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Saad M, Grimaldo-Garcia S, Sweeney A, Mallidi S, Hasan T. Dual-Function Antibody Conjugate-Enabled Photoimmunotherapy Complements Fluorescence and Photoacoustic Imaging of Head and Neck Cancer Spheroids. Bioconjug Chem 2024; 35:51-63. [PMID: 38128912 PMCID: PMC10797594 DOI: 10.1021/acs.bioconjchem.3c00406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/25/2023] [Accepted: 10/30/2023] [Indexed: 12/23/2023]
Abstract
Several molecular-targeted imaging and therapeutic agents are in clinical trials for image-guided surgery and photoimmunotherapy (PIT) for head and neck cancers. In this context, we have previously reported the development, characterization, and specificity of a dual-function antibody conjugate (DFAC) for multimodal imaging and photoimmunotherapy (PIT) of EGFR-overexpressing cancer cells. The DFAC reported previously and used in the present study comprises an EGFR-targeted antibody, cetuximab, conjugated to benzoporphyrin derivative (BPD) for fluorescence imaging and PIT and a Si-centered naphthalocyanine dye for photoacoustic imaging. We report here the evaluation and performance of DFAC in detecting microscopic cancer spheroids by fluorescence and photoacoustic imaging along with their treatment by PIT. We demonstrate that while fluorescence imaging can detect spheroids with volumes greater than 0.049 mm3, photoacoustic imaging-based detection was possible even for the smallest spheroids (0.01 mm3) developed in the study. When subjected to PIT, the spheroids showed a dose-dependent response, with smaller spheroids (0.01 and 0.018 mm3) showing a complete response with no recurrence when treated with 100 J/cm2. Together our results demonstrate the complementary imaging and treatment capacity of DFAC. This potentially enables fluorescence imaging to assess the presence of tumor on a macroscopic scale, followed by photoacoustic imaging for delineating tumor margins guiding surgical resection and elimination of any residual microscopic disease by PIT, in a single intraoperative setting.
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Affiliation(s)
- Mohammad
A. Saad
- Massachusetts
General Hospital and Harvard Medical School, Wellman Center for Photomedicine, Boston, Massachusetts 02114, United States
| | | | - Allison Sweeney
- Department
of Biomedical Engineering, Science and Technology Center, Tufts University, Medford, Massachusetts 02155, United States
| | - Srivalleesha Mallidi
- Massachusetts
General Hospital and Harvard Medical School, Wellman Center for Photomedicine, Boston, Massachusetts 02114, United States
- Department
of Biomedical Engineering, Science and Technology Center, Tufts University, Medford, Massachusetts 02155, United States
| | - Tayyaba Hasan
- Massachusetts
General Hospital and Harvard Medical School, Wellman Center for Photomedicine, Boston, Massachusetts 02114, United States
- Division
of Health Sciences and Technology, Harvard
University and Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
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Saad MA, Grimaldo-Garcia S, Sweeney A, Mallidi S, Hasan T. A Dual Function Antibody Conjugate Enabled Photoimmunotherapy Complements Fluorescence and Photoacoustic Imaging of Head and Neck Cancer Spheroids. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.01.30.526194. [PMID: 36778405 PMCID: PMC9915525 DOI: 10.1101/2023.01.30.526194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Several molecular-targeted imaging and therapeutic agents are in clinical trials for image-guided surgery and photoimmunotherapy (PIT) of head and neck cancers. In this context, we have previously reported the development, characterization, and specificity of a dual function antibody conjugate (DFAC) for multi-modal imaging and photoimmunotherapy (PIT) of EGFR over-expressing cancer cells. The DFAC reported previously and used in the present study, comprises of an EGFR targeted antibody - Cetuximab conjugated to Benzoporphyrin derivative (BPD) for fluorescence imaging and PIT, and a Si-centered naphthalocyanine dye for photoacoustic imaging. We report here the evaluation and performance of DFAC in detecting microscopic cancer spheroids by fluorescence and photoacoustic imaging along with their treatment by PIT. We demonstrate that while fluorescence imaging can detect spheroids with volumes greater than 0.049 mm3, photoacoustic imaging-based detection was possible even for the smallest spheroids (0.01 mm3), developed in the study. When subjected to PIT, the spheroids showed a dose-dependent response with smaller spheroids (0.01 and 0.018 mm3) showing a complete response with no recurrence when treated with 100 J/cm2. Together our results demonstrate the complementary imaging and treatment capacity of DFAC. This potentially enables fluorescence imaging to assess tumor presence on a macroscopic scale followed by photoacoustic imaging for delineating tumor margins guiding surgical resection and elimination of any residual microscopic disease by PIT, in a single intra-operative setting.
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Affiliation(s)
- Mohammad A. Saad
- Wellman Center for Photomedicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | | | - Allison Sweeney
- Department of Biomedical Engineering, Science and Technology Center, Tufts University, Medford, MA, USA
| | - Srivalleesha Mallidi
- Wellman Center for Photomedicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
- Department of Biomedical Engineering, Science and Technology Center, Tufts University, Medford, MA, USA
| | - Tayyaba Hasan
- Wellman Center for Photomedicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
- Division of Health Sciences and Technology, Harvard University and Massachusetts Institute of Technology, Cambridge, MA 02139, USA
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Gomes JPP, Costa ALF, Chone CT, Altemani AMDAM, Altemani JMC, Lima CSP. Free three-dimensional image software in local extension assessment of oral squamous cell carcinoma: a pilot study. Braz J Otorhinolaryngol 2022; 88 Suppl 4:S117-S123. [PMID: 36030174 DOI: 10.1016/j.bjorl.2022.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 06/08/2022] [Accepted: 07/11/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Oral Squamous Cell Carcinoma (OSCC) is conventionally treated by surgical resection, and positive surgical margins strongly increase local recurrence and decrease survival. This study aimed to evaluate whether a Three-Dimensional Segmentation (3DS) image of OSCC confers advantage over Multiplanar Reconstruction (MPR) of OSCC using images of computed tomography scan in surgical planning of tumor resection. METHODS Twenty-six patients with locally advanced OSCC had tumor morphology and dimensions evaluated by MPR images, 3DS images, and Surgical Pathology Specimen (SPS) analyses (gold standard). OSCC resection was performed with curative intent using only MPR images. RESULTS OSCC morphology was more accurately assessed by 3DS than by MPR images. Similar OSCC volumes and dimensions were obtained when MPR images, 3DS images and SPS measurements were considered. Nevertheless, there was a strong correlation between the OSCC longest axis measured by 3DS and SPS analyses (ICC = 0.82; 95% CI 0.59‒0.92), whereas only a moderate correlation was observed between the longest axis of OSCC measured by MPR images and SPS analyses (ICC = 0.51; 95% CI 0.09‒0.78). Taking only SPS with positive margins into account, MPR images and 3DS images underestimated the tumor's longest axis in eight out of 11 (72.7%) and 5 out of the 11 (45.5%) cases, respectively. CONCLUSION Our data present preliminary evidence that 3DS model represents a useful tool for surgical planning of OSCC resection, but confirmation in a larger cohort of patients is required. LEVEL OF EVIDENCE Laboratory study.
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Affiliation(s)
- João Pedro Perez Gomes
- Department of Anesthesiology, Oncology and Radiology, Faculdade de Ciências Médicas da Universidade Estadual de Campinas, Campinas, SP, Brazil
| | | | - Carlos Takahiro Chone
- Department of Ophthalmology and Otorhinolaryngology, Faculdade de Ciências Médicas da Universidade Estadual de Campinas, Campinas, SP, Brazil
| | | | - João Maurício Carrasco Altemani
- Department of Anesthesiology, Oncology and Radiology, Faculdade de Ciências Médicas da Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Carmen Silvia Passos Lima
- Department of Anesthesiology, Oncology and Radiology, Faculdade de Ciências Médicas da Universidade Estadual de Campinas, Campinas, SP, Brazil.
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Bhandari C, Fakhry J, Eroy M, Song JJ, Samkoe K, Hasan T, Hoyt K, Obaid G. Towards Photodynamic Image-Guided Surgery of Head and Neck Tumors: Photodynamic Priming Improves Delivery and Diagnostic Accuracy of Cetuximab-IRDye800CW. Front Oncol 2022; 12:853660. [PMID: 35837101 PMCID: PMC9273965 DOI: 10.3389/fonc.2022.853660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 05/06/2022] [Indexed: 11/17/2022] Open
Abstract
Fluorescence image-guided surgery (IGS) using antibody conjugates of the fluorophore IRDye800CW have revolutionized the surgical debulking of tumors. Cetuximab, an anti-epidermal growth factor receptor (EGFR) monoclonal antibody, conjugated to IRDye800CW (Cet-IRDye800) is the first molecular targeted antibody probe to be used for IGS in head and neck cancer patients. In addition to surgical debulking, Cetuximab-targeted photodynamic therapy (photoimmunotherapy; PIT) is emerging in the clinic as a powerful modality for head and neck tumor photodestruction. A plethora of other photoactivable agents are also in clinical trials for photodynamic-based therapies of head and neck cancer. Considering the vascular and stromal modulating effects of sub-therapeutic photodynamic therapy, namely photodynamic priming (PDP), this study explores the potential synergy between PDP and IGS for a novel photodynamic image-guided surgery (P-IGS) strategy. To the best of our knowledge, this is the first demonstration that PDP of the tumor microenvironment can augment the tumor delivery of full-length antibodies, namely Cet-IRDye800. In this study, we demonstrate a proof-of-concept that PDP primes orthotopic FaDu human head and neck tumors in mice for P-IGS by increasing the delivery of Cet-IRDye800 by up to 138.6%, by expediting its interstitial accumulation by 10.5-fold, and by increasing its fractional tumor coverage by 49.5% at 1 h following Cet-IRDye800 administration. Importantly, PDP improves the diagnostic accuracy of tumor detection by up to 264.2% with respect to vicinal salivary glands at 1 h. As such, PDP provides a time-to-surgery benefit by reducing the time to plateau 10-fold from 25.7 h to 2.5 h. We therefore propose that a pre-operative PDP regimen can expedite and augment the accuracy of IGS-mediated surgical debulking of head and neck tumors and reduce the time-to-IGS. Furthermore, this P-IGS regimen, can also enable a forward-looking post-operative protocol for the photodestruction of unresectable microscopic disease in the surgical bed. Beyond this scope, the role of PDP in the homogenous delivery of diagnostic, theranostic and therapeutic antibodies in solid tumors is of considerable significance to the wider community.
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Affiliation(s)
- Chanda Bhandari
- Department of Bioengineering, University of Texas at Dallas, Richardson, TX, United States
| | - John Fakhry
- Department of Bioengineering, University of Texas at Dallas, Richardson, TX, United States
| | - Menitte Eroy
- Department of Bioengineering, University of Texas at Dallas, Richardson, TX, United States
| | - Jane Junghwa Song
- Department of Bioengineering, University of Texas at Dallas, Richardson, TX, United States
| | - Kimberley Samkoe
- Thayer School of Engineering, Dartmouth College, Hanover, NH, United States
| | - Tayyaba Hasan
- Wellman Center for Photomedicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Division of Health Sciences and Technology, Harvard University and Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Kenneth Hoyt
- Department of Bioengineering, University of Texas at Dallas, Richardson, TX, United States
| | - Girgis Obaid
- Department of Bioengineering, University of Texas at Dallas, Richardson, TX, United States
- *Correspondence: Girgis Obaid,
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5
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Flores dos Santos LC, Fernandes JR, Lima IFP, Bittencourt LDS, Martins MD, Lamers ML. Applicability of autofluorescence and fluorescent probes in early detection of oral potentially malignant disorders: a systematic review and meta-data analysis. Photodiagnosis Photodyn Ther 2022; 38:102764. [DOI: 10.1016/j.pdpdt.2022.102764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 02/10/2022] [Accepted: 02/14/2022] [Indexed: 12/24/2022]
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6
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Crawford KL, Pacheco FV, Lee YJ, Hom M, Rosenthal EL, Nguyen QT, Orosco RK. A Scoping Review of Ongoing Fluorescence-Guided Surgery Clinical Trials in Otolaryngology. Laryngoscope 2021; 132:36-44. [PMID: 34633092 DOI: 10.1002/lary.29891] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 09/17/2021] [Accepted: 09/23/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Fluorescence-guided surgery (FGS) is a rapidly developing intraoperative technology, and many contrast agents are currently under investigation. We sought to provide a review of the current state of FGS clinical trials in Otolaryngology, emphasizing its oncologic applications. METHODS According to the preferred reporting Items for systematic reviews and meta-analyses (PRISMA) workflow for scoping reviews, a clinical trial search was performed across multiple international clinical trials registries, searching for permutations of "fluorescence," "tumor," "surgery," and "nerve" to identify all relevant studies. Studies that were active, enrolling, or soon to be enrolling patients undergoing head and neck surgery were included. RESULTS Nineteen studies were eligible for inclusion. Seventeen studies are focused on FGS for oncologic resection and lymph node detection. One study assesses peripheral nerve fluorescence, and one evaluates normal parathyroid function after thyroidectomy. Contrast agents under development are conjugated to fluorophores that excite in the 800 nm (indocyanine green), 410 nm (5-aminolevulinic acid), 700 nm (Cyanine 5.5), and 525 nm ranges (fluorescein derivatives). CONCLUSION Presently, there are 19 ongoing trials investigating novel FGS contrast agents for their safety, efficacy, and utility in Otolaryngology-Head and Neck Surgery. These agents rely on unique fluorophores and absorption ranges in the near-infrared and visible light spectra. FGS studies are expanding within Otolaryngology-Head and Neck Surgery with profound implications in oncologic surgery, lymph node detection, and anatomic and functional assessment. Laryngoscope, 2021.
