Satadru Ray

Autofluorescence of normal, benign, and malignant ovarian tissues: a pilot study.

OBJECTIVE The objective of this study is to evaluate the efficacy of laser-induced fluorescence (LIF) data obtained at 325-nm pulsed laser excitation for the discrimination of normal, benign, and malignant ovarian tissues. BACKGROUND DATA Several studies have reported that the autofluorescence technique has a high specificity and sensitivity for discrimination between diseased and non-diseased tissues of various cancers, and also has the advantages of being non-invasive and producing a real-time diagnosis. When using this technique on ovarian tissues in most of the previously reported studies, multivariate statistical tools were used and classification analyses were carried out. MATERIALS AND METHODS Autofluorescence spectra of normal, benign, and malignant ovarian tissues were recorded with 325-nm pulsed laser excitation in the spectral region from 350-600 nm in vitro. The spectral analysis for discrimination between the different types of tissues was carried out using principal component analysis (PCA)-based non-parametric k-nearest neighbor (k-NN) analysis. RESULTS A total of 97 (34 normal, 33 benign, and 30 malignant) spectra were obtained from 22 subjects with normal, benign, and malignant tissues. The discrimination analysis of data using a PCA-based k-NN algorithm showed very good discrimination. The performance of the analysis was evaluated by calculating statistical parameters, specificity, sensitivity, and accuracy and were found to be 100%, 90.90%, and 94.2%, respectively. CONCLUSION The results show that the discrimination of normal, benign, and malignant ovarian conditions can be achieved quite successfully using LIF.

Numb chin syndrome as a manifestation of metastatic squamous cell carcinoma of esophagus

Numb chin syndrome (NCS) is a sensory neuropathy presenting with numbness of the chin in the distribution of the mental nerve and the branches of the mandibular division of the trigeminal nerve. Though it can be caused by a benign process, NCS should be regarded as being due to malignancy until proven otherwise. Among the malignancies that cause NCS the most common are breast cancer, prostate cancer, and lymphoreticular malignancy. In squamous cell carcinoma (SCC) of the esophagus, spread to the mandible is a rare and often late event. An often overlooked clinical sign in mandibular metastases is hypoesthesia or paresthesia over the peripheral distribution of the inferior alveolar nerve/mental nerve; this sign has been referred to in the literature as NCS or numb lip syndrome or mental nerve neuropathy. Rarely, this may be the first presentation of a disseminated malignancy. Prognosis is usually poor. The discovery of this symptom should alert the clinician to the possibility of disseminated disease. In this article we report a rare case of metastatic SCC of the esophagus in a 40-year-old male patient who presented with NCS. We also review the mechanism, causes, and evaluation of NCS.

Photoacoustic spectroscopy of ovarian normal, benign, and malignant tissues: a pilot study

Photoacoustic spectra of normal, benign, and malignant ovarian tissues are recorded using 325-nm pulsed laser excitation in vitro. A total of 102 (34 normal, 38 benign, and 30 malignant) spectra are obtained from 22 samples belonging to normal, benign, and malignant subjects. Applying multi-algorithm approach, comprised of methods such as, principal component analysis (PCA) based k-nearest neighbor (k-NN) analysis, artificial neural network (ANN) analysis, and support vector machine (SVM) analysis, classification of the data has been carried out. For PCA, first the calibration set is formed by pooling 45 spectra, 15 belonging to each of pathologically certified normal, benign, and malignant samples. PCA is then performed on the data matrix, comprised of the six spectral features extracted from each of 45 calibration samples, and three principal components (PCs) containing maximum diagnostic information are selected. The scores of the selected PCs are used to train the k-NN, ANN, and SVM classifiers. The ANN used is a classical multilayer feed forward network with back propagation algorithm for its training. For k-NN, the Euclidean distance based algorithm is used and for SVM, one-versus-rest multiclass kernel-radial basis function is used. The performance evaluation of the classification results are obtained by calculating statistical parameters like specificity and sensitivity. ANN and k-NN techniques showed identical performance with specificity and sensitivity values of 100 and 86.76%, whereas SVM had these values at 100 and 80.18%, respectively. In order to determine the relative diagnostic performance of the techniques, receiver operating characteristics analysis is also performed.

