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Gibson C, Wang SC, Phoon A, Thalanki Anantha N, Ottolino-Perry K, Petropoulos S, Qureshi Z, Subramanian V, Shahid A, O'Brien C, Carcone S, Chung S, Tsui T, Son V, Sukhram M, Meng F, Done SJ, Easson AM, Cil T, Reedijk M, Leong WL, DaCosta RS. A handheld device for intra-cavity and ex vivo fluorescence imaging of breast conserving surgery margins with 5-aminolevulinic acid. BMC Biomed Eng 2024; 6:5. [PMID: 38822389 PMCID: PMC11143723 DOI: 10.1186/s42490-024-00079-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 04/19/2024] [Indexed: 06/03/2024] Open
Abstract
BACKGROUND Visualization of cancer during breast conserving surgery (BCS) remains challenging; the BCS reoperation rate is reported to be 20-70% of patients. An urgent clinical need exists for real-time intraoperative visualization of breast carcinomas during BCS. We previously demonstrated the ability of a prototype imaging device to identify breast carcinoma in excised surgical specimens following 5-aminolevulinic acid (5-ALA) administration. However, this prototype device was not designed to image the surgical cavity for remaining carcinoma after the excised lumpectomy specimen is removed. A new handheld fluorescence (FL) imaging prototype device, designed to image both excised specimens and within the surgical cavity, was assessed in a clinical trial to evaluate its clinical utility for first-in-human, real-time intraoperative imaging during index BCS. RESULTS The imaging device combines consumer-grade imaging sensory technology with miniature light-emitting diodes (LEDs) and multiband optical filtering to capture high-resolution white light (WL) and FL digital images and videos. The technology allows for visualization of protoporphyrin IX (PpIX), which fluoresces red when excited by violet-blue light. To date, n = 17 patients have received 20 mg kg bodyweight (BW) 5-ALA orally 2-4 h before imaging to facilitate the accumulation of PpIX within tumour cells. Tissue types were identified based on their colour appearance. Breast tumours in sectioned lumpectomies appeared red, which contrasted against the green connective tissues and orange-brown adipose tissues. In addition, ductal carcinoma in situ (DCIS) that was missed during intraoperative standard of care was identified at the surgical margin at <1 mm depth. In addition, artifacts due to the surgical drape, illumination, and blood within the surgical cavity were discovered. CONCLUSIONS This study has demonstrated the detection of a grossly occult positive margin intraoperatively. Artifacts from imaging within the surgical cavity have been identified, and potential mitigations have been proposed. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01837225 (Trial start date is September 2010. It was registered to ClinicalTrials.gov retrospectively on April 23, 2013, then later updated on April 9, 2020, to reflect the introduction of the new imaging device.).
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Affiliation(s)
- Christopher Gibson
- Princess Margaret Cancer Centre, University Health Network, 101 College Street, M5G 1L7, Toronto, Canada
- Department of Medical Biophysics, University of Toronto, 101 College Street, M5G 1L7, Toronto, Canada
| | - Shirley C Wang
- Princess Margaret Cancer Centre, University Health Network, 101 College Street, M5G 1L7, Toronto, Canada
| | - Arcturus Phoon
- Princess Margaret Cancer Centre, University Health Network, 101 College Street, M5G 1L7, Toronto, Canada
| | - Nayana Thalanki Anantha
- Princess Margaret Cancer Centre, University Health Network, 101 College Street, M5G 1L7, Toronto, Canada
| | - Kathryn Ottolino-Perry