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Affiliation(s)
- Kayva L Crawford
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, California, U.S.A
| | - Fernanda V Pacheco
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, California, U.S.A
| | - Yu-Jin Lee
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California, U.S.A
| | - Marisa Hom
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California, U.S.A
| | - Eben L Rosenthal
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California, U.S.A
| | - Quyen T Nguyen
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, California, U.S.A
| | - Ryan K Orosco
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, California, U.S.A.,Moores Cancer Center, La Jolla, California, U.S.A
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7
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van Schaik JE, Halmos GB, Witjes MJH, Plaat BEC. An overview of the current clinical status of optical imaging in head and neck cancer with a focus on Narrow Band imaging and fluorescence optical imaging. Oral Oncol 2021; 121:105504. [PMID: 34454339 DOI: 10.1016/j.oraloncology.2021.105504] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/25/2021] [Accepted: 08/18/2021] [Indexed: 11/28/2022]
Abstract
Early and accurate identification of head and neck squamous cell carcinoma (HNSCC) is important to improve treatment outcomes and prognosis. New optical imaging techniques may assist in both the diagnostic process as well as in the operative setting by real-time visualization and delineation of tumor. Narrow Band Imaging (NBI) is an endoscopic technique that uses blue and green light to enhance mucosal and submucosal blood vessels, leading to better detection of (pre)malignant lesions showing aberrant blood vessel patterns. Fluorescence optical imaging makes use of near-infrared fluorescent agents to visualize and delineate HNSCC, resulting in fewer positive surgical margins. Targeted fluorescent agents, such as fluorophores conjugated to antibodies, show the most promising results. The aim of this review is: (1) to provide the clinical head and neck surgeon an overview of the current clinical status of various optical imaging techniques in head and neck cancer; (2) to provide an in-depth review of NBI and fluorescence optical imaging, as these techniques have the highest potential for clinical implementation; and (3) to describe future improvements and developments within the field of these two techniques.
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Affiliation(s)
- Jeroen E van Schaik
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
| | - Gyorgy B Halmos
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Max J H Witjes
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, the Netherlands
| | - Boudewijn E C Plaat
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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8
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Napier TS, Udayakumar N, Jani AH, Hartman YE, Houson HA, Moore L, Amm HM, van den Berg NS, Sorace AG, Warram JM. Comparison of Panitumumab-IRDye800CW and 5-Aminolevulinic Acid to Provide Optical Contrast in a Model of Glioblastoma Multiforme. Mol Cancer Ther 2020; 19:1922-1929. [PMID: 32606015 DOI: 10.1158/1535-7163.mct-19-0819] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 01/16/2020] [Accepted: 06/15/2020] [Indexed: 01/02/2023]
Abstract
Maximal safe resection of malignant tissue is associated with improved progression-free survival and better response to radiation and chemotherapy for patients with glioblastoma (GBM). 5-Aminolevulinic acid (5-ALA) is the current FDA-approved standard for intraoperative brain tumor visualization. Unfortunately, autofluorescence in diffuse areas and high fluorescence in dense tissues significantly limit discrimination at tumor margins. This study is the first to compare 5-ALA to an investigational new drug, panitumumab-IRDye800CW, in the same animal model. A patient-derived GBM xenograft model was established in 16 nude mice, which later received injections of 5-ALA, panitumumab-IRDye800CW, IRDye800CW, 5-ALA and IRDye800CW, or 5-ALA and panitumumab-IRDye800CW. Brains were prepared for multi-instrument fluorescence imaging, IHC, and quantitative analysis of tumor-to-background ratio (TBR) and tumor margin accuracy. Statistical analysis was compared with Wilcoxon rank-sum or paired t test. Panitumumab-IRDye800CW had a 30% higher comprehensive TBR compared with 5-ALA (P = 0.0079). SDs for core and margin regions of interest in 5-ALA-treated tissues were significantly higher than those found in panitumumab-IRDye800CW-treated tissues (P = 0.0240 and P = 0.0284, respectively). Panitumumab-IRDye800CW specificities for tumor core and margin were more than 10% higher than those of 5-ALA. Higher AUC for panitumumab-IRDye800CW indicated strong capability to discriminate between normal and malignant brain tissue when compared with 5-ALA. This work demonstrates that panitumumab-IRDye800CW shows potential as a targeting agent for fluorescence intraoperative detection of GBM. Improved margin definition and surgical resection using panitumumab-IRDye800 has the potential to improve surgical outcomes and survival in patients with GBM compared with 5-ALA.
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Affiliation(s)
- Tiara S Napier
- Graduate Biomedical Sciences, University of Alabama at Birmingham, Birmingham, Alabama
| | - Neha Udayakumar
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Aditi H Jani
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Yolanda E Hartman
- Department of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Hailey A Houson
- Department of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Lindsay Moore
- Department of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Hope M Amm
- Department of Oral and Maxillofacial Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Nynke S van den Berg
- Department of Otolaryngology, Stanford University Medical School, Stanford, California
| | - Anna G Sorace
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama.,O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jason M Warram
- Department of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama. .,O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama
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9
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An Update on Surgical Margins in the Head Neck Squamous Cell Carcinoma: Assessment, Clinical Outcome, and Future Directions. Curr Oncol Rep 2020; 22:82. [PMID: 32601821 DOI: 10.1007/s11912-020-00942-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE OF REVIEW Failure to achieve tumor-free margins is the single largest cause of death for head neck cancer patients. At the same time, it is the only factor that is in complete control of the surgeon. This review summarizes evidence for the definition, clinical implications, and methods to achieve optimal margins. RECENT FINDINGS The previous universally followed definition of adequate margin (5 mm in final histopathology) has been disputed. Various biological, optical, and imaging adjuncts can aid in achieving optimal margins. Extent of resection and margins in human papilloma virus (HPV)-positive oropharyngeal cancers and following induction chemotherapy remain controversial. Though practiced widely, frozen section-guided margin revision has not conclusively shown improved local control rates. The role of molecular assessment of margins is promising but not established. The definition of adequate margin differs according to the site in the head neck region. Currently, the 5-mm margin at final histopathology is the most commonly accepted definition of an "adequate" margin.
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Choi N, Jeong HS. Precision surgery for cancer: a new surgical concept in individual tumor biology-based image-guided surgery. PRECISION AND FUTURE MEDICINE 2019. [DOI: 10.23838/pfm.2019.00072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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11
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Cals FLJ, Bakker Schut TC, Caspers PJ, Baatenburg de Jong RJ, Koljenović S, Puppels GJ. Raman spectroscopic analysis of the molecular composition of oral cavity squamous cell carcinoma and healthy tongue tissue. Analyst 2019; 143:4090-4102. [PMID: 30083685 DOI: 10.1039/c7an02106b] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
A Raman tissue spectrum is a quantitative representation of the overall molecular composition of that tissue. Raman spectra are often used as tissue fingerprints without further interpretation of the specific information that they contain about the tissue's molecular composition. In this study, we analyzed the differences in molecular composition between oral cavity squamous cell carcinoma (OCSCC) and healthy tissue structures in tongue, based on their Raman spectra. A total of 1087 histopathologically annotated spectra (142 OCSCC, 202 surface squamous epithelium, 61 muscle, 65 adipose tissue, 581 connective tissue, 26 gland, and 10 nerve) were obtained from Raman maps of 44 tongue samples from 21 patients. A characteristic, average spectrum of each tissue structure was fitted with a set of 55 pure-compound reference spectra, to define the best library of fit-spectra. Reference spectra represented proteins, lipids, nucleic acids, carbohydrates, amino acids and other miscellaneous molecules. A non-negative least-squares algorithm was used for fitting. Individual spectra per histopathological annotation were then fitted with this selected library in order to determine the molecular composition per tissue structure. The spectral contribution per chemical class was calculated. The results show that all characteristic tissue-type spectra could be fitted with a low residual of <4.82%. The content of carbohydrates, proteins and amino acids was the strongest discriminator between OCSCC and healthy tissue. The combination of carbohydrates, proteins and amino acids was used for a classification model of 'tumor' versus 'healthy tissue'. Validation of this model on an independent dataset showed a specificity of 93% at a sensitivity of 100%.
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Affiliation(s)
- F L J Cals
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer institute, University Medical Center Rotterdam, The Netherlands
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12
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Zhang C, Ling X, Guo Y, Yuan C, Cheng H, Ye X, Ma R, Zhang Y, Li Y, Chang X, Kong B, Liu T, Cui H. Evaluation of COC183B2 antibody targeting ovarian cancer by near-infrared fluorescence imaging. Chin J Cancer Res 2019; 31:673-685. [PMID: 31564810 PMCID: PMC6736662 DOI: 10.21147/j.issn.1000-9604.2019.04.11] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objective To evaluate the imaging potential of a novel near-infrared (NIR) probe conjugated to COC183B2 monoclonal antibodies (MAb) in ovarian cancer (OC). Methods The expression of OC183B2 antigen in OC was determined by immunohistochemical (IHC) staining using tissue microarrays with the H-score system and immunofluorescence (IF) staining of tumor cell lines. Imaging probes with the NIR fluorescent dye cyanine 7 (Cy7) conjugated to COC183B2 Mab were chemically engineered. OC183B2-positive human OC cells (SKOV3-Luc) were injected subcutaneously into BALB/c nude mice. Bioluminescent imaging (BLI) was performed to detect tumor location and growth. COC183B2-Cy7 at 1.1, 3.3, 10, or 30 μg were used for in vivo fluorescence imaging, and phosphate-buffered saline (PBS), free Cy7 dye and mouse isotype immunoglobulin G (IgG)-Cy7 (delivered at the same doses as COC183B2-Cy7) were used as controls. Results The expression of OC183B2 with a high H-score was more prevalent in OC tissue than fallopian tube (FT) tissue. Among 417 OC patients, the expression of OC183B2 was significantly correlated with the histological subtype, histological grade, residual tumor size, relapse state and survival status. IF staining demonstrated that COC183B2 specifically expressed in SKOV3 cells but not HeLa cells. In vivo NIR fluorescence imaging indicated that COC183B2-Cy7 was mainly distributed in the xenograft and liver with optimal tumor-to-background (T/B) ratios in the xenograft at 30 μg dose. The highest fluorescent signals in the tumor were observed at 96 h post-injection (hpi). Ex vivo fluorescence imaging revealed the fluorescent signals mainly from the tumor and liver. IHC analysis confirmed that xenografts were OC183B2 positive. Conclusions COC183B2 is a good candidate for NIR fluorescence imaging and imaging-guided surgery in OC.
