  The initial detection and identification of suspicious lesions and the
precise delineation of tumour mar-gins are essential for successful tumour
resection, with progression-free survival linked to rates of complete
resection. However, post-surgical positive margin rates remain high for many
cancers and despite numerous advances in intraoperative imaging and diagnostic
technologies, there exists no single modality that can adequately perform both
tumoural detection and delineation. Here, we demonstrate a multimodal computer
vision-based diagnostic system capable of both the gross detection and
identification of suspicious lesions and the precise delineation of disease
margins. We first show that through visual tracking of a spectroscopic probe,
we enable real-time tumour margin delineation both for ex vivo human tumour
biopsies and for an in vivo tumour xenograft mouse model. We then demonstrate
that the combination of Raman spectroscopic diagnoses with protoporphyrin IX
(PPIX) fluorescence imaging enables fluorescence-guided Raman spectroscopic
margin delineation. Our fluorescence-guided Raman spectroscopic system achieves
superior margin delineation accuracy to fluorescence imaging alone,
demonstrating the potential for our system to achieve improved clinical
outcomes for tumour resection surgeries.