- Princess Margaret Cancer Centre, University Health Network, 101 College Street, M5G 1L7, Toronto, Canada
| | - Stephen Petropoulos
- Princess Margaret Cancer Centre, University Health Network, 101 College Street, M5G 1L7, Toronto, Canada
| | - Zuha Qureshi
- Princess Margaret Cancer Centre, University Health Network, 101 College Street, M5G 1L7, Toronto, Canada
| | - Vasanth Subramanian
- Princess Margaret Cancer Centre, University Health Network, 101 College Street, M5G 1L7, Toronto, Canada
| | - Anam Shahid
- Princess Margaret Cancer Centre, University Health Network, 101 College Street, M5G 1L7, Toronto, Canada
| | - Cristiana O'Brien
- Princess Margaret Cancer Centre, University Health Network, 101 College Street, M5G 1L7, Toronto, Canada
| | - Steven Carcone
- The Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, 200 Elizabeth Street, 10th Floor Eaton Wing, M5G 2C4, Toronto, Canada
| | - Suzanne Chung
- The Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, 200 Elizabeth Street, 10th Floor Eaton Wing, M5G 2C4, Toronto, Canada
| | - Teresa Tsui
- The Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, 200 Elizabeth Street, 10th Floor Eaton Wing, M5G 2C4, Toronto, Canada
| | - Viktor Son
- Princess Margaret Cancer Centre, University Health Network, 101 College Street, M5G 1L7, Toronto, Canada
- Laboratory Medicine Program, University Health Network, 200 Elizabeth Street, 11th Floor Eaton Wing, M5G 2C4, Toronto, Canada
| | - Mayleen Sukhram
- Princess Margaret Cancer Centre, University Health Network, 101 College Street, M5G 1L7, Toronto, Canada
- Laboratory Medicine Program, University Health Network, 200 Elizabeth Street, 11th Floor Eaton Wing, M5G 2C4, Toronto, Canada
| | - Fannong Meng
- Princess Margaret Cancer Centre, University Health Network, 101 College Street, M5G 1L7, Toronto, Canada
- Laboratory Medicine Program, University Health Network, 200 Elizabeth Street, 11th Floor Eaton Wing, M5G 2C4, Toronto, Canada
| | - Susan J Done
- Princess Margaret Cancer Centre, University Health Network, 101 College Street, M5G 1L7, Toronto, Canada
- Laboratory Medicine Program, University Health Network, 200 Elizabeth Street, 11th Floor Eaton Wing, M5G 2C4, Toronto, Canada
- Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, 1 King's College Circle, M5S 1A8, Toronto, Canada
| | - Alexandra M Easson
- Princess Margaret Cancer Centre, University Health Network, 101 College Street, M5G 1L7, Toronto, Canada
- Surgical Oncology Department, Princess Margaret Cancer Centre, University Health Network, 610 University Ave, M5T 2M9, Toronto, Canada
| | - Tulin Cil
- Princess Margaret Cancer Centre, University Health Network, 101 College Street, M5G 1L7, Toronto, Canada
- Surgical Oncology Department, Princess Margaret Cancer Centre, University Health Network, 610 University Ave, M5T 2M9, Toronto, Canada
| | - Michael Reedijk
- Princess Margaret Cancer Centre, University Health Network, 101 College Street, M5G 1L7, Toronto, Canada
- Surgical Oncology Department, Princess Margaret Cancer Centre, University Health Network, 610 University Ave, M5T 2M9, Toronto, Canada
| | - Wey L Leong
- Princess Margaret Cancer Centre, University Health Network, 101 College Street, M5G 1L7, Toronto, Canada
- Surgical Oncology Department, Princess Margaret Cancer Centre, University Health Network, 610 University Ave, M5T 2M9, Toronto, Canada
| | - Ralph S DaCosta
- Princess Margaret Cancer Centre, University Health Network, 101 College Street, M5G 1L7, Toronto, Canada.
- Department of Medical Biophysics, University of Toronto, 101 College Street, M5G 1L7, Toronto, Canada.
- Techna Institute, University Health Network, 124-100 College Street, M5G 1P5, Toronto, Canada.