Second Primary Malignant Neoplasms: A Clinicopathological Analysis from a Cancer Centre in India

CONTEXT Patients diagnosed with a cancer have a life time risk of developing another de novo malignancy depending on various inherited, environmental and iatrogenic risk factors. Of late the detection of new primary has increased mainly due to refinement in both diagnostic and treatment modalities. Cancer victims are surviving longer and thus are more likely to develop a new metachronous malignancy. AIMS To report our observed trend of increase in prevalence of both synchronous and metachronous second malignant neoplasms among cancer victims and to review the relevant literature. SETTINGS AND DESIGN A hospital based retrospective collection of prospective data of patients diagnosed with second denovo malignancy. MATERIALS AND METHOD The study was conducted over a 5 year period from July 2008 to June 2012. All patients diagnosed with a histologically proven second malignancy as per Warren Gates criteria were included. Various details regarding sex, age at presentation, synchronous or metachronous, treatment and outcome were recorded. CONCLUSIONS The occurrence of multiple primary malignancies is not rare. Awareness of the possibility alerts the clinician in evaluation of patients with a known malignancy presenting with unusual sites of metastasis. Individualizing the treatment according to the stages of the primaries will result in durable cancer control particularly in synchronous double malignancy.

Malignant extrarenal rhabdoid tumor of the vulva in an adult

Sarcomas of the vulva account for only 1-3% of all vulvar malignancies. Most common vulvar sarcomas are leiomyosarcomas, malignant fibrohistiocytomas, and aggressive angiomyxomas. Malignant rhabdoid tumor (MRT) of the kidney is a distinctive clinicopathological entity that is recognized as a highly aggressive renal tumor of childhood. Extrarenal malignant rhabdoid tumors have been proposed to exist at several sites, including soft parts. MRT of the vulva is a rare and very aggressive neoplasm. Median survival reported in other studies is 9 months. Only 10 cases have been reported thus far in the English literature. We are reporting the 11 th case who remains disease free 30 months following surgery and radiotherapy till the time of reporting.

Prediction of absorption coefficients by pulsed laser induced photoacoustic measurements

In the current study, a pulsed laser induced photoacoustic spectroscopy setup was designed and developed, aiming its application in clinical diagnostics. The setup was optimized with carbon black samples in water and with various tryptophan concentrations at 281nm excitations. The sensitivity of the setup was estimated by determining minimum detectable concentration of tryptophan in water at the same excitation, and was found to be 0.035mM. The photoacoustic experiments were also performed with various tryptophan concentrations at 281nm excitation for predicting optical absorption coefficients in them and for comparing the outcomes with the spectrophotometrically-determined absorption coefficients for the same samples. Absorption coefficients for a few serum samples, obtained from some healthy female volunteers, were also determined through photoacoustic and spectrophotometric measurements at the same excitations, which showed good agreement between them, indicating its clinical implications.

A screening model for oral cancer using risk scores: development and validation

OBJECTIVE A study was conducted to develop and validate a screening model using risk scores to identify individuals at high risk for developing oral cancer in an Indian population. METHODS Life-course data collected from a multicentre case-control study in India were used. Interview was conducted to collect information on predictors limited to the time before the onset of symptoms or cancer diagnosis. Predictors included statistically significant risk factors in the multivariable model. A risk score for each predictor was derived from respective odds ratios (OR). Discrimination of the final model, risk scores and various risk score cut-offs was examined using the c statistic. The optimal cut-off was determined as the one with good area under curve (AUC) and high sensitivity. Predictive ability of the regression model and cut-off risk score was determined by calculating sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Models were validated from a bootstrap sample. RESULTS Smoking, chewing quid and/or tobacco, alcohol, a family history of upper aero-digestive tract cancer, diet and oral hygiene behaviour were the predictors. Risk scores ranged from 0 to 28. Area under the receiver operating characteristic (ROC) curve for risk scores was good (0.866). The sensitivity (0.928) and negative predictive value (0.927) were high, while specificity (0.603) and positive predictive value (0.607) were low for a risk score cut-off of 6. CONCLUSION A risk score model to screen for individuals with high risk of oral cancer with satisfactory predictive ability was developed in the Indian population. Validation of the model in other populations is necessary before it can be recommended to identify subgroups of the population to be directed towards more extensive clinical evaluation.