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Affiliation(s)
- Chen Zhang
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing 100044, China.,Center of Gynecologic Oncology, Peking University People's Hospital, Beijing 100044, China
| | - Xinyu Ling
- State Key Laboratory of Natural and Biomimetic Drugs, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China
| | - Yanxiu Guo
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing 100044, China.,Center of Gynecologic Oncology, Peking University People's Hospital, Beijing 100044, China
| | - Cunzhong Yuan
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Hongyan Cheng
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing 100044, China.,Center of Gynecologic Oncology, Peking University People's Hospital, Beijing 100044, China
| | - Xue Ye
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing 100044, China.,Center of Gynecologic Oncology, Peking University People's Hospital, Beijing 100044, China
| | - Ruiqiong Ma
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing 100044, China.,Center of Gynecologic Oncology, Peking University People's Hospital, Beijing 100044, China
| | - Yinli Zhang
- Department of Pathology, Peking University People's Hospital, Beijing 100044, China
| | - Yi Li
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing 100044, China
| | - Xiaohong Chang
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing 100044, China.,Center of Gynecologic Oncology, Peking University People's Hospital, Beijing 100044, China
| | - Beihua Kong
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Tao Liu
- State Key Laboratory of Natural and Biomimetic Drugs, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China
| | - Heng Cui
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing 100044, China.,Center of Gynecologic Oncology, Peking University People's Hospital, Beijing 100044, China
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13
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Shaw SK, Liu W, Gómez Durán CFA, Schreiber CL, Betancourt Mendiola MDL, Zhai C, Roland FM, Padanilam SJ, Smith BD. Non-Covalently Pre-Assembled High-Performance Near-Infrared Fluorescent Molecular Probes for Cancer Imaging. Chemistry 2018; 24:13821-13829. [PMID: 30022552 DOI: 10.1002/chem.201801825] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 07/05/2018] [Indexed: 12/15/2022]
Abstract
New fluorescent molecular probes, which can selectively target specific cell surface receptors, are needed for microscopy, in vivo imaging, and image guided surgery. The preparation of multivalent probes using standard synthetic chemistry can be a laborious process due to low reaction yields caused by steric effects. In this study, fluorescent molecular probes were prepared by a programmed non-covalent pre-assembly process that used a near-infrared fluorescent squaraine dye to thread a macrocycle bearing a cyclic arginine-glycine-aspartate peptide antagonist (cRGDfK) as a cancer targeting unit. Cell microscopy studies using OVCAR-4 (ovarian cancer) and A549 (lung cancer) cells that express high levels of the integrin αvβ3 or αvβ5 receptors, respectively, revealed a multivalent cell targeting effect. That is, there was comparatively more cell uptake of a pre-assembled probe equipped with two copies of the cRGDfK antagonist than a pre-assembled probe with only one appended cRGDfK antagonist. The remarkably high photostability and low phototoxicity of these near-infrared probes allowed for acquisition of long-term fluorescence movies showing endosome trafficking in living cells. In vivo near-infrared fluorescence imaging experiments compared the biodistribution of a targeted and untargeted probe in a xenograft mouse tumor model. The average tumor-to-muscle ratio for the pre-assembled targeted probe was 3.6 which matches the tumor targeting performance reported for analogous cRGDfK-based probes that were prepared entirely by covalent synthesis. The capability to excite these pre-assembled near-infrared fluorescent probes with blue or deep-red excitation light makes it possible to determine if a target site is located superficially or buried in tissue, a probe performance feature that is likely to be very helpful for eventual applications such as fluorescence guided surgery.
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Affiliation(s)
- Scott K Shaw
- Department of Chemistry & Biochemistry, University of Notre Dame, 236 Nieuwland Science Hall, Notre Dame, IN, 46545, USA
| | - Wenqi Liu
- Department of Chemistry & Biochemistry, University of Notre Dame, 236 Nieuwland Science Hall, Notre Dame, IN, 46545, USA
| | | | - Cynthia L Schreiber
- Department of Chemistry & Biochemistry, University of Notre Dame, 236 Nieuwland Science Hall, Notre Dame, IN, 46545, USA
| | | | - Canjia Zhai
- Department of Chemistry & Biochemistry, University of Notre Dame, 236 Nieuwland Science Hall, Notre Dame, IN, 46545, USA
| | - Felicia M Roland
- Department of Chemistry & Biochemistry, University of Notre Dame, 236 Nieuwland Science Hall, Notre Dame, IN, 46545, USA
| | - Simon J Padanilam
- Department of Chemistry & Biochemistry, University of Notre Dame, 236 Nieuwland Science Hall, Notre Dame, IN, 46545, USA
| | - Bradley D Smith
- Department of Chemistry & Biochemistry, University of Notre Dame, 236 Nieuwland Science Hall, Notre Dame, IN, 46545, USA
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14
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Targeting CD44v6 for fluorescence-guided surgery in head and neck squamous cell carcinoma. Sci Rep 2018; 8:10467. [PMID: 29992954 PMCID: PMC6041314 DOI: 10.1038/s41598-018-28059-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 06/08/2018] [Indexed: 02/01/2023] Open
Abstract
Head and neck squamous cell carcinoma (HNSCC) is an often highly invasive tumor, infiltrating functionally important tissue areas. Achieving complete tumor resection and preserving functionally relevant tissue structures depends on precise identification of tumor-free resection margins during surgery. Fluorescence-guided surgery (FGS), by intraoperative detection of tumor cells using a fluorescent tracer, may guide surgical excision and identify tumor-positive resection margins. Using a literature survey on potential surface molecules followed by immunohistochemical validation, we identified CD44 variant 6 (CD44v6) as a constitutively expressed antigen in the invasion zone of HNSCC lesions. The monoclonal anti-CD44v6 antibody BIWA was labeled with both a near-infrared fluorescent dye (IRDye800CW) and a radioactive label (Indium-111) and dual-modality imaging was applied in a locally invasive tumor mouse model. BIWA accurately detected human HNSCC xenografts in mice with a tumor uptake of 54 ± 11% ID/g and invasion regions with an accuracy of 94%. When dissected under clinical-like conditions, tumor remnants approximately 0.7 mm in diameter consisting of a few thousand cells were identified by fluorescence imaging, resulting in reliable dissection of invasive microregions. These data indicate that CD44v6 is a suitable target for reliable near-infrared detection and FGS of invasive HNSCC lesions in vivo.
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15
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Pogue BW, Feng J, LaRochelle EP, Bruža P, Lin H, Zhang R, Shell JR, Dehghani H, Davis SC, Vinogradov SA, Gladstone DJ, Jarvis LA. Maps of in vivo oxygen pressure with submillimetre resolution and nanomolar sensitivity enabled by Cherenkov-excited luminescence scanned imaging. Nat Biomed Eng 2018; 2:254-264. [PMID: 30899599 PMCID: PMC6424530 DOI: 10.1038/s41551-018-0220-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Low signal-to-noise ratios and limited imaging depths restrict the ability of optical-imaging modalities to detect and accurately quantify molecular emissions from tissue. Here, by using a scanning external X-ray beam from a clinical linear accelerator to induce Cherenkov excitation of luminescence in tissue, we demonstrate in vivo mapping of the oxygenation of tumours at depths of several millimetres, with submillimetre resolution and nanomolar sensitivity. This was achieved by scanning thin sheets of the X-ray beam orthogonally to the emission-detection plane, and by detecting the signal via a time-gated CCD camera synchronized to the radiation pulse. We also show with experiments using phantoms and with simulations that the performance of Cherenkov-excited luminescence scanned imaging (CELSI) is limited by beam size, scan geometry, probe concentration, radiation dose and tissue depth. CELSI might provide the highest sensitivity and resolution in the optical imaging of molecular tracers in vivo.
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Affiliation(s)
- Brian W Pogue
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA. .,Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
| | - Jinchao Feng
- Faculty of Information Technology, Beijing University of Technology, Beijing, China
| | | | - Petr Bruža
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA
| | - Huiyun Lin
- Key Laboratory of OptoElectronic Science and Technology for Medicine of Ministry of Education, Fujian Provincial Key Laboratory of Photonics Technology, Fujian Normal University, Fuzhou, China
| | - Rongxiao Zhang
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA
| | - Jennifer R Shell
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA
| | - Hamid Dehghani
- School of Computer Science, University of Birmingham, Birmingham, UK
| | - Scott C Davis
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA.,Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Sergei A Vinogradov
- Department of Biochemistry and Biophysics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - David J Gladstone
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA.,Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.,Department of Medicine, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - Lesley A Jarvis
- Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.,Department of Medicine, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
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16
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Wu C, Gleysteen J, Teraphongphom NT, Li Y, Rosenthal E. In-vivo optical imaging in head and neck oncology: basic principles, clinical applications and future directions. Int J Oral Sci 2018; 10:10. [PMID: 29555901 PMCID: PMC5944254 DOI: 10.1038/s41368-018-0011-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 12/29/2017] [Accepted: 01/10/2018] [Indexed: 02/05/2023] Open
Abstract
Head and neck cancers become a severe threat to human's health nowadays and represent the sixth most common cancer worldwide. Surgery remains the first-line choice for head and neck cancer patients. Limited resectable tissue mass and complicated anatomy structures in the head and neck region put the surgeons in a dilemma between the extensive resection and a better quality of life for the patients. Early diagnosis and treatment of the pre-malignancies, as well as real-time in vivo detection of surgical margins during en bloc resection, could be leveraged to minimize the resection of normal tissues. With the understanding of the head and neck oncology, recent advances in optical hardware and reagents have provided unique opportunities for real-time pre-malignancies and cancer imaging in the clinic or operating room. Optical imaging in the head and neck has been reported using autofluorescence imaging, targeted fluorescence imaging, high-resolution microendoscopy, narrow band imaging and the Raman spectroscopy. In this study, we reviewed the basic theories and clinical applications of optical imaging for the diagnosis and treatment in the field of head and neck oncology with the goal of identifying limitations and facilitating future advancements in the field.
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Affiliation(s)
- Chenzhou Wu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - John Gleysteen
- Department of Otolaryngology, University of Tennessee Health Science Center, 38163, Memphis, TN, USA
| | | | - Yi Li
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
| | - Eben Rosenthal
- Department of Otolaryngology and Radiology, Stanford University, 94305, Stanford, CA, USA.
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17
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Hofmann CL, O’Sullivan MC, Detappe A, Yu Y, Yang X, Qi W, Landon CD, Therien MJ, Dewhirst MW, Ghoroghchian PP, Palmer GM. NIR-emissive PEG-b-TCL micelles for breast tumor imaging and minimally invasive pharmacokinetic analysis. NANOSCALE 2017; 9:13465-13476. [PMID: 28861570 PMCID: PMC5661869 DOI: 10.1039/c7nr02363d] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Motivated by the goal of developing a fully biodegradable optical contrast agent with translational clinical potential, a nanoparticle delivery vehicle was generated from the self-assembly of poly(ethylene-glycol)-block-poly(trimethylene carbonate-co-caprolactone) (PEG-b-TCL) copolymers. Cryogenic transmission electron microscopy verified that PEG-b-TCL-based micelles were formed at low solution temperatures (∼38 °C). Detailed spectroscopic experiments validated facile loading of large quantities of the high emission dipole strength, tris(porphyrin)-based fluorophore PZn3 within their cores, and the micelles displayed negligible in vitro and in vivo toxicities in model systems. The pharmacokinetics and biodistribution of PZn3-loaded PEG-b-TCL-based micelles injected intravenously were determined via ex vivo near-infrared (NIR) imaging of PZn3 emission in microcapillary tubes containing minute quantities of blood, to establish a novel method for minimally invasive pharmacokinetic monitoring. The in vivo circulatory half-life of the PEG-b-TCL-based micelles was found to be ∼19.6 h. Additionally, longitudinal in vivo imaging of orthotopically transplanted breast tumors enabled determination of micelle biodistribution that correlated to ex vivo imaging results, demonstrating accumulation predominantly within the tumors and livers of mice. The PEG-b-TCL-based micelles quickly extravasated within 4T1 orthotopic mammary carcinomas, exhibiting peak accumulation at ∼48 h following intravenous tail-vein injection. In summary, PEG-b-TCL-based micelles demonstrated favorable characteristics for further development as in vivo optical contrast agents for minimally invasive imaging of breast tumors.