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Pop CF, Veys I, Bormans A, Larsimont D, Liberale G. Fluorescence imaging for real-time detection of breast cancer tumors using IV injection of indocyanine green with non-conventional imaging: a systematic review of preclinical and clinical studies of perioperative imaging technologies. Breast Cancer Res Treat 2024; 204:429-442. [PMID: 38182824 PMCID: PMC10959791 DOI: 10.1007/s10549-023-07199-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 11/22/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND This review summarizes the available data on the effectiveness of indocyanine green fluorescence imaging (ICG-FI) for real-time detection of breast cancer (BC) tumors with perioperative imaging technologies. METHODS PubMed and Scopus databases were exhaustively searched for publications on the use of the real-time ICG-FI evaluation of BC tumors with non-conventional breast imaging technologies. RESULTS Twenty-three studies were included in this review. ICG-FI has been used for BC tumor identification in 12 orthotopic animal tumor experiences, 4 studies on animal assessment, and for 7 human clinical applications. The BC tumor-to-background ratio (TBR) was 1.1-8.5 in orthotopic tumor models and 1.4-3.9 in animal experiences. The detection of primary human BC tumors varied from 40% to 100%. The mean TBR reported for human BC varied from 2.1 to 3.7. In two studies evaluating BC surgical margins, good sensitivity (93.3% and 100%) and specificity (60% and 96%) have been reported, with a negative predictive value of ICG-FI to predict margin involvement intraoperatively of 100% in one study. CONCLUSIONS The use of ICG-FI as a guiding tool for the real-time identification of BC tumors and for the assessment of tumor boundaries is promising. There is great variability between the studies with regard to timing and dose. Further evidence is needed to assess whether ICG-guided BC surgery may be implemented as a standard of care.
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Affiliation(s)
- C Florin Pop
- Department of Surgical Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Rue Meylemeersch 90, 1070, Brussels, Belgium.
| | - Isabelle Veys
- Department of Surgical Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Rue Meylemeersch 90, 1070, Brussels, Belgium
| | - Anne Bormans
- Institutional Library, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Denis Larsimont
- Department of Pathology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Gabriel Liberale
- Department of Surgical Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Rue Meylemeersch 90, 1070, Brussels, Belgium
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Kedrzycki MS, Chon HTW, Leiloglou M, Chalau V, Leff DR, Elson DS. Fluorescence guided surgery imaging systems for breast cancer identification: a systematic review. JOURNAL OF BIOMEDICAL OPTICS 2024; 29:030901. [PMID: 38440101 PMCID: PMC10911048 DOI: 10.1117/1.jbo.29.3.030901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 01/10/2024] [Accepted: 02/06/2024] [Indexed: 03/06/2024]
Abstract
Significance Breast-conserving surgery (BCS) is limited by high rates of positive margins and re-operative interventions. Fluorescence-guided surgery seeks to detect the entire lesion in real time, thus guiding the surgeons to remove all the tumor at the index procedure. Aim Our aim was to identify the optimal combination of a camera system and fluorophore for fluorescence-guided BCS. Approach A systematic review of medical databases using the terms "fluorescence," "breast cancer," "surgery," and "fluorescence imaging" was performed. Cameras were compared using the ratio between the fluorescent signal from the tumor compared to background fluorescence, as well as diagnostic accuracy measures, such as sensitivity, specificity, and positive predictive value. Results Twenty-one studies identified 14 camera systems using nine different fluorophores. Twelve cameras worked in the infrared spectrum. Ten studies reported on the difference in strength of the fluorescence signal between cancer and normal tissue, with results ranging from 1.72 to 4.7. In addition, nine studies reported on whether any tumor remained in the resection cavity (5.4% to 32.5%). To date, only three studies used the fluorescent signal for guidance during real BCS. Diagnostic accuracy ranged from 63% to 98% sensitivity, 32% to 97% specificity, and 75% to 100% positive predictive value. Conclusion In this systematic review, all the studies reported a clinically significant difference in signal between the tumor and normal tissue using various camera/fluorophore combinations. However, given the heterogeneity in protocols, including camera setup, fluorophore studied, data acquisition, and reporting structure, it was impossible to determine the optimal camera and fluorophore combination for use in BCS. It would be beneficial to develop a standardized reporting structure using similar metrics to provide necessary data for a comparison between camera systems.
