Detection of bladder cancer cells using quantitative interferometric label-free imaging flow cytometry.

Bladder cancer is one of the most common cancers with a high recurrence rate. Patients undergo mandatory yearly scrutinies, including cystoscopies, which makes bladder cancer highly distressing and costly. Here, we aim to develop a non-invasive, label-free method for the detection of bladder cancer cells in urine samples, which is based on interferometric imaging flow cytometry. Eight urothelial carcinoma and one normal urothelial cell lines, along with red and white blood cells, imaged quantitatively without staining by an interferometric phase microscopy module while flowing in a microfluidic chip, and classified by two machine-learning algorithms, based on deep-learning semantic segmentation convolutional neural network and extreme gradient boosting. Furthermore, urine samples obtained from bladder-cancer patients and healthy volunteers were imaged, and classified by the system. We achieved accuracy and area under the curve (AUC) of 99% and 97% for the cell lines on both machine-learning algorithms. For the real urine samples, the accuracy and AUC were 96% and 96% for the deep-learning algorithm and 95% and 93% for the gradient-boosting algorithm, respectively. By combining label-free interferometric imaging flow cytometry with high-end classification algorithms, we achieved high-performance differentiation between healthy and malignant cells. The proposed technique has the potential to supplant cystoscopy in the bladder cancer surveillance and diagnosis space.

Analyzing Blood Cells of High-Risk Myelodysplastic Syndrome Patients Using Interferometric Phase Microscopy and Fluorescent Flow Cytometry.

Myelodysplastic syndromes (MDSs) are a group of potentially deadly diseases that affect the morphology and function of neutrophils. Rapid diagnosis of MDS is crucial for the initiation of treatment that can vastly improve disease outcome. In this work, we present a new approach for detecting morphological differences between neutrophils isolated from blood samples of high-risk MDS patients and blood bank donors (BBDs). Using fluorescent flow cytometry, neutrophils were stained with 2',7'-dichlorofluorescin diacetate (DCF), which reacts with reactive oxygen species (ROS), and Hoechst, which binds to DNA. We observed that BBDs possessed two cell clusters (designated H and L), whereas MDS patients possessed a single cluster (L). Later, we used FACS to sort the H and the L cells and used interferometric phase microscopy (IPM) to image the cells without utilizing cell staining. IPM images showed that H cells are characterized by low optical path delay (OPD) in the nucleus relative to the cytoplasm, especially in cell vesicles containing ROS, whereas L cells are characterized by low OPD in the cytoplasm relative to the nucleus and no ROS-containing vesicles. Moreover, L cells present a higher average OPD and dry mass compared to H cells. When examining neutrophils from MDS patients and BBDs by IPM during flow, we identified ~20% of cells as H cells in BBDs in contrast to ~4% in MDS patients. These results indicate that IPM can be utilized for the diagnosis of complex hematological pathologies such as MDS.

On-chip label-free cell classification based directly on off-axis holograms and spatial-frequency-invariant deep learning.

We present a rapid label-free imaging flow cytometry and cell classification approach based directly on raw digital holograms. Off-axis holography enables real-time acquisition of cells during rapid flow. However, classification of the cells typically requires reconstruction of their quantitative phase profiles, which is time-consuming. Here, we present a new approach for label-free classification of individual cells based directly on the raw off-axis holographic images, each of which contains the complete complex wavefront (amplitude and quantitative phase profiles) of the cell. To obtain this, we built a convolutional neural network, which is invariant to the spatial frequencies and directions of the interference fringes of the off-axis holograms. We demonstrate the effectiveness of this approach using four types of cancer cells. This approach has the potential to significantly improve both speed and robustness of imaging flow cytometry, enabling real-time label-free classification of individual cells.

Sperm Inspection for In Vitro Fertilization via Self-Assembled Microdroplet Formation and Quantitative Phase Microscopy.

