Identified Early Stage Mycosis Fungoides from Psoriasis and Atopic
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This file has been cleaned of potential threats. If you confirm that the file is coming from a trusted source, you can send the following SHA-256 hash value to your admin for the original file. 406f9bd19b25f0bdfc772d29809a174bceaf46307ceda4409fc0ebe06fbec6cb To view the reconstructed contents, please SCROLL DOWN to next page. Opt Quant Electron DOI 10.1007/s11082-014-0017-x Identified early stage mycosis fungoides from psoriasis and atopic dermatitis using non-invasive color contrast enhancement by LEDs lighting Yu-Ping Hsiao · Hsiang-Chen Wang · Shih-Hua Chen · Chung-Hung Tsai · Jen-Hung Yang Received: 26 June 2014 / Accepted: 3 September 2014 © Springer Science+Business Media New York 2014 Abstract Mycosis fungoides (MF) is the most common type of cutaneous T cell lymphoma (CTCL) and may progress internally over time. MF is clinically categorized as poorly defined areas of erythema, flat patches, thin plaques, and tumors. The diagnosis of early stage of MF (patch and early plaque mycosis fungoides) has been a major diagnostic challenge in der- matology because of the lack of highly characteristic immunophenotypical markers and the Y.-P. Hsiao Dermatology Department, Chung Shan Medical University Hospital, No.110, Sec. 1, Jianguo N. Rd., South Dist., Taichung City 40201, Taiwan Y.-P. Hsiao · C.-H. Tsai School of Medicine, Institute of Medicine, Chung Shan Medical University, No.110, Sec. 1, Jianguo N. Rd., South Dist., Taichung City 40201, Taiwan H.-C. Wang · S.-H. Chen Graduate Institute of Opto-Mechatronics, National Chung Cheng University, 168, University Rd., Min-Hsiung, Chia-Yi 62102, Taiwan e-mail: [email protected] C.-H. Tsai Department of Pathology, Chung Shan Medical University Hospital, Taichung City 40201, Taiwan J.-H. Yang School of Medicine, Tzu Chi University, No.701, Zhongyang Rd., Sec. 3, Hualien 97004, Taiwan J.-H. Yang (B) Department of Dermatology, Buddhist Tzu Chi General Hospital, No. 707, Sec. 3, Chung Yang Rd., Hualien 97004, Taiwan e-mail: [email protected] H.-C. Wang · S.-H. Chen Advanced Institute of Manufacturing with High-tech Innovations (AIM-HI), National Chung Cheng University, 168, University Rd., Min-Hsiung, Chia-Yi 62102, Taiwan 123 Y.-P. Hsiao et al. heterogeneity of clinical presentations of MF. In this study, the spectrum of each picture ele- ment of the patient’s skin image was obtained by multi-spectral imaging technology (MSI). Spectra of normal or pathological skin were collected from 30 patients (10 early stage MF, 10 psoriasis vulgaris, and 10 atopic dermatitis). An algorithm combined with multi-spectral imaging and color reproduction technique is applied to find the best enhancement of the dif- ference between normal and abnormal skin regions. Accordingly, an illuminant with specific intensity ratio of red, green, and blue LEDs is proposed, which has optimal color enhance- ment for MF detection. Compared with the fluorescent lighting commonly in the use now, the color difference between normal and inflamed skin can be improved from 11.8414 to 17.4002 with a 47% increase, 8.7671 to 12.8544 with a 26.3% increase, and 11.0735 to 17.2634 with a 34.3% increase for MF, psoriasis, and atopic dermatitis patients, respectively, thus making medical diagnosis more efficient, so helping patients receive early treatment. Keywords Mycosis fungoides · Biomedical optical imaging · Color contrast enhancement · Multispectral imaging · Image reconstruction techniques · Illumination design 1 Introduction Mycosis fungoides (MF) is a heterogeneous group of malignant lymphomas that revealed the propensity for neoplasmic T lymphocytes to infiltrate the skin. The clinical diagnosis is always a challenge for physicians because the diversity of manifestations that MF could be the red, scaly patches or thickened plaques that often mimic chronic eczema, atopic dermatitis, or psoriasis (Willemze et al. 2005; Frye et al. 2012; Lee and Hwang 2012). A study among cutaneous lymphoma patients in Holland and Austria showed that 1,476 of 1,905 cases were MF patients, constituting 77.5% of the total number of patients. The study was conducted by the World Health Organization and the European Organization for Research and Treatment of Cancer in 2005 (Willemze et al. 2005). MF commonly occurred in patients aged from 40 to 69 and were often diagnosed in males, with an occurrence rate of two males for every one female. People with dark skin also exhibited higher susceptibility to the disease than those with white skin (with an incidence ratio of 1.6) (Willemze et al. 2005). Cancerous lymphocytes are classified as primary or secondary. Primary cancerous lym- phocytes are attracted to the skin through the lymphocytes in blood by the cytohormone, whereas secondary lymphoma cells are brought to the skin by blood circulation from the lymph node (Whittaker et al. 2003). Pathologic changes in mycosis fungoides, the most common type of CTCL, refer to the process in which mutant T lymphocytes break out of the corium from the capillaries, continuing upwards to attack the epidermal