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Affiliation(s)
- Martha S. Kedrzycki
- Institute of Global Health Innovation, Imperial College London, Hamlyn Centre, London, United Kingdom
- Imperial College London, Department of Surgery and Cancer, London, United Kingdom
- Imperial College Healthcare NHS Trust, Department of Breast Surgery, London, United Kingdom
| | - Hazel T. W. Chon
- Imperial College London, Department of Surgery and Cancer, London, United Kingdom
| | - Maria Leiloglou
- Institute of Global Health Innovation, Imperial College London, Hamlyn Centre, London, United Kingdom
- Imperial College London, Department of Surgery and Cancer, London, United Kingdom
| | - Vadzim Chalau
- Institute of Global Health Innovation, Imperial College London, Hamlyn Centre, London, United Kingdom
- Imperial College London, Department of Surgery and Cancer, London, United Kingdom
| | - Daniel R. Leff
- Institute of Global Health Innovation, Imperial College London, Hamlyn Centre, London, United Kingdom
- Imperial College London, Department of Surgery and Cancer, London, United Kingdom
- Imperial College Healthcare NHS Trust, Department of Breast Surgery, London, United Kingdom
| | - Daniel S. Elson
- Institute of Global Health Innovation, Imperial College London, Hamlyn Centre, London, United Kingdom
- Imperial College London, Department of Surgery and Cancer, London, United Kingdom
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Dinakaran D, Wilson BC. The use of nanomaterials in advancing photodynamic therapy (PDT) for deep-seated tumors and synergy with radiotherapy. Front Bioeng Biotechnol 2023; 11:1250804. [PMID: 37849983 PMCID: PMC10577272 DOI: 10.3389/fbioe.2023.1250804] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/22/2023] [Indexed: 10/19/2023] Open
Abstract
Photodynamic therapy (PDT) has been under development for at least 40 years. Multiple studies have demonstrated significant anti-tumor efficacy with limited toxicity concerns. PDT was expected to become a major new therapeutic option in treating localized cancer. However, despite a shifting focus in oncology to aggressive local therapies, PDT has not to date gained widespread acceptance as a standard-of-care option. A major factor is the technical challenge of treating deep-seated and large tumors, due to the limited penetration and variability of the activating light in tissue. Poor tumor selectivity of PDT sensitizers has been problematic for many applications. Attempts to mitigate these limitations with the use of multiple interstitial fiberoptic catheters to deliver the light, new generations of photosensitizer with longer-wavelength activation, oxygen independence and better tumor specificity, as well as improved dosimetry and treatment planning are starting to show encouraging results. Nanomaterials used either as photosensitizers per se or to improve delivery of molecular photosensitizers is an emerging area of research. PDT can also benefit radiotherapy patients due to its complementary and potentially synergistic mechanisms-of-action, ability to treat radioresistant tumors and upregulation of anti-tumoral immune effects. Furthermore, recent advances may allow ionizing radiation energy, including high-energy X-rays, to replace external light sources, opening a novel therapeutic strategy (radioPDT), which is facilitated by novel nanomaterials. This may provide the best of both worlds by combining the precise targeting and treatment depth/volume capabilities of radiation therapy with the high therapeutic index and biological advantages of PDT, without increasing toxicities. Achieving this, however, will require novel agents, primarily developed with nanomaterials. This is under active investigation by many research groups using different approaches.
