Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Archana Dambal

"Journal of clinical and diagnostic research is a welcome change in publishing practices. It aims to reach out to the grass-root level researchers who do not lack in experience, clinical material and ideas, but lack in their knowledge in English language and statistics. The journal achieves it's aim by supporting in these exact domains.
It also gives due credit to all research designs like descriptive and qualitative studies while many journals ignore these important study designs. The rigorous review process does not allow any compromise in quality
It is indexed in many indexing agencies and the articles are available under creative commons licence free of cost
The frequency of publication supports many aspiring authors from India and other countries.
It's wide scope welcomes articles across various specialities in medicine. In an era when there is an unscientific insistence on speciality specific research by regulatory bodies in medical education, JCDR supports collaborative research across specialities. I wish the publisher all the best in his future endeavors."



Dr. Archana Dambal
Department of General Medicine,
Belgaum Institute of Medical Sciences,Belgaum, Karnataka,INDIA,
On 30 Nov 2018




Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
For authors, the manuscripts can be uploaded online through an easily navigable portal, on other hand, reviewers appreciate the systematic handling of all manuscripts. The way JCDR has emerged as an effective medium for publishing wide array of observations in Indian context, I wish the editorial team success in their endeavour"



Dr Bhanu K Bhakhri
Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dematolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

Original article / research
Year : 2011 | Month : December | Volume : 5 | Issue : 8 | Page : 1574 - 1577

Optical Spectroscopy: A Promising Diagnostic Tool for Breast Lesions

Sanjay Kala, Chayanika Pantola, Asha Agarwal, Asima Pradhan, Sudeep Thakur

1. Associate Professor Department of General Surgery GSVM Medical College, Kanpur U.P. India, 208002 2. Lecturer, Department of Pathology, GSVM. Medical College, Kanpur U.P. India, 208002 3. Professor, Department of Pathology, GSVM. Medical College, Kanpur U.P. India, 208002 4. Associate Professor CELT, Department of Physics, IIT, Kanpur U.P. India - 208002. 5. Department of Pathology, G.S.V.M. Medical College, Kanpur U.P. India - 208002.

Correspondence Address :
Dr. Sanjay Kala
L-21 GSVM Medical College, Kanpur
U.P., India - 208002
Phone: +919839210012
E-mail: dr_sanjay_kala@yahoo.com

Abstract

Background: With the rising trend of breast cancer, there is a need to develop a diagnostic procedure which can solve the problem of differentiating the benign and malignant lumps and of detecting breast cancer at an early stage. Intrinsic fluorescence is an important step in this regards. Auto-fluorescence from biological tissues involves evaluating the biomolecular environment through optical spectroscopy.
Aim of study: To study the role of optical spectroscopy in differentiating the benign from the malignant breast lesions by detecting the change in the intrinsic fluorescence, especially of Flavin adenine dinucleotide (FAD) and porphyrins.
Method: A study of 37 patients with breast lumps was done, out of which 14 had benign and 23 had malignant lesions. After excision for the intrinsic fluorescence study, fresh samples were taken and excited by using an optical spectrophotometer.
Results: This study showed that intrinsic fluorescence is a good method of investigation with a sensitivity of 68% and a specificity of 73%.
Conclusion: Optical spectroscopy has a bright future in differentiating the benign and malignant lesions of the breast. Furthermore, it can detect cancer at an early stage.

