光學同調斷層掃瞄技術於口腔癌診斷之研究

口腔癌在台灣男性癌症排名第四，對於一般口腔癌病患，早期診斷可高達百分之七十五的五年以上存活率。光學同調斷層掃瞄技術可以提供縱切面的組織造影，並具有高解析、高造影速度以及較深的造影深度(2~3 mm)等優點，因此光學同調斷層掃瞄技術適合作為口腔癌早期診斷的工具。在這研究中，我們應用光學同調斷層掃瞄技術於離體以及臨床的口腔癌研究。我們建立了一套掃頻式的光學同調斷層掃瞄系統，首先針對從口腔癌病患身上切除的口腔癌樣本做掃瞄。這套系統具備8 um 的縱向解析度以及靈敏度可達108 dB，透過這套系統掃瞄，可區分出正常以及癌組織。在臨床上，我們將此掃頻式的光學同調斷層掃瞄系統接上一特別設計的掃瞄探頭，在醫院針對口腔癌前病變和口腔癌病患掃瞄，並統計上分析有效的診斷指標。在這部分，我們提出了三種指標，其中包含縱向強度分佈的標準差、由縱向強度分佈的空間頻域頻譜所得到的指數衰減常數(α)，以及當上皮層和結締組織間的介面仍存在時，所得到的上皮層厚度。另外，我們分析在統一標準和個別相對標準下，這些診斷指標的靈敏度以及明確度。由結果發現，針對中度上皮變異以及鱗狀細胞癌，標準差以及α值將會是很好的診斷指標。另一方面，上皮層厚度適合用作上皮增生以及中度上皮變異診斷上的指標。另外，我們也利用此可攜式的掃頻式光學同調斷層掃瞄系統來追蹤評估口腔癌病患經由光動力療法治療後其復原情形。我們將列出其中兩位病患治療後的結果，並藉由上述三種診斷指標來分析光學同調斷層掃瞄系統的掃瞄結果。

關鍵字

光學同調斷層掃瞄；口腔癌；醫學影像

並列摘要

Oral cavity cancer has recently become the fourth leading cancer for men in Taiwan. The main causes include the habits of alcoholconsumption, chewing betel nuts (Areca catechu) and smoking cigarettes.For patients with ocalized diseases (earlier phases) at diagnosis, the 5-yr survival rate is as high as 75%, which reveals the significances of earlydiagnosis. Oral cancer study including lesion canning and diagnosisindicator analysis are demonstrated.In the dissertation, we first demonstrate the ex vivo imaging of oralcancerous samples with a SS-OCT system. With the axial resolution of 8um in free space and system sensitivity of 108 dB in this system, we can well differentiate normal and abnormal oral tissue samples. We analyze the lateral variation of A-mode scanning profiles to show two parameters of SS-OCT signal including decay constant in the exponential fitting and standard deviation of the SS-OCT signal intensity for determining the lateral expansion range of abnormal oral tissue. Then, the SS-OCT system is equipped with a probe for clinical oral cavity scanning. In clinical diagnosis, three indicators, including the standard deviation (SD) of an A-mode scan signal profile, the exponential decay constant (α) of an A-mode-scan spatial-frequency spectrum, and the epithelium thickness (T) when the boundary between epithelium and iii lamina propria can still be identified, are proposed. The sensitivity and specificity of the three indicators are discussed based on universal and individual relative criteria. It is found that SD and α are good diagnosisindicators for MD and SCC. On the other hand, T is a good diagnosisindicator for EH and MD. The SS-OCT system is also used to clinically scan oral cancerpatients for tracking the progress of photodynamic therapy. The progresses of two patient cases are reported based on the calibrations of the variation trends of three indicators mentioned above.

並列關鍵字

Optical Coherence Tomography ； Oral Cancer ； Biomedical imaging

參考文獻

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[1-5] R. Huber, M. Wojtkowski, and J. G. Fujimoto, “Fourier Domain Mode Locking (FDML): A new laser operating regime and application for optical coherence tomography,” Opt. Express 14,3225-3237 (2006).

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光學同調斷層掃瞄技術於口腔癌診斷之研究

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