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Affiliation(s)
- Deepak Dinakaran
- National Cancer Institute, National Institute of Health, Bethesda, MD, United States
- Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Brian C. Wilson
- Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
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5
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Martell MT, Haven NJM, Cikaluk BD, Restall BS, McAlister EA, Mittal R, Adam BA, Giannakopoulos N, Peiris L, Silverman S, Deschenes J, Li X, Zemp RJ. Deep learning-enabled realistic virtual histology with ultraviolet photoacoustic remote sensing microscopy. Nat Commun 2023; 14:5967. [PMID: 37749108 PMCID: PMC10519961 DOI: 10.1038/s41467-023-41574-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 09/11/2023] [Indexed: 09/27/2023] Open
Abstract
The goal of oncologic surgeries is complete tumor resection, yet positive margins are frequently found postoperatively using gold standard H&E-stained histology methods. Frozen section analysis is sometimes performed for rapid intraoperative margin evaluation, albeit with known inaccuracies. Here, we introduce a label-free histological imaging method based on an ultraviolet photoacoustic remote sensing and scattering microscope, combined with unsupervised deep learning using a cycle-consistent generative adversarial network for realistic virtual staining. Unstained tissues are scanned at rates of up to 7 mins/cm2, at resolution equivalent to 400x digital histopathology. Quantitative validation suggests strong concordance with conventional histology in benign and malignant prostate and breast tissues. In diagnostic utility studies we demonstrate a mean sensitivity and specificity of 0.96 and 0.91 in breast specimens, and respectively 0.87 and 0.94 in prostate specimens. We also find virtual stain quality is preferred (P = 0.03) compared to frozen section analysis in a blinded survey of pathologists.
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Affiliation(s)
- Matthew T Martell
- Department of Electrical and Computer Engineering, University of Alberta, 116 Street & 85 Avenue, Edmonton, AB, T6G 2R3, Canada
| | - Nathaniel J M Haven
- Department of Electrical and Computer Engineering, University of Alberta, 116 Street & 85 Avenue, Edmonton, AB, T6G 2R3, Canada
| | - Brendyn D Cikaluk
- Department of Electrical and Computer Engineering, University of Alberta, 116 Street & 85 Avenue, Edmonton, AB, T6G 2R3, Canada
| | - Brendon S Restall
- Department of Electrical and Computer Engineering, University of Alberta, 116 Street & 85 Avenue, Edmonton, AB, T6G 2R3, Canada
| | - Ewan A McAlister
- Department of Electrical and Computer Engineering, University of Alberta, 116 Street & 85 Avenue, Edmonton, AB, T6G 2R3, Canada
| | - Rohan Mittal
- Department of Laboratory Medicine and Pathology, University of Alberta, 11405 87 Avenue NW, Edmonton, AB, T6G 1C9, Canada
| | - Benjamin A Adam
- Department of Laboratory Medicine and Pathology, University of Alberta, 11405 87 Avenue NW, Edmonton, AB, T6G 1C9, Canada
| | - Nadia Giannakopoulos
- Department of Laboratory Medicine and Pathology, University of Alberta, 11405 87 Avenue NW, Edmonton, AB, T6G 1C9, Canada
| | - Lashan Peiris
- Department of Surgery, University of Alberta, 8440 - 112 Street, Edmonton, AB, T6G 2B7, Canada
| | - Sveta Silverman
- Department of Laboratory Medicine and Pathology, University of Alberta, 11405 87 Avenue NW, Edmonton, AB, T6G 1C9, Canada
| | - Jean Deschenes
- Department of Laboratory Medicine and Pathology, University of Alberta, 11405 87 Avenue NW, Edmonton, AB, T6G 1C9, Canada
| | - Xingyu Li
- Department of Electrical and Computer Engineering, University of Alberta, 116 Street & 85 Avenue, Edmonton, AB, T6G 2R3, Canada
| | - Roger J Zemp
- Department of Electrical and Computer Engineering, University of Alberta, 116 Street & 85 Avenue, Edmonton, AB, T6G 2R3, Canada.