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Affiliation(s)
- Christina L. Hofmann
- Biomedical Engineering Department, Duke University, Room 136 Hudson Hall, Durham, NC 27708, USA
| | - Melanie C. O’Sullivan
- Department of Chemistry, Duke University, French Family Science Center, 124 Science Drive, Durham, NC 27708, USA
| | - Alexandre Detappe
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston MA, 02215, USA
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115
- Koch Institute for Integrative Cancer Research at Massachusetts Institute of Technology, 77 Massachusetts Avenue, Room 76-261F, Cambridge MA, 02139, USA
| | - Yingjie Yu
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston MA, 02215, USA
| | - Xi Yang
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston MA, 02215, USA
| | - Wei Qi
- Department of Chemistry, Duke University, French Family Science Center, 124 Science Drive, Durham, NC 27708, USA
| | - Chelsea D. Landon
- Department of Pathology, Duke University Medical Center, Box 3455, Durham, NC 27710, USA
| | - Michael J. Therien
- Department of Chemistry, Duke University, French Family Science Center, 124 Science Drive, Durham, NC 27708, USA
| | - Mark W. Dewhirst
- Biomedical Engineering Department, Duke University, Room 136 Hudson Hall, Durham, NC 27708, USA
- Department of Pathology, Duke University Medical Center, Box 3455, Durham, NC 27710, USA
- Radiation Oncology Department, Duke University Medical Center, Box 3455, Durham, NC 27710, USA
| | - P. Peter Ghoroghchian
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston MA, 02215, USA
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115
- Koch Institute for Integrative Cancer Research at Massachusetts Institute of Technology, 77 Massachusetts Avenue, Room 76-261F, Cambridge MA, 02139, USA
| | - Gregory M. Palmer
- Radiation Oncology Department, Duke University Medical Center, Box 3455, Durham, NC 27710, USA
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18
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Abstract
Margin assessment remains a critical component of oncologic care for head and neck cancer patients. As an integrated team, both surgeons and pathologists work together to assess margins in these complex patients. Differences in method of margin sampling can impact obtainable information and effect outcomes. Additionally, what distance is an "adequate or clear" margin for patient care continues to be debated. Ultimately, future studies and potentially secondary modalities to augment pathologic assessment of margin assessment (i.e., in situ imaging or molecular assessment) may enhance local control in head and neck cancer patients.
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Affiliation(s)
- Michelle D Williams
- Department of Pathology, Head and Neck Section, MD Anderson Cancer Center, The University of Texas, 1515 Holcombe Blvd, Unit 085, Houston, TX, 77030, USA.
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19
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Choi N, Cho JK, Lee EK, Won SJ, Kim BY, Baek CH. Transoral bisected resection for T1-2 oral tongue squamous cell carcinoma to secure adequate deep margin. Oral Oncol 2017; 73:70-76. [PMID: 28939079 DOI: 10.1016/j.oraloncology.2017.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 08/04/2017] [Accepted: 08/09/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND To investigate the clinical usefulness of transoral bisected resection (TBR) asa new method to secure adequate deep resection margin in T1-2 oral tongue squamous cell carcinomas (SCC). METHODS Among 75 patients with cT1-2N0 oral tongue SCCs, 45 (60%) received transoral en-bloc resection (TER) while 30 (40%) received patients underwent TBR. Primary tumor resection was performed with 1.5-cm surgical resection margin for both groups. Mucosal and deep resection margins, adjuvant treatments including re-resection of the tongue and cheomoradiotherapy, local and regional recurrence free survival, and overall survival were compared between the two groups. RESULTS Mean deep resection margin in the TBR group was 9.9mm (95% CI: 8.4-11.4mm), which was significantly (P<0.001) wider than that of the TER group (mean: 5.4mm, 95% CI: 4.5-6.3mm). However, mucosal resection margins were not significantly (P=0.153) different between the two groups. Re-resection of tongue was performed for 6 (13.3%) of 17 (37.8%) patients with inadequate deep resection margin in the TER group and none (0%) in 4 (13.3%) patients with inadequate deep resection margin in the TBR group. Adjuvant radiation due to inadequate deep resection margin was performed for 6.7% of patients in both groups. The TBR group had better local recurrence free survival than the TER group. However, regional recurrence free survival and overall survival were not significantly different between the two groups. CONCLUSION TBR could provide adequate deep resection margin for early stage tongue cancers with better local tumor control than TER. It can decrease the necessity of adjuvant treatment for re-resection of the tongue.
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Affiliation(s)
- Nayeon Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Jae-Keun Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, Inje University Ilsan Paik Hospital, Inje University School of Medicine, Goyang, Republic of Korea
| | - Eun Kyu Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Sung Jun Won
- Department of Otorhinolaryngology-Head and Neck Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Bo Young Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Chung-Hwan Baek
- Department of Otorhinolaryngology-Head and Neck Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea; Department of Medical Device Management & Research, SAIHST, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea.
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20
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Zhang RR, Schroeder AB, Grudzinski JJ, Rosenthal EL, Warram JM, Pinchuk AN, Eliceiri KW, Kuo JS, Weichert JP. Beyond the margins: real-time detection of cancer using targeted fluorophores. Nat Rev Clin Oncol 2017; 14:347-364. [PMID: 28094261 PMCID: PMC5683405 DOI: 10.1038/nrclinonc.2016.212] [Citation(s) in RCA: 290] [Impact Index Per Article: 41.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Over the past two decades, synergistic innovations in imaging technology have resulted in a revolution in which a range of biomedical applications are now benefiting from fluorescence imaging. Specifically, advances in fluorophore chemistry and imaging hardware, and the identification of targetable biomarkers have now positioned intraoperative fluorescence as a highly specific real-time detection modality for surgeons in oncology. In particular, the deeper tissue penetration and limited autofluorescence of near-infrared (NIR) fluorescence imaging improves the translational potential of this modality over visible-light fluorescence imaging. Rapid developments in fluorophores with improved characteristics, detection instrumentation, and targeting strategies led to the clinical testing in the early 2010s of the first targeted NIR fluorophores for intraoperative cancer detection. The foundations for the advances that underline this technology continue to be nurtured by the multidisciplinary collaboration of chemists, biologists, engineers, and clinicians. In this Review, we highlight the latest developments in NIR fluorophores, cancer-targeting strategies, and detection instrumentation for intraoperative cancer detection, and consider the unique challenges associated with their effective application in clinical settings.
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Affiliation(s)
- Ray R Zhang
- Department of Radiology, University of Wisconsin-Madison (UW-Madison), 600 Highland Avenue, Madison, Wisconsin 53792, USA
- Department of Neurological Surgery, UW-Madison, 600 Highland Avenue, Madison, Wisconsin 53792, USA
| | - Alexandra B Schroeder
- Medical Engineering, Morgridge Institute for Research, 330 North Orchard Street, Madison, Wisconsin 53715, USA
- Laboratory for Optical and Computational Instrumentation, 1675 Observatory Drive, Madison Wisconsin 53706, USA
- Department of Medical Physics, UW-Madison, 1111 Highland Avenue, Madison, Wisconsin 53705, USA
| | - Joseph J Grudzinski
- Department of Medical Physics, UW-Madison, 1111 Highland Avenue, Madison, Wisconsin 53705, USA
| | - Eben L Rosenthal
- Department of Otolaryngology, Stanford Cancer Center, 875 Blake Wilbur Drive, Stanford, California 94305, USA
| | - Jason M Warram
- Department of Otolaryngology, University of Alabama at Birmingham, 1670 University Boulevard, Birmingham, Alabama 35294, USA
| | - Anatoly N Pinchuk
- Department of Radiology, University of Wisconsin-Madison (UW-Madison), 600 Highland Avenue, Madison, Wisconsin 53792, USA
| | - Kevin W Eliceiri
- Medical Engineering, Morgridge Institute for Research, 330 North Orchard Street, Madison, Wisconsin 53715, USA
- Laboratory for Optical and Computational Instrumentation, 1675 Observatory Drive, Madison Wisconsin 53706, USA
- Department of Medical Physics, UW-Madison, 1111 Highland Avenue, Madison, Wisconsin 53705, USA
- Carbone Cancer Center, UW-Madison, 600 Highland Avenue Madison, Wisconsin 53792, USA
| | - John S Kuo
- Department of Neurological Surgery, UW-Madison, 600 Highland Avenue, Madison, Wisconsin 53792, USA
- Carbone Cancer Center, UW-Madison, 600 Highland Avenue Madison, Wisconsin 53792, USA
| | - Jamey P Weichert
- Department of Radiology, University of Wisconsin-Madison (UW-Madison), 600 Highland Avenue, Madison, Wisconsin 53792, USA
- Department of Medical Physics, UW-Madison, 1111 Highland Avenue, Madison, Wisconsin 53705, USA
- Carbone Cancer Center, UW-Madison, 600 Highland Avenue Madison, Wisconsin 53792, USA
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21
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Hussain T, Savariar EN, Diaz-Perez JA, Messer K, Pu M, Tsien RY, Nguyen QT. Surgical molecular navigation with ratiometric activatable cell penetrating peptide for intraoperative identification and resection of small salivary gland cancers. Head Neck 2016; 38:715-23. [PMID: 25521629 PMCID: PMC4472578 DOI: 10.1002/hed.23946] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2014] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND We evaluated the use of intraoperative fluorescence guidance by enzymatically cleavable ratiometric activatable cell-penetrating peptide (RACPPPLGC(Me)AG) containing Cy5 as a fluorescent donor and Cy7 as a fluorescent acceptor for salivary gland cancer surgery in a mouse model. METHODS Surgical resection of small parotid gland cancers in mice was performed with fluorescence guidance or white light (WL) imaging alone. Tumor identification accuracy, operating time, and tumor-free survival were compared. RESULTS RACPP guidance aided tumor detection (positive histology in 90% [27/30] vs 48% [15/31] for WL; p < .001). An approximate 25% ratiometric signal increase as the threshold to distinguish between tumor and adjacent tissue, yielded >90% detection sensitivity and specificity. Operating time was reduced by 54% (p < .001), and tumor-free survival was increased with RACPP guidance (p = .025). CONCLUSION RACPP provides real-time intraoperative guidance leading to improved survival. Ratiometric signal thresholds can be set according to desired detection accuracy levels for future RACPP applications.
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Affiliation(s)
- Timon Hussain
- Division of Head and Neck Surgery, University of California San Diego
| | | | | | - Karen Messer
- Division of Biostatistics, Moores Cancer Center, University of California San Diego
| | - Minya Pu
- Division of Biostatistics, Moores Cancer Center, University of California San Diego
| | - Roger Y. Tsien
- Department of Pharmacology, University of California San Diego
- Howard Hughes Medical Institute, University of California San Diego
| | - Quyen T. Nguyen
- Division of Head and Neck Surgery, University of California San Diego
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22
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Fluorescence guided resection (FGR): A primer for oncology. Photodiagnosis Photodyn Ther 2016; 13:73-80. [DOI: 10.1016/j.pdpdt.2015.11.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 11/25/2015] [Accepted: 11/26/2015] [Indexed: 01/27/2023]
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23
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Kossatz S, Brand C, Gutiontov S, Liu JTC, Lee NY, Gönen M, Weber WA, Reiner T. Detection and delineation of oral cancer with a PARP1 targeted optical imaging agent. Sci Rep 2016; 6:21371. [PMID: 26900125 PMCID: PMC4761964 DOI: 10.1038/srep21371] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 01/20/2016] [Indexed: 12/01/2022] Open
Abstract
Earlier and more accurate detection of oral squamous cell carcinoma (OSCC) is essential to improve the prognosis of patients and to reduce the morbidity of surgical therapy. Here, we demonstrate that the nuclear enzyme Poly(ADP-ribose)Polymerase 1 (PARP1) is a promising target for optical imaging of OSCC with the fluorescent dye PARPi-FL. In patient-derived OSCC specimens, PARP1 expression was increased 7.8 ± 2.6-fold when compared to normal tissue. Intravenous injection of PARPi-FL allowed for high contrast in vivo imaging of human OSCC models in mice with a surgical fluorescence stereoscope and high-resolution imaging systems. The emitted signal was specific for PARP1 expression and, most importantly, PARPi-FL can be used as a topical imaging agent, spatially resolving the orthotopic tongue tumors in vivo. Collectively, our results suggest that PARP1 imaging with PARPi-FL can enhance the detection of oral cancer, serve as a screening tool and help to guide surgical resections.