Keywords

Intrinsic fluorescence, Flavin adenine dinucleotide, Porphyrins, Breast lesions

How to cite this article :

Sanjay Kala, Chayanika Pantola, Asha Agarwal, Asima Pradhan, Sudeep Thakur. OPTICAL SPECTROSCOPY: A PROMISING DIAGNOSTIC TOOL FOR BREAST LESIONS. Journal of Clinical and Diagnostic Research [serial online] 2011 December [cited: 2019 Feb 17 ]; 5:1574-1577. Available from
http://jcdr.net/back_issues.asp?issn=0973-709x&year=2011&month=December&volume=5&issue=8&page=1574-1577&id=1774

Introduction
Having a breast lump is an enigma for a female at any age. Cancer of the breast stands out as one of the most ominous of all the cancers in females. Also, despite the vast knowledge of the disease, its incidence has never shown a declining trend. It is also one of the most treatable forms of cancer, if it can be diagnosed at its early stage and so the best way to curtail the effects of the disease and to improve the survival is to diagnose it as early as possible. According to the National Cancer Institute, up to 10% of all the breast cancers, roughly 20,000 cases per year in the United States, fail to be discovered by X-ray mammography. Also, X-ray mammography uses ionizing radiation and it requires uncomfortable breast compression. It also suffers from a significant number of false positives that often lead to unnecessary biopsy, since biopsy is generally required to determine malignancy in most of the women with an abnormal mammogram. All the three techniques, X-ray mammography, ultrasound, and magnetic resonance imaging provide high spatial resolution, but comparatively little information about the molecular-level changes in the breast tissue (1),(2),(3). On the other hand, if we could differentiate whether the breast lump is benign or malignant by a single investigation which is not only non-invasive / minimally invasive, then it would definitely become the investigation of choice. It is in this setting of the diagnostic dilemma of the diseases of the breast that fluorescence studies hold promise. The morphological and chemical changes that occur when a tissue proliferates in an exaggerated normal or abnormal fashion cause the fluorophores inside the tissue to fluorescence differently as compared to their normal environment. Fluorescence spectroscopy can differentiate the biochemical and morphological changes of the normal and diseased tissues. In our study, the fluorophores which were studied were FAD and porphyrins, because they have been proven to best correlate with the number of dividing cells and the metabolic activity of the cell. When they are excited at 436 nm, they show peak fluorescence at 530 nm and 630 nm respectively.

Material and Methods

A study on 37 cases was done in a period of one year from January 2007 to January 2008. Of these 37, 14 benign and 23 malignant samples ( histologically proven) were considered for fluorescence analysis.
Intrinsic fluorescence studies :-
Fresh tissue samples were obtained immediately after surgery. The suspected tumour tissue was selected, it was separated from the normal tissue and it was sent for laser spectroscopic studies. Simultaneously, the surrounding normal tissue was also taken for fluorescence analysis. The tissue which was selected for study was taken into the chunk and thoroughly cleaned and washed with normal saline to remove blood and slimy material. Then, it was placed in normal saline. During the experiments, the tissue was kept at room temperature and it was kept moist with isotonic saline. The tissue was placed on a quartz plate of size 3 cm x 1 cm x 2 cm. The fluorescence spectra of the tissues were recorded by using a Fluorolog-3 spectrofluorometer (Jobin Yvon, USA). The samples were excited with an Ozone free Xenon lamp of 450-W power, which delivered light from 240 nm to 850 nm for the sample excitation by using an emission spectrometer and a photo multiplier tube (PMT, Model R928) and for the simultaneous recording of the elastic scattering spectra. The output of the detector was connected to a computer for data acquisition and analysis. The samples were excited by using vertically polarized light. The parallel (VV) and perpendicular (VH) components of the fluorescence were collected in the reflection geometry. In the same geometry, the parallel and perpendicular components of the scattered light were also collected. In this research, we have studied the cross-polarized (VH) fluorescence spectra of the sample and have compared it with the intrinsic fluorescence of the sample. The fluorescence power per unit area which escaped from the tissue was related to the distribution of the excitation radiation within the tissue. For histopathological examination, the corresponding tissue was taken and it was placed in 10% buffered formalin and was processed for making paraffin blocks for routine histological diagnosis by the haematoxylin and eosin method.