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Gibson C, Phoon A, DaCosta RS. Customizable optical tissue phantom platform for characterization of fluorescence imaging device sensitivity. JOURNAL OF BIOMEDICAL OPTICS 2023; 28:086004. [PMID: 37655212 PMCID: PMC10467488 DOI: 10.1117/1.jbo.28.8.086004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/13/2023] [Accepted: 08/15/2023] [Indexed: 09/02/2023]
Abstract
Significance Optical tissue phantoms serve as inanimate and stable reference materials used to calibrate, characterize, standardize, and test biomedical imaging instruments. Although various types of solid tissue phantoms have been described in the literature, current phantom models are limited in that they do not have a depth feature that can be adjusted in real-time, they cannot be adapted to other applications, and their fabrication can be laborious and costly. Aim Our goal was to develop an optical phantom that could assess the imaging performance of fluorescence imaging devices and be customizable for different applications. Approach We developed a phantom with three distinct components, each of which can be customized. Results We present a method for fabricating a solid optical tissue that contains (1) an adjustable depth capability using thin film phantoms, (2) a refillable chip loaded with fluorophores of the user's choice in various desired quantities, and (3) phantom materials representative of different tissue types. Conclusions This article describes the development of phantom models that are customizable, adaptable, and easy to design and fabricate.
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Affiliation(s)
- Christopher Gibson
- University Health Network, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- University of Toronto, Department of Medical Biophysics, Toronto, Ontario, Canada
| | - Arcturus Phoon
- University Health Network, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Ralph S DaCosta
- University Health Network, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- University of Toronto, Department of Medical Biophysics, Toronto, Ontario, Canada
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Kedrzycki MS, Elson DS, Leff DR. Guidance in breast-conserving surgery: tumour localization versus identification. Br J Surg 2022:6901362. [PMID: 36515686 PMCID: PMC10361673 DOI: 10.1093/bjs/znac409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 10/06/2022] [Accepted: 11/01/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Martha S Kedrzycki
- Department of Surgery and Cancer, Imperial College London, London, UK.,Department of Breast Surgery, Charing Cross Hospital, Imperial Healthcare Trust, London, UK
| | - Daniel S Elson
- Department of Surgery and Cancer, Imperial College London, London, UK.,Hamlyn Centre, Imperial College London, Institute of Global Health Innovation, London, UK
| | - Daniel R Leff
- Department of Surgery and Cancer, Imperial College London, London, UK.,Department of Breast Surgery, Charing Cross Hospital, Imperial Healthcare Trust, London, UK
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Enlarging the Scope of 5-Aminolevulinic Acid-Mediated Photodiagnosis towards Breast Cancers. Int J Mol Sci 2022; 23:ijms232314900. [PMID: 36499224 PMCID: PMC9735814 DOI: 10.3390/ijms232314900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/25/2022] [Accepted: 11/26/2022] [Indexed: 11/30/2022] Open
Abstract
Today, most research on treating cancers targets one single cancer, often because of the very specific operation principle of the therapy. For instance, immunotherapies require the expression of a particular antigen, which might not be expressed in all cancers or in all patients. What about metastases? Combination therapies are promising but require treatment personalization and are an expensive approach that many health systems are not willing to pay for. Resection of cancerous tissues may be conducted beforehand. However, the precise location and removal of tumors are in most cases, hurdles that require margins to prevent recurrence. Herein, we further demonstrate the wide application of aminolevulinate-based photodynamic diagnosis and therapy toward breast cancers. By selecting four breast cancer cell lines that represent the main breast tumor subtypes, we investigated their ability to accumulate the fluorescent protoporphyrin IX upon treatment with the marketed 5-aminolevulinic acid hexyl ester (ALA-Hex) or our new and more stable derivative PSI-ALA-Hex. We found that all cell lines were able to accumulate PpIX under a few hours independent of their hormonal status with both treatments. Additionally, this accumulation was less dose-dependent with PSI-ALA-Hex and induced similar or higher fluorescence intensity than ALA-Hex in three out of four cell lines. The toxicity of the two molecules was not different up to 0.33 mM. However, PSI-ALA-Hex was more toxic at 1 mM, even though lower concentrations of PSI-ALA-Hex led to the same PpIX accumulation level. Additional illumination with blue light to induce cell death by generating reactive oxygen species was also considered. The treatments led to a dramatic death of the BT-474 cells under all conditions. In SK-BR-3 and MCF-7, ALA-Hex was also very efficient at all concentrations. However, increasing doses of PSI-ALA-Hex (0.33 and 1 mM) surprisingly led to a higher viability rate. In contrast, the triple-negative breast cancer cells MDA-MB-231 showed a higher death induction with higher concentrations of ALA-Hex or PSI-ALA-Hex. Derivatives of ALA seem promising as fluorescence-guided resection tools and may enable subsequent completion of cancer cell destruction by blue light irradiation.