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Affiliation(s)
- Susanne Kossatz
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Christian Brand
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Stanley Gutiontov
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Jonathan T C Liu
- Department of Mechanical Engineering, University of Washington, Seattle, WA 98195, USA
| | - Nancy Y Lee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Mithat Gönen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Wolfgang A Weber
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.,Department of Radiology, Weill Cornell Medical College, New York, NY 10065, USA.,Molecular Pharmacology Program, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Thomas Reiner
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.,Department of Radiology, Weill Cornell Medical College, New York, NY 10065, USA
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24
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Dong C, Yang S, Shi J, Zhao H, Zhong L, Liu Z, Jia B, Wang F. SPECT/NIRF Dual Modality Imaging for Detection of Intraperitoneal Colon Tumor with an Avidin/Biotin Pretargeting System. Sci Rep 2016; 6:18905. [PMID: 26732543 PMCID: PMC4702112 DOI: 10.1038/srep18905] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 11/30/2015] [Indexed: 01/24/2023] Open
Abstract
We describe herein dual-modality imaging of intraperitoneal colon tumor using an avidin/biotin pretargeting system. A novel dual-modality probe, 99mTc-HYNIC-lys(Cy5.5)-PEG4-biotin, was designed, synthesized and characterized. Single-photon emission computed tomography/ computed tomography (SPECT/CT) imaging and near infrared fluorescence (NIRF) imaging were developed using intraperitoneal LS180 human colon adenocarcinoma xenografts. Following avidin preinjection for 4 hours, 99mTc-HYNIC-lys(Cy5.5)-PEG4-biotin could successfully detect colon tumors of different sizes inside the abdominal region using both modalities, and the imaging results showed no differences. Biodistribution studies demonstrated that the tumors had a very high uptake of the probe 99mTc-HYNIC-lys(Cy5.5)-PEG4-biotin (12.74 ± 1.89% ID/g at 2 h p.i.), and the clearance from blood and other normal tissues occured very fast. The low tumor uptake in the non-pretargeted mice (1.63 ± 0.50% ID/g at 2 h p.i.) and tumor cell staining results showed excellent tumor binding specificity of the pretargeting system. The ability of the novel probe to show excellent imaging quality with high tumor-to-background contrast, a high degree of binding specificity with tumors and excellent in vivo biodistribution pharmacokinetics should prove that the avidin/biotin based dual-modality pretargeting probe is a promising imaging tool during the entire period of tumor diagnosis and treatment.
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Affiliation(s)
- Chengyan Dong
- Medical Isotopes Research Center and Department of Radiation Medicine, School of Basic Medical Sciences, Peking University, Beijing 100191, China.,Interdisciplinary Laboratory, Institute of Biophysics, Chinese Academy of Sciences, Beijing 100101, China
| | - Sujuan Yang
- Medical Isotopes Research Center and Department of Radiation Medicine, School of Basic Medical Sciences, Peking University, Beijing 100191, China
| | - Jiyun Shi
- Interdisciplinary Laboratory, Institute of Biophysics, Chinese Academy of Sciences, Beijing 100101, China
| | - Huiyun Zhao
- Medical Isotopes Research Center and Department of Radiation Medicine, School of Basic Medical Sciences, Peking University, Beijing 100191, China.,Medical and Healthy Analytical Center, Peking University, Beijing 100191, China
| | - Lijun Zhong
- Medical and Healthy Analytical Center, Peking University, Beijing 100191, China
| | - Zhaofei Liu
- Medical Isotopes Research Center and Department of Radiation Medicine, School of Basic Medical Sciences, Peking University, Beijing 100191, China
| | - Bing Jia
- Medical Isotopes Research Center and Department of Radiation Medicine, School of Basic Medical Sciences, Peking University, Beijing 100191, China
| | - Fan Wang
- Medical Isotopes Research Center and Department of Radiation Medicine, School of Basic Medical Sciences, Peking University, Beijing 100191, China.,Interdisciplinary Laboratory, Institute of Biophysics, Chinese Academy of Sciences, Beijing 100101, China.,State Key Laboratory of Natural and Biomimetic Drugs, Center for Molecular and Translational Medicine, Peking University, Beijing 100191, China
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Dittberner A, Rodner E, Ortmann W, Stadler J, Schmidt C, Petersen I, Stallmach A, Denzler J, Guntinas-Lichius O. Automated analysis of confocal laser endomicroscopy images to detect head and neck cancer. Head Neck 2015; 38 Suppl 1:E1419-26. [PMID: 26560348 DOI: 10.1002/hed.24253] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2015] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The purpose of this study was to develop an automated image analysis algorithm to discriminate between head and neck cancer and nonneoplastic epithelium in confocal laser endomicroscopy (CLE) images. METHODS CLE was applied to image head and neck cancer epithelium in vivo. Histopathologic diagnosis from biopsies was used to classify the CLE images offline as cancer or noncancer tissue. The classified images were used to train automated software based on distance map histograms. The performance of the final algorithm was confirmed by "leave 2 patients out" cross-validation and area under the curve (AUC)/receiver operating characteristic (ROC) analysis. RESULTS Ninety-two CLE videos and 92 biopsies were analyzed from 12 patients. One hundred two frames of classified neoplastic tissue and 52 frames of nonneoplastic tissue were used for cross-validation of the developed algorithm. AUC varied from 0.52 to 0.92. CONCLUSION The proposed software allows an objective classification of CLE images of head and neck cancer and adjacent nonneoplastic epithelium. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1419-E1426, 2016.
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Affiliation(s)
- Andreas Dittberner
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany.,Department of Otorhinolaryngology, Head and Neck Surgery, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Erik Rodner
- Department of Computer Science, Friedrich Schiller University, Jena, Germany
| | - Wolfgang Ortmann
- Department of Computer Science, Friedrich Schiller University, Jena, Germany
| | - Joachim Stadler
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany.,Department of Otorhinolaryngology, Heinrich-Braun-Klinikum, Zwickau, Germany
| | - Carsten Schmidt
- Division of Gastroenterology, Hepatology and Infectious Diseases, Department of Internal Medicine IV, Jena University Hospital, Jena, Germany
| | - Iver Petersen
- Institute of Pathology, Jena University Hospital, Jena, Germany
| | - Andreas Stallmach
- Division of Gastroenterology, Hepatology and Infectious Diseases, Department of Internal Medicine IV, Jena University Hospital, Jena, Germany
| | - Joachim Denzler
- Department of Computer Science, Friedrich Schiller University, Jena, Germany
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26
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Shrivastava A, Ding H, Kothandaraman S, Wang SH, Gong L, Williams M, Milum K, Zhang S, Tweedle MF. A high-affinity near-infrared fluorescent probe to target bombesin receptors. Mol Imaging Biol 2015; 16:661-9. [PMID: 24604209 DOI: 10.1007/s11307-014-0727-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE This study aimed to create new optical surgical navigation NIRF probes for prostate and breast cancers. PROCEDURES IR800-linker-QWAVGHLM-NH2 with linker = GSG, GGG, and G-Abz4 were synthesized and characterized. IC50 for bombesin receptors (BBN-R) in PC-3 prostate and T47D breast cancer cells, fluorescence microscopy in PC-3 cells, and NIRF imaging in mice PC-3 tumor xenografts were studied. RESULTS GGG, GSG, and G-Abz4 derivatives had IC50 (nM) for BBN-R+ PC-3 cells = 187 ± 31, 56 ± 5, and 2.6 ± 0.2 and T47D cells = 383 ± 1, 57.4 ± 1.2, and 3.1 ± 1.1, respectively. By microscopy the Abz4 derivative showed the highest uptake, was competed with by BBN, and had little to no binding to BBN-R- cells. In NIRF imaging the G-Abz4 probe was brighter than GGG probe in BBN-R+ tissues in vivo and tissues, tumors, and tumor slices ex vivo. Uptake could be partially blocked in BBN-R+ pancreas but not visibly in tumor. CONCLUSIONS Linker choice can dominate peptidic BBN-R binding. The G-Abz4 linker yields a higher affinity and specific BBN-R binder in this series of molecules.
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Affiliation(s)
- Ajay Shrivastava
- Department of Radiology, The Ohio State University, Columbus, OH, 43210, USA
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27
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Patsias A, Giraldez-Rodriguez L, Polydorides AD, Richards-Kortum R, Anandasabapathy S, Quang T, Sikora AG, Miles B. Feasibility of transoral robotic-assisted high-resolution microendoscopic imaging of oropharyngeal squamous cell carcinoma. Head Neck 2015; 37:E99-102. [PMID: 25327825 DOI: 10.1002/hed.23892] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2014] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Transoral robotic-assisted oncologic surgery of the head and neck offers promising functional results. Nonetheless, the efficacy of oncologic surgery remains critically dependent on obtaining negative margins. We aimed to integrate a miniaturized high-resolution fiber-optic microendoscope (HRME), which provides real-time histological assessment, with the da Vinci robotic system (Intuitive Surgical, Sunnyvale, CA). METHODS Three patients undergoing transoral robotic surgery (TORS) were prospectively enrolled in this study. Optical imaging of the oropharynx was performed intraoperatively with the robotic-assisted HRME. RESULTS All patients underwent the procedure successfully with no complications. The HRME was successfully integrated with the da Vinci robotic system. Several sites of the oropharynx and associated malignancy were imaged, which correlated with the standard histopathological analysis. CONCLUSION Transoral robotic-assisted HRME imaging of the oropharynx is a safe and technically feasible approach, providing a real-time histological assessment and may serve as a valuable aid in oncologic surgery.
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Affiliation(s)
- Alexis Patsias
- Department of Otolaryngology - Head and Neck Surgery, Head and Neck Cancer Translational Research Program, The Icahn School of Medicine at Mount Sinai, New York, New York
| | - Laureano Giraldez-Rodriguez
- Department of Otolaryngology - Head and Neck Surgery, Head and Neck Cancer Translational Research Program, The Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | | | - Timothy Quang
- Department of Bioengineering, Rice University, Houston, Texas
| | - Andrew G Sikora
- Department of Otolaryngology - Head and Neck Surgery, Head and Neck Cancer Translational Research Program, The Icahn School of Medicine at Mount Sinai, New York, New York
| | - Brett Miles
- Department of Otolaryngology - Head and Neck Surgery, Head and Neck Cancer Translational Research Program, The Icahn School of Medicine at Mount Sinai, New York, New York
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Miles BA, Patsias A, Quang T, Polydorides AD, Richards-Kortum R, Sikora AG. Operative margin control with high-resolution optical microendoscopy for head and neck squamous cell carcinoma. Laryngoscope 2015; 125:2308-16. [PMID: 26059758 DOI: 10.1002/lary.25400] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2015] [Indexed: 12/27/2022]
Abstract
OBJECTIVES/HYPOTHESIS High-resolution microendoscopy (HRME) provides real-time visualization of the mucosal surface in the upper aerodigestive tract. This technology allows noninvasive discrimination of benign and neoplastic epithelium and has potential applications for intraoperative margin detection. STUDY DESIGN Single institution, prospective, feasibility trial (phase I) of in vivo optical imaging. METHODS The study was conducted on patients with squamous cell carcinoma of the upper aerodigestive tract. High-resolution microendoscopy images obtained during surgery were correlated with histopathologic diagnosis to determine the ability of HRME to differentiate between benign and malignant mucosa. Blinded reviewers evaluated HRME images and made determinations of the status of the mucosa. Accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and interrater agreement between multiple raters were calculated to determine the accuracy of HRME imaging. RESULTS The mean accuracy of reviewers in differentiating neoplastic or benign mucosa was 95.1% (95% confidence interval [CI], 94%-96%). Sensitivity and specificity were 96% (95% CI, 94%-99%) and 95% (95 % CI, 90%-99%), respectively. The NPV was 98% (95% CI, 97%-99%), and PPV was 91% (95% CI, 85%-98%). The Fleiss kappa statistic for interrater reliability was 0.81, with a standard error of 0.014 and a 95% CI (0.78-0.84). CONCLUSION High-resolution microendoscopy allows real-time discrimination between benign and neoplastic mucosa. High levels of sensitivity and specificity can be obtained with this technology when interrogating mucosal surfaces. Despite several technical limitations, HRME shows promise as a technique for intraoperative margin control and platform for molecular imaging technologies. LEVEL OF EVIDENCE 3b.