Serum butyrylcholinesterase and zinc in breast cancer

Context: Even though, a large number of serological, molecular markers have been proposed for breast cancer screening, most of them lack specificity, sensitivity, prognostic value, and cost effectiveness. Butyrylcholinesterase (BChE) and its genes are aberrantly expressed in a variety of human cancers. It has-been linked to tumorigenesis, cell proliferation, and cell differentiation. Zinc (Zn) is a cofactor for superoxide dismutase, an enzyme that protects cellular components against free radical-induced damage and carcinogenesis. Therefore, the aim of present study was to estimate and compare serum BChE and serum Zn levels in healthy controls and biopsy proven breast cancer patients before definitive therapy. Aims: To estimate and compare serum BChE and serum Zn levels in healthy controls and biopsy proven breast cancer patients before definitive therapy. Settings and Design: Serum BChE and Zn were estimated in 46 newly diagnosed (preoperative) female patients with breast cancer and 50 healthy female volunteers. Subjects and Methods: Serum BChE and Zn were estimated by spectrophotometric method. Statistical Analysis Used: Data was expressed as median and inter quartile range. Comparisons between different stages of cancer were done using Kruskal–Wallis test. Results: There was a significant increase in serum BChE and Zn in breast cancer patients compared to controls (P < 0.001). Serum BChE showed a significant increase and Zn was significantly decreased in different stages of breast cancer. Conclusions: Both BChE and Zn are inexpensive and can easily be analyzed and may play a role in the management of breast cancer.

Hypermethylation of Death-Associated Protein Kinase (DAPK1) and its association with oral carcinogenesis - An experimental and meta-analysis study

OBJECTIVES The value of abnormal DNA methylation of DAPK1 promoter and its association with various cancers have been suggested in the literature. To establish the significance of DNA methylation of DAPK1 promoter in oral squamous cell carcinoma (OSCC), we a) performed a case-control study, b) evaluated published data for its utility in the diagnosis and prognosis of OSCC and c) identified the association of DAPK1 gene expression with promoter DNA methylation status. DESIGN Bisulfite gene sequencing of DAPK1 promoter region was performed on non-malignant and malignant oral samples. Further, using a systematic search, 330 publications were retrieved from PubMed, Scopus, and Google Scholar and 11 relevant articles were identified. RESULTS Significant association of DAPK1 promoter methylation with OSCC (p<0.0001) was observed in the case-control study. The studies chosen for meta-analysis showed prognostic and predictive significance of DAPK1 gene promoter, despite defined inconsistencies in few studies. Overall, we obtained a statistically significant (p-value<0.001) association for both sensitivity and specificity of DAPK1 DNA promoter methylation in oral cancer cases, without publication bias. CONCLUSION DNA hypermethylation of DAPK1 gene promoter is a promising biomarker for OSCC prediction/prognostics and suggests further validation in large distinct cohorts to facilitate translation to clinics.

Photoacoustic spectroscopy based evaluation of breast cancer condition

Photoacoustic spectroscopy, a hybrid of optics and acoustics has been gaining popularity in the biomedical field very fast. The main aim in the present study was to apply this technique to detect and distinguish breast tumor tissues from normal and hence develop a tool for clinical applications. There were 224 photoacoustic spectra recorded from 28 normal and 28 breast tumor tissues using PZT detector at 281nm pulsed laser excitations from Nd-YAG laser pumped frequency doubled dye laser system. The recorded time domain photoacoustic spectra were fast Fourier transformed into frequency domain patterns in the frequency region 0-1250kHz and from each pattern, 7 features (mean, median, mode, variance, standard deviation, area under the curve & spectral residual after fitting with 10th degree polynomial) were extracted using MATLAB algorithms. These features were then tested for their significance between normal and malignant conditions using Student T-test and two of them (variance, std. deviation) showing significant variation were selected for further discrimination analysis using supervised quadratic discriminate analysis (QDA). In QDA, 60 spectra from each of the normal and malignant were used for making the respective calibration sets and the remaining 52 spectra from each were used for the validation. The performance of the analysis tested for the frequency region 406.25 - 625.31 kHz, showed specificity and sensitivity values of 100% and 88.46% respectively suggesting possible application of the technique in breast tumor detection.