VIBRATIONAL SPECTROSCOPY FOR THE ASSESSMENT OF VULVAL DISEASE

Abstract

Vibrational spectroscopic diagnostic techniques have significant potential to improve the care of women with benign, premalignant and malignant vulval diseases by reducing the reliance on traditional biopsy and histopathology. These techniques also have the potential to augment clinicians’ ability to differentiate different types of vulval disease at the time of surgery for neoplastic vulval disease. In addition, vibrational spectroscopic techniques offer the opportunity to assess molecular changes associated with the development of vulval cancer that are not apparent on routine histopathological assessment. The work outlined in this thesis evaluates the role of emerging techniques in vibrational spectroscopy to address this need within three key themes: 1. Developmentofavibrationalspectroscopicdiagnostictechniquetoreducethe reliance on traditional biopsy and histopathological diagnosis. 2. Developmentofavibrationalspectroscopicdiagnostictechniqueforimproving the delineation of disease margins at the time of surgery for pre-malignant and malignant vulval conditions. 3. Evaluation of a vibrational spectroscopic tool for augmenting and automating aspects of vulval histopathology. Raman spectroscopic mapping of 91 fresh frozen vulval tissue sections combined with multivariate spectral analysis was used to demonstrate that malignant vulval disease could be differentiated from non-neoplastic and premalignant vulval disease with a sensitivity of 97% and specificity of 78%. The technique was then tested in experimental conditions closer to in-vivo application, measuring spectra from 91 whole fresh frozen tissue blocks using microscope and probe Raman systems. This demonstrated the technique could differentiate malignant from non-neoplastic and premalignant vulval disease with sensitivities of 84% to 92% and specificities of 84% to 64% respectively. In a separate investigation vulval tissue blocks from 27 women with suspected lichen sclerosus underwent Raman spectroscopic point measurements. Multivariate analysis demonstrated Raman spectroscopy could be used to differentiate lichen sclerosus from other vulval disorders with a similar clinical appearance with a sensitivity of sensitivity of 91% and specificity of 80%. Fourier transform infrared (FTIR) spectroscopic mapping of 93 fixed paraffin embedded tissue sections was used to demonstrate that malignant vulval disease could be differentiated from non-neoplastic and premalignant with vulval disease with an approximate sensitivity of 100% and specificity of 79%. In addition FTIR spectroscopy was used to differentiate molecular changes in vulval intraepithelial neoplasia (VIN) and lichen sclerosus (LS) found in association with vulval squamous cell carcinoma (SCC). Analysis of FTIR spectroscopic tissue maps from 48 patients demonstrated the technique could differentiate LS associated with SCC with a sensitivity of approximately 100% and specificity of 84% and VIN associated with SCC with a sensitivity of approximately 100% and specificity 58%. This thesis demonstrates the considerable potential of vibrational spectroscopy in this clinical setting. The research has made significant progress in each of the three themes outlined above and indicates that further work is warranted to develop the techniques towards routine clinical application.