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Affiliation(s)
- Brett A Miles
- Department of Otolaryngology-Head and Neck Surgery, Division of Head and Neck Oncology
| | - Alexis Patsias
- Department of Otolaryngology-Head and Neck Surgery, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
| | | | | | | | - Andrew G Sikora
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A
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Owens EA, Hyun H, Tawney JG, Choi HS, Henary M. Correlating molecular character of NIR imaging agents with tissue-specific uptake. J Med Chem 2015; 58:4348-56. [PMID: 25923454 DOI: 10.1021/acs.jmedchem.5b00475] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Near-infrared (NIR) fluorescent contrast agents are emerging in optical imaging as sensitive, cost-effective, and nonharmful alternatives to current agents that emit harmful ionizing radiation. Developing spectrally distinct NIR fluorophores to visualize sensitive vital tissues to selectively avoid them during surgical resection of diseased tissue is of great significance. Herein, we report the synthetic variation of pentamethine cyanine fluorophores with modifications of physicochemical properties toward prompting tissue-specific uptake into sensitive tissues (i.e., endocrine glands). Tissue-specific targeting and biodistribution studies revealed localization of contrast agents in the adrenal and pituitary glands, pancreas, and lymph nodes with dependence on molecular characteristics. Incorporation of hydrophobic heterocyclic rings, alkyl groups, and halogens allowed a fine-tuning capability to the hydrophobic character and dipole moment for observing perturbation in biological activity in response to minor structural alterations. These NIR contrast agents have potential for clinical translation for intraoperative imaging in the delineation of delicate glands.
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Affiliation(s)
- Eric A Owens
- †Center for Diagnostics and Therapeutics, Center for Biotechnology and Drug Design, Department of Chemistry, Georgia State University, Petit Science Center, 100 Piedmont Ave SE, Atlanta, Georgia 30303, United States
| | - Hoon Hyun
- ‡Division of Hematology/Oncology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, 330 Brookline Avenue, Massachusetts 02215, United States
| | - Joseph G Tawney
- †Center for Diagnostics and Therapeutics, Center for Biotechnology and Drug Design, Department of Chemistry, Georgia State University, Petit Science Center, 100 Piedmont Ave SE, Atlanta, Georgia 30303, United States
| | - Hak Soo Choi
- ‡Division of Hematology/Oncology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, 330 Brookline Avenue, Massachusetts 02215, United States
| | - Maged Henary
- †Center for Diagnostics and Therapeutics, Center for Biotechnology and Drug Design, Department of Chemistry, Georgia State University, Petit Science Center, 100 Piedmont Ave SE, Atlanta, Georgia 30303, United States
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Giataganas P, Hughes M, Yang GZ. Force adaptive robotically assisted endomicroscopy for intraoperative tumour identification. Int J Comput Assist Radiol Surg 2015; 10:825-32. [PMID: 25900339 DOI: 10.1007/s11548-015-1179-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 03/13/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE For effective tumour margin definition for cancer surgery, there is an increasing demand for the development of real-time intraoperative tissue biopsy techniques. Recent advances in miniaturized biophotonics probes have permitted the development of endomicroscopy techniques that are clinically attractive. With these approaches, cellular-level imaging can be achieved through millimetre-scale flexible probes and be performed in real-time, in vivo and in situ. Due to the limited field of view and flexibility of these probes, however, large area tissue coverage for acquiring histology-like images over complex three-dimensional surfaces is challenging. This is particularly the case because current surgical robots, such as the Da Vinci ®, lack haptic feedback, making it difficult to maintain optimum tissue contact when these probes are deployed in vivo. METHODS This paper proposes a simple force-controlled pick-up probe that can be integrated with the Da Vinci instruments for intraoperative endomicroscopy imaging. The device uses a new low-friction air bearing with adaptive axial force control to maintain constant contact between the tissue and the imaging probe, facilitating microscopy scans over complex surfaces. Detailed ex vivo user experiments have been conducted to demonstrate the effectiveness of the technique. RESULTS The adaptive probe mount could achieve consistent low-magnitude probe-sample contact forces compared with a rigid mount. In the user study, the adaptive probe combined with a high frame rate endomicroscopy system allowed larger mosaics to be generated over curved surfaces. CONCLUSIONS The device can improve the performance of large area mosaicking over complex 3D surfaces with improved handling and intraoperative control.
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Affiliation(s)
- Petros Giataganas
- Hamlyn Centre for Robotic Surgery, Institute of Global Health Innovation, Imperial College London, London, SW7 2AZ, UK,
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31
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Rosca EV, Wright M, Gonitel R, Gedroyc W, Miller AD, Thanou M. Thermosensitive, near-infrared-labeled nanoparticles for topotecan delivery to tumors. Mol Pharm 2015; 12:1335-46. [PMID: 25826624 DOI: 10.1021/mp5002679] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Liposomal nanoparticles have proven to be versatile systems for drug delivery. However, the progress in clinic has been slower and less efficient than expected. This suggests a need for further development using carefully designed chemical components to improve usefulness under clinical conditions and maximize therapeutic effect. For cancer chemotherapy, PEGylated liposomes were the first nanomedicine to reach the market and have been used clinically for several years. Approaches toward targeted drug delivery using next generation "thermally triggered" nanoparticles are now in clinical trials. However, clinically tested thermosensitive liposomes (TSLs) lack the markers that allow tumor labeling and improved imaging for tissue specific applied hyperthermia. Here we describe the development of optically labeled TSLs for image guidance drug delivery and proof-of-concept results for their application in the treatment of murine xenograft tumors using the anticancer drug topotecan. These labeled TSLs also allow the simultaneous, real-time diagnostic imaging of nanoparticle biodistribution using a near-infrared (NIR; 750-950 nm) fluorophore coupled to a lipidic component of the lipid bilayer. When combined with multispectral fluorescence analysis, this allows for specific and high sensitivity tracking of the nanoparticles in vivo. The application of NIR fluorescence-labeled TSLs could have a transformative effect on future cancer chemotherapy.
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Affiliation(s)
- Elena V Rosca
- †Institute of Pharmaceutical Science, King's College London, London, U.K
| | - Michael Wright
- †Institute of Pharmaceutical Science, King's College London, London, U.K
| | - Roman Gonitel
- †Institute of Pharmaceutical Science, King's College London, London, U.K
| | - Wladyslaw Gedroyc
- §Department of Experimental Medicine, Imperial College London, London, U.K
| | - Andrew D Miller
- †Institute of Pharmaceutical Science, King's College London, London, U.K
| | - Maya Thanou
- †Institute of Pharmaceutical Science, King's College London, London, U.K
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Rosenthal EL, Warram JM, Bland KI, Zinn KR. The status of contemporary image-guided modalities in oncologic surgery. Ann Surg 2015; 261:46-55. [PMID: 25599326 DOI: 10.1097/sla.0000000000000622] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To review the current trends in optical imaging to guide oncologic surgery. BACKGROUND Surgical resection remains the cornerstone of therapy for patients with early stage solid malignancies and more than half of all patients with cancer undergo surgery each year. The technical ability of the surgeon to obtain clear surgical margins at the initial resection remains crucial to improve overall survival and long-term morbidity. Current resection techniques are largely based on subjective and subtle changes associated with tissue distortion by invasive cancer. As a result, positive surgical margins occur in a significant portion of tumor resections, which is directly correlated with a poor outcome. METHODS A comprehensive review of studies evaluating optical imaging techniques is performed. RESULTS A variety of cancer imaging techniques have been adapted or developed for intraoperative surgical guidance that have been shown to improve functional and oncologic outcomes in randomized clinical trials. There are also a large number of novel, cancer-specific contrast agents that are in early stage clinical trials and preclinical development that demonstrate significant promise to improve real-time detection of subclinical cancer in the operative setting. CONCLUSIONS There has been an explosion of intraoperative imaging techniques that will become more widespread in the next decade.
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Affiliation(s)
- Eben L Rosenthal
- *Departments of Surgery and †Radiology, The University of Alabama at Birmingham, Birmingham, AL
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Lu G, Wang D, Qin X, Halig L, Muller S, Zhang H, Chen A, Pogue BW, Chen ZG, Fei B. Framework for hyperspectral image processing and quantification for cancer detection during animal tumor surgery. JOURNAL OF BIOMEDICAL OPTICS 2015; 20:126012. [PMID: 26720879 PMCID: PMC4691647 DOI: 10.1117/1.jbo.20.12.126012] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Accepted: 11/25/2015] [Indexed: 05/15/2023]
Abstract
Hyperspectral imaging (HSI) is an imaging modality that holds strong potential for rapid cancer detection during image-guided surgery. But the data from HSI often needs to be processed appropriately in order to extract the maximum useful information that differentiates cancer from normal tissue. We proposed a framework for hyperspectral image processing and quantification, which includes a set of steps including image preprocessing, glare removal, feature extraction, and ultimately image classification. The framework has been tested on images from mice with head and neck cancer, using spectra from 450- to 900-nm wavelength. The image analysis computed Fourier coefficients, normalized reflectance, mean, and spectral derivatives for improved accuracy. The experimental results demonstrated the feasibility of the hyperspectral image processing and quantification framework for cancer detection during animal tumor surgery, in a challenging setting where sensitivity can be low due to a modest number of features present, but potential for fast image classification can be high. This HSI approach may have potential application in tumor margin assessment during image-guided surgery, where speed of assessment may be the dominant factor.
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Affiliation(s)
- Guolan Lu
- Georgia Institute of Technology and Emory University, The Wallace H. Coulter Department of Biomedical Engineering, Atlanta, Georgia 30332, United States
| | - Dongsheng Wang
- Emory University, School of Medicine, Department of Hematology and Medical Oncology, , Atlanta, Georgia 30332, United States
| | - Xulei Qin
- Emory University, School of Medicine, Department of Radiology and Imaging Sciences, , Atlanta, Georgia 30332, United States
| | - Luma Halig
- Emory University, School of Medicine, Department of Radiology and Imaging Sciences, , Atlanta, Georgia 30332, United States
| | - Susan Muller
- Emory University, School of Medicine, Department of Otolaryngology, , Atlanta, Georgia 30332, United States
| | - Hongzheng Zhang
- Emory University, School of Medicine, Department of Otolaryngology, , Atlanta, Georgia 30332, United States
| | - Amy Chen
- Emory University, School of Medicine, Department of Otolaryngology, , Atlanta, Georgia 30332, United States
| | - Brian W. Pogue
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire 03755, United States
| | - Zhuo Georgia Chen
- Emory University, School of Medicine, Department of Hematology and Medical Oncology, , Atlanta, Georgia 30332, United States
| | - Baowei Fei
- Georgia Institute of Technology and Emory University, The Wallace H. Coulter Department of Biomedical Engineering, Atlanta, Georgia 30332, United States
- Emory University, School of Medicine, Department of Radiology and Imaging Sciences, , Atlanta, Georgia 30332, United States
- Winship Cancer Institute of Emory University, Atlanta, Georgia 30322, United States
- Address all correspondence to: Baowei Fei, E-mail:
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Atallah I, Milet C, Coll JL, Reyt E, Righini CA, Hurbin A. Role of near-infrared fluorescence imaging in head and neck cancer surgery: from animal models to humans. Eur Arch Otorhinolaryngol 2014; 272:2593-600. [PMID: 25115313 DOI: 10.1007/s00405-014-3224-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Accepted: 07/29/2014] [Indexed: 12/18/2022]
Abstract
Complete resection of head and neck cancers with negative surgical margins improves the prognosis of the disease and decreases the recurrence rate. Near-infrared fluorescence-guided surgery of head and neck cancer is a rapidly evolving field that represents an invaluable tool for tumor detection and resection. Here, we present a literature review of the principles of near-infrared fluorescence imaging and its use in head and neck cancer surgery. We discuss important studies in both animal models and humans that have been carried out up to this point. We also outline the important fluorescent molecules and devices used in head and neck fluorescence imaging-guided surgery. Although near-infrared fluorescence-guided surgery for head and neck cancers showed efficacy in animal models, its use in humans is limited by the small number of fluorescent probes that are approved for clinical use. However, it is considered as a novel surgical aid that helps delineate tumor margins preoperatively and could spare patients from the added morbidity that is associated with additional surgery or chemoradiation. In addition, it is a useful tool to detect sentinel lymph nodes as well as metastatic lymph nodes.