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Scolaro L, Lorenser D, Quirk BC, Kirk RW, Ho LA, Thomas E, Li J, Saunders CM, Sampson DD, Fuller RO, McLaughlin RA. Multimodal imaging needle combining optical coherence tomography and fluorescence for imaging of live breast cancer cells labeled with a fluorescent analog of tamoxifen. JOURNAL OF BIOMEDICAL OPTICS 2022; 27:076004. [PMID: 35831923 PMCID: PMC9278982 DOI: 10.1117/1.jbo.27.7.076004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 06/28/2022] [Indexed: 06/15/2023]
Abstract
SIGNIFICANCE Imaging needles consist of highly miniaturized focusing optics encased within a hypodermic needle. The needles may be inserted tens of millimeters into tissue and have the potential to visualize diseased cells well beyond the penetration depth of optical techniques applied externally. Multimodal imaging needles acquire multiple types of optical signals to differentiate cell types. However, their use has not previously been demonstrated with live cells. AIM We demonstrate the ability of a multimodal imaging needle to differentiate cell types through simultaneous optical coherence tomography (OCT) and fluorescence imaging. APPROACH We characterize the performance of a multimodal imaging needle. This is paired with a fluorescent analog of the therapeutic drug, tamoxifen, which enables cell-specific fluorescent labeling of estrogen receptor-positive (ER+) breast cancer cells. We perform simultaneous OCT and fluorescence in situ imaging on MCF-7 ER+ breast cancer cells and MDA-MB-231 ER- cells. Images are compared against unlabeled control samples and correlated with standard confocal microscopy images. RESULTS We establish the feasibility of imaging live cells with these miniaturized imaging probes by showing clear differentiation between cancerous cells. CONCLUSIONS Imaging needles have the potential to aid in the detection of specific cancer cells within solid tissue.
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Affiliation(s)
- Loretta Scolaro
- The University of Adelaide, Australian Research Council Centre of Excellence for Nanoscale Biophotonics, Faculty of Health and Medical Sciences, Adelaide, South Australia, Australia
- The University of Adelaide, Institute for Photonics and Advanced Sensing, Adelaide, South Australia, Australia
- The University of Western Australia, School of Engineering, Optical+Biomedical Engineering Laboratory, Crawley, Western Australia, Australia
| | - Dirk Lorenser
- The University of Western Australia, School of Engineering, Optical+Biomedical Engineering Laboratory, Crawley, Western Australia, Australia
| | - Bryden C. Quirk
- The University of Adelaide, Australian Research Council Centre of Excellence for Nanoscale Biophotonics, Faculty of Health and Medical Sciences, Adelaide, South Australia, Australia
- The University of Adelaide, Institute for Photonics and Advanced Sensing, Adelaide, South Australia, Australia
- The University of Western Australia, School of Engineering, Optical+Biomedical Engineering Laboratory, Crawley, Western Australia, Australia
| | - Rodney W. Kirk
- The University of Adelaide, Australian Research Council Centre of Excellence for Nanoscale Biophotonics, Faculty of Health and Medical Sciences, Adelaide, South Australia, Australia
- The University of Adelaide, Institute for Photonics and Advanced Sensing, Adelaide, South Australia, Australia
- The University of Western Australia, School of Engineering, Optical+Biomedical Engineering Laboratory, Crawley, Western Australia, Australia
| | - Louisa A. Ho
- The University of Western Australia, School of Molecular Sciences, Crawley, Western Australia, Australia
| | - Elizabeth Thomas
- The University of Western Australia, Medical School, Division of Surgery, Nedlands, Western Australia, Australia
| | - Jiawen Li
