 324370
Project Start Date: 10/04/2013

The ABLADE project stems from the innovative idea to transfer the technologies of multi-functional lasers to the endoluminal approach for managing the diagnosis and treatment of urinary bladder cancers, thus improving early diagnosis and accuracy over the current white light based endoscopic approach and transurethral resection using electrodiathermy.
This transfer of knowledge is enabled by the incorporation of new laser sources with different wavelengths into a compact system designed specifically to address some of the unmet clinical needs identified by a large systematic review with meta analysis and cost-effectiveness study.
The ultimate goal of ABLADE is to dramatically enhance the advantages of traditional flexible endoscopic inspection of the urinary bladder by integrating new multifunctional laser diagnostic and phototherapy technologies to realise a system suitable for outpatients or day case based diagnosis and treatment of the urinary bladder.

Early Cancer Detection Using Photonic Crystal Lasers (EDOCAL)

The EDOCAL project is being funded by the 7 th Framework Program for Research and Technological Development, grant agreement number 231993, by the European Union.

The aim of the EDOCAL project is to create a breakthrough tool for early detection of cancerous cells by combining state of the art laser and imaging technology with leading medical research. It combines advanced, proven, low cost telecom and state of the art semiconductor technologies with the latest advances and insights into medical procedures provided by the RTD partners.