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Affiliation(s)
- Ihab Atallah
- Albert Bonniot Institute, CRI INSERM/UJF U823, BP170, 38042, Grenoble Cedex 9, France,
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Abbaci M, Breuskin I, Casiraghi O, De Leeuw F, Ferchiou M, Temam S, Laplace-Builhé C. Confocal laser endomicroscopy for non-invasive head and neck cancer imaging: A comprehensive review. Oral Oncol 2014; 50:711-6. [DOI: 10.1016/j.oraloncology.2014.05.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 05/09/2014] [Accepted: 05/11/2014] [Indexed: 01/14/2023]
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Abstract
PURPOSE OF REVIEW To review optical imaging technologies in urologic surgery aimed to facilitate intraoperative imaging and tissue interrogation. RECENT FINDINGS Emerging new optical imaging technologies can be integrated in the operating room environment during minimally invasive and open surgery. These technologies include macroscopic fluorescence imaging that provides contrast enhancement between normal and diseased tissue and microscopic imaging that provides tissue characterization. SUMMARY Optical imaging technologies that have reached the clinical arena in urologic surgery were reviewed, including photodynamic diagnosis, near infrared fluorescence imaging, optical coherence tomography, and confocal laser endomicroscopy.
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Nathan CAO, Kaskas NM, Ma X, Chaudhery S, Lian T, Moore-Medlin T, Shi R, Mehta V. Confocal Laser Endomicroscopy in the Detection of Head and Neck Precancerous Lesions. Otolaryngol Head Neck Surg 2014; 151:73-80. [DOI: 10.1177/0194599814528660] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 02/28/2014] [Indexed: 12/20/2022]
Abstract
Objective This study aimed to determine the feasibility of using probe-based confocal laser endomicroscopy (pCLE) in the diagnostic differentiation of non-neoplastic lesions from precancerous and cancerous lesions of head and neck patients. Study Design Diagnostic test evaluation. Setting Louisiana State University Health Shreveport. Subjects and Methods Intravenous injection of fluorescein was given to patients with precancerous and cancerous head and neck lesions (n = 21) followed by the use of a 1.8-mm GastroFlex probe in the oral cavity with subsequent biopsies of selected areas. Probe-based confocal laser endomicroscopy images were compared to histologic evaluation of visualized sites using sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV). Results The dorsal surface of the tongue was not well visualized. The remaining nonkeratinized subsites, including the buccal mucosa, floor of mouth, and ventral tongue, were well visualized. Diagnoses based on pCLE images correlated well with the gold standard diagnoses based on tissue histology. The overall sensitivity for diagnosis of dysplasia versus nondysplasia was 80.0% (95% confidence interval [CI], 62.0-98.0), specificity and PPV were 100%, and the NPV was 80.0% (95% CI, 60.0-100.0). The overall specificity, sensitivity, PPV, and NPV for pCLE diagnosis of carcinoma versus nondysplasia were 100%. The overall sensitivity for diagnosis of carcinoma versus dysplasia was 85.7% (95% CI, 73.0-99.0), specificity and PPV were 100%, and the NPV was 80.0% (95% CI, 60.0-100.0). Conclusion The pCLE is a promising method for differentiating between nondysplastic, precancerous, and cancerous lesions of the head and neck.
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Affiliation(s)
- Cherie-Ann O. Nathan
- Department of Otolaryngology–Head & Neck Surgery, Louisiana State University Health Shreveport, Shreveport, Louisiana, USA
- Feist-Weiller Cancer Center, Louisiana State University Health Shreveport, Shreveport, Louisiana, USA
| | - Nadine M. Kaskas
- Louisiana State University Health Shreveport School of Medicine, Shreveport, Louisiana, USA
| | - Xiaohui Ma
- Department of Otolaryngology–Head & Neck Surgery, Louisiana State University Health Shreveport, Shreveport, Louisiana, USA
| | - Shubnum Chaudhery
- Department of Otolaryngology–Head & Neck Surgery, Louisiana State University Health Shreveport, Shreveport, Louisiana, USA
- Department of Pathology, Louisiana State University Health Shreveport, Shreveport, Louisiana, USA
| | - Timothy Lian
- Department of Otolaryngology–Head & Neck Surgery, Louisiana State University Health Shreveport, Shreveport, Louisiana, USA
- Feist-Weiller Cancer Center, Louisiana State University Health Shreveport, Shreveport, Louisiana, USA
| | - Tara Moore-Medlin
- Department of Otolaryngology–Head & Neck Surgery, Louisiana State University Health Shreveport, Shreveport, Louisiana, USA
| | - Runhua Shi
- Feist-Weiller Cancer Center, Louisiana State University Health Shreveport, Shreveport, Louisiana, USA
| | - Vikas Mehta
- Department of Otolaryngology–Head & Neck Surgery, Louisiana State University Health Shreveport, Shreveport, Louisiana, USA
- Feist-Weiller Cancer Center, Louisiana State University Health Shreveport, Shreveport, Louisiana, USA
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van Driel PBAA, van der Vorst JR, Verbeek FPR, Oliveira S, Snoeks TJA, Keereweer S, Chan B, Boonstra MC, Frangioni JV, van Bergen en Henegouwen PMP, Vahrmeijer AL, Lowik CWGM. Intraoperative fluorescence delineation of head and neck cancer with a fluorescent anti-epidermal growth factor receptor nanobody. Int J Cancer 2013; 134:2663-73. [PMID: 24222574 DOI: 10.1002/ijc.28601] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 09/27/2013] [Indexed: 12/30/2022]
Abstract
Intraoperative near-infrared (NIR) fluorescence imaging is a technology with high potential to provide the surgeon with real-time visualization of tumors during surgery. Our study explores the feasibility for clinical translation of an epidermal growth factor receptor (EGFR)-targeting nanobody for intraoperative imaging and resection of orthotopic tongue tumors and cervical lymph node metastases. The anti-EGFR nanobody 7D12 and the negative control nanobody R2 were conjugated to the NIR fluorophore IRDye800CW (7D12-800CW and R2-800CW). Orthotopic tongue tumors were induced in nude mice using the OSC-19-luc2-cGFP cell line. Tumor-bearing mice were injected with 25 µg 7D12-800CW, R2-800CW or 11 µg 800CW. Subsequently, other mice were injected with 50 or 75 µg of 7D12-800CW. The FLARE imaging system and the IVIS spectrum were used to identify, delineate and resect the primary tumor and cervical lymph node metastases. All tumors could be clearly identified using 7D12-800CW. A significantly higher tumor-to-background ratio (TBR) was observed in mice injected with 7D12-800CW compared to mice injected with R2-800CW and 800CW. The highest average TBR (2.00 ± 0.34 and 2.72 ± 0.17 for FLARE and IVIS spectrum, respectively) was observed 24 hr after administration of the EGFR-specific nanobody. After injection of 75 µg 7D12-800CW cervical lymph node metastases could be clearly detected. Orthotopic tongue tumors and cervical lymph node metastases in a mouse model were clearly identified intraoperatively using a recently developed fluorescent EGFR-targeting nanobody. Translation of this approach to the clinic would potentially improve the rate of radical surgical resections.
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Affiliation(s)
- P B A A van Driel
- Department of Radiology and Molecular Imaging, Leiden University Medical Center, Leiden, The Netherlands; Percuros B.V., Enschede, The Netherlands
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39
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Master AM, Sen Gupta A. EGF receptor-targeted nanocarriers for enhanced cancer treatment. Nanomedicine (Lond) 2013; 7:1895-906. [PMID: 23249333 DOI: 10.2217/nnm.12.160] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
The 'nanomedicine' approach has revolutionized cancer therapy by enabling the packaging of therapeutic agents within engineered nanovehicles that can specifically accumulate within the tumor stroma and then be internalized within cancer cells, to render site-selective action while minimizing nonspecific uptake and harmful side effects. While the specific accumulation within the tumor stroma is rendered by the ability of the nanovehicles to passively permeate through the tumor's leaky vasculature, the cellular internalization is often achieved by exploiting receptor-mediated active endocytotic mechanisms using receptor-specific ligand decoration on the vehicle surface. To this end, a highly important receptor found in several cancers is the EGF receptor, which has been implicated in tumor aggression and proliferation. In this context, we provide a comprehensive review of the various approaches of ligand decorations on nanovehicles for active targeting to EGF receptors, and discuss their pros and cons towards optimizing the design of EGF receptor-targeted nanomedicine systems.
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Affiliation(s)
- Alyssa M Master
- Department of Biomedical Engineering, Case Western Reserve University, 2071 Martin Luther King Drive, Cleveland, OH 44106, USA
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40
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Current World Literature. Curr Opin Oncol 2013; 25:325-30. [DOI: 10.1097/cco.0b013e328360f591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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41
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Rietbergen DDD, van den Berg NS, van Leeuwen FWB, Valdés Olmos RA. Hybrid techniques for intraoperative sentinel lymph node imaging: early experiences and future prospects. ACTA ACUST UNITED AC 2013. [DOI: 10.2217/iim.13.16] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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42
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Heath CH, Deep NL, Beck LN, Day KE, Sweeny L, Zinn KR, Huang CC, Rosenthal EL. Use of panitumumab-IRDye800 to image cutaneous head and neck cancer in mice. Otolaryngol Head Neck Surg 2013; 148:982-90. [PMID: 23525846 DOI: 10.1177/0194599813482290] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To assess the feasibility of panitumumab in real-time fluorescent imaging and histologic processing of cutaneous squamous cell carcinoma (cSCC) in mice. DESIGN A near-infrared (NIR) fluorescent probe (IRDye800CW) was covalently linked to a monoclonal antibody-targeting epidermal growth factor receptor (panitumumab) or nonspecific IgG and injected into mice bearing flank xenografts from a cSCC cell line (SCC-13 or SRB-12; n = 7), human split-thickness skin grafts (STSGs; n = 3), or a human tumor explant (n = 1). The tumor and lymph nodes were imaged and dissected using fluorescence guidance with the SPY imaging system and verified with a charge-coupled NIR system. An NIR scanning device (Odyssey) was used to measure fluorescence intensity in histological sections. SUBJECTS Immunodeficient mice. SETTING In vivo and in vitro imaging lab. RESULTS Tumor tissue could be delineated from the human STSG with tumor-to-background ratios of 4.5 (Pearl) and 3.4 (SPY). Tumor detection was substantially improved with panitumumab-IRDye800 compared with IgG-IRDye800. Biopsies positive for fluorescence were assessed by histology and immunohistochemistry (n = 18/18) to confirm the presence of tumor, yielding a 100% sensitivity. Biopsies of nonfluorescent tissue negative for malignancy (n = 18/18) yielded a specificity of 100%. Furthermore, the SPY system was able to detect residual disease as small as 200 µm in diameter. In addition, the Odyssey confirmed fluorescence of microscopic disease (in tumor samples of frozen and paraffin-embedded histologic specimens) but not in adjacent noncancerous tissue. CONCLUSIONS These data suggest panitumumab-IRDye800 may have clinical utility in detection and removal of subclinical cSCC using Food and Drug Administration-approved imaging hardware.
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Affiliation(s)
- C Hope Heath
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama 35294-0012, USA
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43
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Abstract
Although the modern surgical era is highlighted by multiple technological advances and innovations, one area that has remained constant is the dependence of the surgeon's vision on white-light reflectance. This renders different body tissues in a limited palette of various shades of pink and red, thereby limiting the visual contrast available to the operating surgeon. Healthy tissue, anatomic variations, and diseased states are seen as slight discolorations relative to each other and differences are inherently limited in dynamic range. In the upcoming years, surgery will undergo a paradigm shift with the use of targeted fluorescence imaging probes aimed at augmenting the surgical armamentarium by expanding the "visible" spectrum available to surgeons. Such fluorescent "smart probes" will provide real-time, intraoperative, pseudo-color, high-contrast delineation of both normal and pathologic tissues. Fluorescent surgical molecular guidance promises another major leap forward to improve patient safety and clinical outcomes, and to reduce overall healthcare costs. This review provides an overview of current and future surgical applications of fluorescence imaging in diseased and nondiseased tissues and focus on the innovative fields of image processing and instrumentation.