Results

Breast tissue consists of fibrous and fatty tissues. The fluorescence spectra were recorded in parallel (VV) and perpendicular (VH) and the simultaneous scattering was also recorded. Considering the fact that in the emission spectra, the maximum intensity at 530 nm is due to FAD and that at 630 nm is due to porphyrin we calculated the area under 20 nm bandwidth at each of these wavelengths i.e. 530 ± 10 and 630 ± 10. This was done for the tumourous tissue and for its normal counterpart also. Thus, we could plot the ratio of FAD in abnormal tissues (benign and malignant) to that in normal tissues and also similarly for porphyrin; for each patient. The comparison between VH and intrinsic fluorescence could be done if we made a scatter plot of the ratio of the area under the 20mm bandwidth of FAD and porphyrin in normal tissues to that in cancerous tissues for both VH and intrinsic fluorescence (Table/Fig 1) and (Table/Fig 2). A ratio which was less than one would show that the concentrations of FAD and porphyrin were more in the cancerous (benign or malignant) tissues as compared to those the normal tissues. Thus, the intrinsic fluorescence was much accurate as compared to the VH fluorescence when we took all the benign and malignant tissue samples together (Table/Fig 1) and (Table/Fig 2). Though this held true if we considered the malignant tissues only (Table/Fig 5) and
(Table/Fig 6), there was an insignificant difference between the VH and intrinsic fluorescence spectra when only the benign tissue (Table/Fig 3) and (Table/Fig 4) samples are considered. We classified the lumps as benign or malignant histologically. Then, we compared the results of different spectra in the normal as well as in abnormal tissues (Table/Fig 7) and compared the results of the benign and malignant lesions (Table/Fig 8).