layer (Girardi et al. 2004). In most MF cases, patients first experience problems such as dry, reddish, and itchy skin. Some patients present with local skin depigmentation, experience itchiness, or have speckles such as rashes (World Health Organization 2009). It could be misdiagnosed as ordinary psoriasis, atopic dermatitis, or eczema if the doctor lacks relevant experience in differential diagnosis. Current methods used to detect MF include incision biopsy, blood tests, and lymphogra- phy (Hong Kong Cancer Fund 2007; Willemze and Dreyling 2010). Lymphography is similar to computerized tomography (CT) in which a radio contrast agent is injected into the lym- phatic vessel; incision biopsy involves cutting open the skin for histopathological diagnosis; and blood tests are conducted using a needle head to pierce the skin. The aforementioned procedures are invasive, painful and psychologically stressful. These techniques must also be performed repeatedly for subsequent monitoring, and the results can be confirmed only 123 Non-invasive color contrast enhancement by LEDs lighting after a considerable period of time. Among the disadvantages of conventional detection methods are that they are invasive, painful, and time-consuming. In addition, conventional detection methods can only be performed by doctors with extensive experience and skills. Consequently, real-time diagnosis becomes difficult. The application of spectroscopy and illumination in biomedicine has recently been inves- tigated (Yamaguchi et al. 2005; Yamaguchi 2001; Lee et al. 2009; Park et al. 2007; Hashimoto et al. 2011). The real-time property of multi-spectral image reproduction technology is shown to exhibit the greatest potential. For one image, we can find the individual spectrum of each pixel point by multi-spectral imaging (MSI). Calculation of the different spectra can enhance the color contrast between the normal and the pathological images, thus increasing diagnostic efficiency (Wang and Chen 2012; Wang et al. 2010, 2013). In this study, we collected pictures from thirty patients (ten patients with MF, ten patients with psoriasis vulgaris, and ten patients with atopic dermatitis, respectively). The inclusion criteria were early stage MF with patches or plaques phases, psoriasis vulgaris, and atopic dermatitis. There are four stages of mycosis fungoides depending on the degree of skin manifestation, nodal involvement, and internal organ metastasis. We recruited patients with early stage mycosis fungoides with patches or plaques phases. The limitations of this study were that tumor-stage mycosis fungoides were excluded, and the penetration depth of LED was <1mm(Cowen et al. 2007). After the spectra showing different pathological changes and the normal region were obtained, spectra of a commercial RGB LED with peak wavelengths at 460, 530, and 617nm for blue, green, and red respectively, are applied to illuminate the normal skin and the pathological skin and calculate the color difference by changing the intensity ratio of each peak. Principal component analysis (PCA) was conducted for the normal spectra and the pathological spectra of the three MF patients and then the eigenvector of MF (six basic functions) was obtained. The spectra of all patients with similar presentations were then analyzed using the MF eigenvector, and the principal component score of all pathological and normal spectra was determined. Skin diseases with similar symptoms were distinguished according to use some special LEDs lighting. Thus, skin lymphoma, psoriasis, and atopic dermatitis were identified. 2 Materials and methods 2.1 Images of cutaneous lymphoma, psoriasis, and atopic dermatitis All images of the patients and the pathological sections in this study were provided by the Dermatology Department of Chung Shan Medical University Hospital. Initially, pictures of ten MF patients were taken. However, the initial symptoms of MF were similar to those of psoriasis and atopic dermatitis; therefore, images of ten psoriasis and ten atopic dermati- tis patients were also taken to represent the control group. This study was reviewed and approved by the Chung Shan Medical University Hospital (IRB No CS12126) institutional review board. These images, which are clearer than those taken with a camera, also reveal ery- themas in the pathological regions. Figure 1a shows the pathological result of a 35-year-old man with MF. Figure 1d reveals the pathological changes in patient CA. The yellow arrows in this figure indicate epidermotropism of atypical lymphocytes. The increased and bizzare lymphocytes rushed into the epidermis; thus, patients CA has been diagnosed with cutaneous lymphoma. Figure 1b shows the pathological region of a 42-year-old male psoriasis patient PA. The symptom of initial psoriasis is similar to that of MF: patches of slight erythema in the pathological region, as shown in Fig. 1b. Figure 1e shows a section image with a 123 Y.-P. Hsiao et al. Fig. 1 a–c The images of the pathological skin of MF patients CA, psoriasis patients PA, and atopic dermatitis patients AA; d–f the histopathological results of patient CA, PA, and AA, respectively.