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Affiliation(s)
- Ryan K Orosco
- Division of Head and Neck Surgery, University of California San Diego, La Jolla, CA 92093-0647, USA
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Heath CH, Deep NL, Sweeny L, Zinn KR, Rosenthal EL. Use of panitumumab-IRDye800 to image microscopic head and neck cancer in an orthotopic surgical model. Ann Surg Oncol 2012; 19:3879-87. [PMID: 22669455 PMCID: PMC3595117 DOI: 10.1245/s10434-012-2435-y] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Indexed: 01/02/2023]
Abstract
BACKGROUND Fluorescence imaging hardware (SPY) has recently been developed for intraoperative assessment of blood flow via detection of probes emitting in the near-infrared (NIR) spectrum. This study sought to determine if this imaging system was capable of detecting micrometastatic head and neck squamous cell carcinoma (HNSCC) in preclinical models. METHODS A NIR fluorescent probe (IRDye800CW) was covalently linked to a monoclonal antibody targeting epidermal growth factor receptor (EGFR; panitumumab) or nonspecific IgG. HNSCC flank (SCC-1) and orthotopic (FADU and OSC19) xenografts were imaged 48-96 h after systemic injection of labeled panitumumab or IgG. The primary tumor and regional lymph nodes were dissected using fluorescence guidance with the SPY system and grossly assessed with a charge-coupled NIR system (Pearl). Histologic slides were also imaged with a NIR charged-coupled device (Odyssey) and fluorescence intensity was correlated with pathologic confirmation of disease. RESULTS Orthotopic tongue tumors were clearly delineated from normal tissue with tumor-to-background ratios of 2.9 (Pearl) and 2.3 (SPY). Disease detection was significantly improved with panitumumab-IRDye compared to IgG-IRDye800 (P < 0.05). Tissue biopsy samples (average size 3.7 mm) positive for fluorescence were confirmed for pathologic disease by histology and immunohistochemistry (n = 25 of 25). Biopsy samples of nonfluorescent tissue were proven to be negative for malignancy (n = 28 of 28). The SPY was able to detect regional lymph node metastasis (<1.0 mm) and microscopic areas of disease. Standard histological assessment in both frozen and paraffin-embedded histologic specimens was augmented using the Odyssey. CONCLUSIONS Panitumumab-IRDye800 may have clinical utility in detection and removal of microscopic HNSCC using existing intraoperative optical imaging hardware and may augment analysis of frozen and permanent pathology.
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MESH Headings
- Animals
- Antibodies, Monoclonal
- Carcinoma, Squamous Cell/diagnosis
- Carcinoma, Squamous Cell/surgery
- ErbB Receptors/antagonists & inhibitors
- ErbB Receptors/immunology
- Head and Neck Neoplasms/diagnosis
- Head and Neck Neoplasms/surgery
- Humans
- Immunoenzyme Techniques
- Indoles
- Lymphatic Metastasis
- Mice
- Mice, SCID
- Microscopy, Fluorescence
- Models, Anatomic
- Optical Imaging
- Panitumumab
- Spectroscopy, Near-Infrared
- Surgery, Computer-Assisted
- Transplantation, Heterologous
- Tumor Cells, Cultured
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Affiliation(s)
- C. Hope Heath
- Department of Surgery, University of Alabama at Birmingham,
Birmingham, AL 35294
| | - Nicholas L. Deep
- Department of Surgery, University of Alabama at Birmingham,
Birmingham, AL 35294
| | - Larissa Sweeny
- Department of Surgery, University of Alabama at Birmingham,
Birmingham, AL 35294
| | - Kurt R Zinn
- Radiology, University of Alabama at Birmingham, Birmingham, AL 35294
| | - Eben L. Rosenthal
- Department of Surgery, University of Alabama at Birmingham,
Birmingham, AL 35294
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45
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Meyer T, Guntinas-Lichius O, von Eggeling F, Ernst G, Akimov D, Schmitt M, Dietzek B, Popp J. Multimodal nonlinear microscopic investigations on head and neck squamous cell carcinoma: toward intraoperative imaging. Head Neck 2012; 35:E280-7. [PMID: 22987435 DOI: 10.1002/hed.23139] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2012] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Prognosis and appropriate treatment of head and neck squamous cell carcinoma (HNSCC) depend on the tumor type routinely derived by invasive histopathology. A promising noninvasive alternative is nonlinear optical imaging, which is capable of in vivo tissue visualization for tumor typing and grading. METHODS AND RESULTS Thin tissue sections from 3 patients aged 56 to 60 years presenting advanced carcinoma of the hypopharynx, larynx, and left tonsil were investigated by coherent anti-Stokes Raman scattering (CARS), second-harmonic generation (SHG), and 2 photon excited fluorescence (TPEF) to study the morphochemistry of the tissues. Morphologic alterations of prognostic significance, such as cell density, nuclear to cytoplasm ratio, and keratinization as well as the underlying compositional changes during malignant transformation were determined, such as the distributions of lipids, collagen, and autofluorophors. CONCLUSIONS Nonlinear imaging provides a noninvasive optical biopsy of the epithelial layer comparable to staining microscopy. By integration into an operational microscope, routine screening of suspicious lesions and surgical guidance can be realized.
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Levy LL, Vila PM, Park RW, Schwarz R, Polydorides AD, Teng MS, Gurudutt VV, Genden EM, Miles B, Anandasabapathy S, Gillenwater AM, Richards-Kortum R, Sikora AG. High-Resolution Optical Imaging of Benign and Malignant Mucosa in the Upper Aerodigestive Tract: An Atlas for Image-Guided Surgery. ACTA ACUST UNITED AC 2012; 2012. [PMID: 23641314 DOI: 10.5402/2012/364285] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND High-resolution optical imaging provides real-time visualization of mucosa in the upper aerodigestive tract (UADT) which allows non-invasive discrimination of benign and neoplastic epithelium. The high-resolution microendoscope (HRME) utilizes a fiberoptic probe in conjunction with a tissue contrast agent to display nuclei and cellular architecture. This technology has broad potential applications to intraoperative margin detection and early cancer detection. METHODS Our group has created an extensive image collection of both neoplastic and normal epithelium of the UADT. Here, we present and describe imaging characteristics of benign, dysplastic, and malignant mucosa in the oral cavity, oropharynx, larynx, and esophagus. RESULTS There are differences in the nuclear organization and overall tissue architecture of benign and malignant mucosa which correlate with histopathologic diagnosis. Different anatomic subsites also display unique imaging characteristics. CONCLUSION HRME allows discrimination between benign and neoplastic mucosa, and familiarity with the characteristics of each subsite facilitates correct diagnosis.
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Affiliation(s)
- Lauren L Levy
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai School of Medicine, New York, NY 10029, USA
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Hinni ML, Ferlito A, Brandwein-Gensler MS, Takes RP, Silver CE, Westra WH, Seethala RR, Rodrigo JP, Corry J, Bradford CR, Hunt JL, Strojan P, Devaney KO, Gnepp DR, Hartl DM, Kowalski LP, Rinaldo A, Barnes L. Surgical margins in head and neck cancer: A contemporary review. Head Neck 2012; 35:1362-70. [DOI: 10.1002/hed.23110] [Citation(s) in RCA: 201] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2012] [Indexed: 11/10/2022] Open
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48
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Keereweer S, Mol IM, Vahrmeijer AL, Van Driel PBAA, Baatenburg de Jong RJ, Kerrebijn JDF, Löwik CWGM. Dual wavelength tumor targeting for detection of hypopharyngeal cancer using near-infrared optical imaging in an animal model. Int J Cancer 2012; 131:1633-40. [PMID: 22234729 DOI: 10.1002/ijc.27430] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Accepted: 12/21/2011] [Indexed: 12/29/2022]
Abstract
Optical imaging is a promising technique to visualize cancer tissue during surgery. In this study, we explored the use of combinations of near-infrared (NIR) fluorescence agents that emit fluorescence signal at different wavelengths and each target specific tumor characteristics. Two combinations of agents (ProSense680 combined with 2DG CW800 and MMPSense680 combined with EGF CW800) were used to detect hypopharyngeal cancer in an animal model. ProSense680 and MMPSense680 detect increased activity of cathepsins and matrix metalloproteinases, respectively. These enzymes are mainly found in the invasive tumor border due to degradation of the extracellular matrix. 2DG CW800 detects tumor cells with high glucose metabolism and EGF CW800 is internalized by the epidermal growth factor receptor of tumor cells. Whole-body imaging revealed clear demarcation of tumor tissue using all four agents. The tumor-to-background ratio (standard deviation, p-value) was 3.69 (0.72, p < 0.001) for ProSense680; 4.26 (1.33, p < 0.001) for MMPSense680; 5.81 (3.59, p = 0.02) for 2DG CW800 and 4.84 (1.56, p < 0.001) for EGF CW800. Fluorescence signal corresponded with histopathology and immunohistochemistry, demonstrating signal of ProSense680 and MMPSense680 in the invasive tumor border, and signal of 2DG CW800 and EGF CW800 in the tumor tissue. In conclusion, we demonstrated the feasibility of dual wavelength tumor detection using different targeting strategies simultaneously in an animal model. Combined targeting at different wavelengths allowed simultaneous imaging of different tumor characteristics. NIR fluorescence optical imaging has the potential to be translated into the clinic in order to improve the complete removal of tumors by real-time image-guided surgery.
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Affiliation(s)
- Stijn Keereweer
- Department of Otorhinolaryngology Head and Neck Surgery, Erasmus Medical Center, Rotterdam, The Netherlands.
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Zhao Q, Jiang H, Cao Z, Yang L, Mao H, Lipowska M. A handheld fluorescence molecular tomography system for intraoperative optical imaging of tumor margins. Med Phys 2012; 38:5873-8. [PMID: 22047351 DOI: 10.1118/1.3641877] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
PURPOSE Accurate identification of tumor margins presents a major challenge in the surgical treatment of human cancers. Inability of complete removal of tumor lesions after surgery causes local recurrence and increases the incidence of developing tumor metastasis. It is clear that novel approaches that allow defining tumor margins intraoperatively for removal of small tumor lesions in the surgical cavity is critical for improving prognosis of cancer patients. To facilitate image-guided surgery using targeted optical imaging probes, we have developed a reflection-mode fluorescence molecular tomography (FMT) system with a handheld probe that is able to provide three-dimensional tumor margin information. METHODS The imaging method and system were validated using both simulated and phantom experiments. We further examined the accuracy of the handheld FMT system in an orthotopic mouse mammary tumor model following systemic delivery of near-infrared (NIR) dye-labeled and urokinase plasminogen activator receptor targeted magnet iron oxide nanoparticles. RESULTS Our results show that when the targets are located within 5 mm beneath the surface of the media, fluorescent images can be reliably detected and reconstructed with an average positional error of 0.5 mm laterally and 1.5 mm axially. For in vivo imaging in the mouse tumor model, the location and size of the tumor detected by FMT correlated well with that measured by the magnetic resonance imaging (MRI). CONCLUSIONS Our system can three-dimensionally image targets located at a depth of up to 7 mm. The in vivo results suggest that in combination with targeted optical imaging probes, this handheld FMT system can be potentially used as an intraoperative tool for the detection of tumor margins and for image-guided surgery.
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Affiliation(s)
- Qing Zhao
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL 32611, USA
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50
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da Silva SD, Ferlito A, Takes RP, Brakenhoff RH, Valentin MD, Woolgar JA, Bradford CR, Rodrigo JP, Rinaldo A, Hier MP, Kowalski LP. Advances and applications of oral cancer basic research. Oral Oncol 2011; 47:783-91. [PMID: 21802978 DOI: 10.1016/j.oraloncology.2011.07.004] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2011] [Revised: 07/01/2011] [Accepted: 07/05/2011] [Indexed: 12/19/2022]
Abstract
Cancer of the oral cavity accounts for almost 3% of cancer cases in the world. The incidence varies widely reflecting geographic differences in exposure to risk factors. The recent rise in younger age groups and females seen in many countries is of particular concern. Treatment and management of complications, locoregional recurrence and further primary tumors result in high morbidity and mortality especially when the disease is advanced stage at initial diagnosis. Progress in cancer research has provided abundant new knowledge about cellular processes and molecular biology underlying oral carcinogenesis and tumor progression. The present review attempts to summarize the current most widely-used research approaches and their application in the prevention, diagnosis, effective treatment, and improved outcome of oral cancer.
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Affiliation(s)
- Sabrina Daniela da Silva
- Department of Otolaryngology-Head and Neck Surgery, Jewish General Hospital, McGill University, Montreal, Canada
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