Discussion

Auto fluorescence from biological tissues has been under investigation for many years. This involves the evaluation of the biomolecular environment through optical spectroscopy. This study was aimed at comparing an entirely new technique optical spectroscopy in differentiating the abnormal from the normal breast tissue by detecting the chemical changes that occurred at the molecular level. There are a large number of biomolecules in tissues that emit light (auto fluoresce) under photo-excitation. The most dominant tissue fluorophores are tryptophan, collagen, elastin, NADH, flavoproteins, and porphyrins. Each fluorophore has a distinct absorption and emission spectrum. Similarly, for the application of optical spectroscopy for the characterization of organic or inorganic materials, auto-fluorescence spectroscopy can be used to quantify the relative distribution of the different fluorophores in the tissue components for diagnostic purposes. Pioneering work by Alfano et al. highlighted the potential of autofluorescence spectroscopy for cancer detection (4). Gupta et al. reported in an in vitro study which involved 63 patients and aimed to evaluate autofluorescence spectroscopy under excitation in the near-UV region (nitrogen laser) (5), that significant changes were observed in the spectrally integrated auto-fluorescence intensity from the normal, benign, and cancerous breast tissues. The intensity ratios of the cancerous tissues to the benign tumour and normal tissues were found to be 3.2 and 2.8, respectively. A discrimination parameter based on the spectrally integrated intensity alone provided a sensitivity and specificity of up to 99.6%. A similarly high sensitivity was reported by Hage et al. who used laser-induced auto-fluorescence spectroscopy under 548 nm excitation (6). The experiments in the study by Palmer et al. included the characterization of tissues by using autofluorescence spectroscopy under multiple excitation wavelengths in the ultraviolet-visible range. They were successful in discriminating the malignant and non-malignant tissues, with a sensitivity and specificity of 70% and 92%, respectively (7). The analysis of the results suggested that the important fluorophores for breast cancer diagnosis, most likely were tryptophane, NAD(P) H, and flavoproteins. Polarized fluorescence spectral profiles and anisotropy showed a definite distinction among the malignant, benign and normal human breast tissues in a study which was conducted by Laxmi et al in 2001 (8). Majumdar et al, in 1999, discriminated human breast malignant lesions by using nitrogen excited auto-fluorescence spectra, which showed a sensitivity of 85.5% and a specificity of 87% (9). Svensson et al, in 2005, showed intra and inter subjects as well as contra lateral variations of optical and physiological properties in breast tissues, as measured by using four wavelength time resolved spectroscopy (10). Recently, an idea for the diagnosis of breast cancer by the non-invasive probing of calcification by using transmission Raman spectroscopy was given by Matousek et al in 2007 (11). Krishna et al, in 2008, reviewed the Raman spectroscopic approach for metabolic fingerprinting in breast cancer detection (12). Our study also showed comparable results. We can differentiate benign and malignant tissues on the basis of the ratio of the normal and abnormal tissues, which if less than one, denotes tumourous conditions. Our results showed that the intrinsic fluorescence study was a good investigative method with a sensitivity of 68 % for FAD and 73% for porphyrin, though it was still in a very early stage of development. This research needs a longer study period and analysis with more number of samples for it to give better results with a high diagnostic accuracy. In all the cases, it was possible to diagnose whether a tumour was actually present or not (by checking for a significant change in the area under the curve at 530 ± 10 nm and 630 ± 10 nm for the tumour tissue as compared to the normal tissue). The sensitivity for the malignant lesions was more than that for the benign lesions . Intrinsic fluorescence spectra is a better screening tool as compared to the VH spectra. Porphyrin is a better biochemical parameter in the intrinsic fluorescence spectra, whereas FAD is a better biochemical parameter in the VH spectra for abnormal (especially malignant) lesions. Also, porphyrin is a better biochemical parameter in the VH spectra for benign lesions. As compared to histopathology, this technique had an overall diagnostic accuracy of around 83% in the intrinsic spectra in detecting porphyrin accumulation. This is a relatively good value for a new investigative method. The study is an aid for the development of a probe which can be used to detect early malignant changes in vivo. Overall, optical spectroscopy, mainly the intrinsic fluorescence analysis for FAD and porphyrin, has shown encouraging results It has a bright future in diagnostics to differentiate the benign and malignant legions of the breast. Furthermore, it can detect cancer an an early stage, and can thus aid in better patient management. The histological examination of breast tissues is currently being performed by selecting one of the well-developed invasive breast biopsy techniques (i.e., excisional biopsy, axillary node dissection, sentinel node dissection, or fine needle aspiration), depending on the location, size, palpability, and the characteristics of the abnormality. Breast excisions remain one of the most common surgical operations for diagnosing and treating breast cancer. In the current setting, while frozen section analysis is available, there are technical limitations in cutting certain types of tissues and as a result, an immediate histological analysis is not possible or practical. Therefore, developing a technology that can offer the detection and delineation of the tumour margins in real time may be very useful for a surgeon during a diagnostic or therapeutic procedure. The progress to date in using various optical spectroscopy methods for the classification of breast tissues arguably provides a solid foundation for the development of spectroscopy- based instrumentation for real time pathological assessment. Most of the approaches use single point measurement techniques that interrogate a small volume of tissue at each measurement. As mentioned earlier, the potential role of this technology in addressing clinical needs which are related to breast cancer detection and treatment may be used for intraoperative tissue characterization in real time or via designing thin fiberoptic needles to reach the suspected location within the breast for the evaluation of a suspected lesion (13),(14),,(15).

References

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Carney PA, Kasales CJ, Tosteson ANA, Weiss JE, Goodrich ME, Poplack SP, et al. Likelihood of additional work-up among women who undergo routine screening mammography: the impact of age, breast density, and hormone therapy use. Prev Med 2004;39 (1):48–55.
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Hindle WH, Davis LWD, Wright D. Clinical value of mammography for symptomatic women who are aged 35 years and younger. Am J Obstet Gynecol 1999;180(6 Pt 1):1484–90.
3.
Hata T, Takahashi H, Watanabe K, Takahashi M, Taguchi K, Itoh T, et al. Magnetic resonance imaging for the preoperative evaluation of breast cancer: a comparative study between mammography and ultrasonography. J Am Coll Surg 2004;198 (2):190–97.
4.
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