We present a new method for the selection of individual sperm cells using a microfluidic device that automatically traps each cell in a separate microdroplet that then individually self-assembles with other microdroplets, permitting the controlled measurement of the cells using quantitative phase microscopy. Following cell trapping and droplet formation, we utilize quantitative phase microscopy integrated with bright-field imaging for individual sperm morphology and motility inspection. We then perform individual sperm selection using a single-cell micromanipulator, which is enhanced by the microdroplet-trapping procedure described above. This method can improve sperm selection for intracytoplasmic sperm injection, a common type of in vitro fertilization procedure.

Real-Time Stain-Free Classification of Cancer Cells and Blood Cells Using Interferometric Phase Microscopy and Machine Learning.

We present a method for real-time visualization and automatic processing for detection and classification of untreated cancer cells in blood during stain-free imaging flow cytometry using digital holographic microscopy and machine learning in throughput of 15 cells per second. As a preliminary model for circulating tumor cells in the blood, following an initial label-free rapid enrichment stage based on the cell size, we applied our holographic imaging approach, providing the quantitative optical thickness profiles of the cells during flow. We automatically classified primary and metastatic colon cancer cells, where the two types of cancer cells were isolated from the same individual, as well as four types of blood cells. We used low-coherence off-axis interferometric phase microscopy and a microfluidic channel to image cells during flow quantitatively. The acquired images were processed and classified based on their morphology and quantitative phase features during the cell flow. We achieved high accuracy of 92.56% for distinguishing between the cells, enabling further automatic enrichment and cancer-cell grading from blood. © 2020 International Society for Advancement of Cytometry.

Polarization-independent differential interference contrast and off-axis holography combined module.

We present an external portable module for transforming bright-field microscopy to differential interference contrast (DIC) microscopy and digital holographic microscopy together. The module is composed of simple optical elements, positioned between the microscope output plane and the digital camera plane; thus, it can be integrated externally with existing microscopes. The proposed module enables polarization DIC imaging, without special polarization elements, under either white-light or coherent illumination, providing label-free imaging of biological samples, as recorded directly by the digital camera. In addition, by rotating one element inside the module, an off-axis hologram is created on the camera under coherent illumination, thus providing the possibility for reconstruction of the quantitative phase profile of the same sample. The method is demonstrated for imaging silica microspheres and biological cells.

Label-free discrimination and selection of cancer cells from blood during flow using holography-induced dielectrophoresis.

We present a method for label-free imaging and sorting of cancer cells in blood, which is based on a dielectrophoretic microfluidic chip and label-free interferometric phase microscopy. The chip used for imaging has been embedded with dielectrophoretic electrodes, and therefore it can be used to sort the cells based on the decisions obtained during the cell flow by the label-free quantitative imaging method. Hence, we obtained a real-time, automatic, label-free imaging flow cytometry with the ability to sort the cells during flow. To validate our model, we combined into the label-free imaging interferometer a fluorescence imaging channel that indicated the correctness of the label-free sorting. We have achieved above 98% classification success and 69% sorting accuracy at flow rates of 4 to 7 µL hr-1 . In the future, this method is expected to help in label-free sorting of circulating tumor cells in blood following an initial state-of-the-art cell enrichment.

Quantitative phase imaging by wide-field interferometry with variable shearing distance uncoupled from the off-axis angle.

We introduce a new shearing interferometry module for digital holographic microscopy, in which the off-axis angle, which defines the interference fringe frequency, is not coupled to the shearing distance, as is the case in most shearing interferometers. Thus, it enables the selection of shearing distance based on the spatial density of the sample, without losing spatial frequency content due to overlapping of the complex wave fronts in the spatial frequency domain. Our module is based on a 4f imaging unit and a diffraction grating, in which the hologram is generated from two mutually coherent, partially overlapping sample beams, with adjustable shearing distance, as defined by the position of the grating, but with a constant off-axis angle, as defined by the grating period. The module is simple, easy to align, and presents a nearly common-path geometry. By placing this module as an add-on unit at the exit port of an inverted microscope, quantitative phase imaging can easily be performed. The system is characterized by a 2.5 nm temporal stability and a 3.4 nm spatial stability, without using anti-vibration techniques. We provide quantitative phase imaging experiments of silica beads with different shearing distances, red blood cell fluctuations, and cancer cells flowing in a micro-channel, which demonstrate the capability and versatility of our approach in different imaging scenarios.