- The University of Adelaide, Australian Research Council Centre of Excellence for Nanoscale Biophotonics, Faculty of Health and Medical Sciences, Adelaide, South Australia, Australia
- The University of Adelaide, Institute for Photonics and Advanced Sensing, Adelaide, South Australia, Australia
- The University of Western Australia, School of Engineering, Optical+Biomedical Engineering Laboratory, Crawley, Western Australia, Australia
- The University of Adelaide, School of Electrical and Electronic Engineering, Adelaide, South Australia, Australia
| | - Christobel M. Saunders
- The University of Western Australia, Medical School, Division of Surgery, Nedlands, Western Australia, Australia
- Fiona Stanley Hospital, Breast Centre, Murdoch, Western Australia, Australia
- Royal Perth Hospital, Breast Clinic, Perth, Western Australia, Australia
| | - David D. Sampson
- The University of Western Australia, School of Engineering, Optical+Biomedical Engineering Laboratory, Crawley, Western Australia, Australia
- University of Surrey, School of Biosciences and Medicine, Surrey Biophotonics, Guildford, United Kingdom
- University of Surrey, Advanced Technology Institute, School of Physics, Surrey Biophotonics, Guildford, United Kingdom
| | - Rebecca O. Fuller
- The University of Western Australia, School of Molecular Sciences, Crawley, Western Australia, Australia
- University of Tasmania, School of Natural Sciences – Chemistry, Hobart, Tasmania, Australia
| | - Robert A. McLaughlin
- The University of Adelaide, Australian Research Council Centre of Excellence for Nanoscale Biophotonics, Faculty of Health and Medical Sciences, Adelaide, South Australia, Australia
- The University of Adelaide, Institute for Photonics and Advanced Sensing, Adelaide, South Australia, Australia
- The University of Western Australia, School of Engineering, Optical+Biomedical Engineering Laboratory, Crawley, Western Australia, Australia
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Recent Advances in Intraoperative Lumpectomy Margin Assessment for Breast Cancer. CURRENT BREAST CANCER REPORTS 2022. [DOI: 10.1007/s12609-022-00451-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Intraoperative Margin Trials in Breast Cancer. CURRENT BREAST CANCER REPORTS 2022. [DOI: 10.1007/s12609-022-00450-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Abstract
Purpose of Review
Obtaining negative margins in breast conservation surgery continues to be a challenge. Re-excisions are difficult for patients and expensive for the health systems. This paper reviews the literature on current strategies and intraoperative clinical trials to reduce positive margin rates.
Recent Findings
The best available data demonstrate that intraoperative imaging with ultrasound, intraoperative pathologic assessment such as frozen section, and cavity margins have been the most successful intraoperative strategies to reduce positive margins. Emerging technologies such as optical coherence tomography and fluorescent imaging need further study but may be important adjuncts.
Summary
There are several proven strategies to reduce positive margin rates to < 10%. Surgeons should utilize best available resources within their institutions to produce the best outcomes for their patients.
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Wilson BC, Eu D. Optical Spectroscopy and Imaging in Surgical Management of Cancer Patients. TRANSLATIONAL BIOPHOTONICS 2022. [DOI: 10.1002/tbio.202100009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Brian C. Wilson
- Princess Margaret Cancer Centre/University Health Network 101 College Street Toronto Ontario Canada
- Department of Medical Biophysics, Faculty of Medicine University of Toronto Canada
| | - Donovan Eu
- Department of Otolaryngology‐Head and Neck Surgery‐Surgical Oncology, Princess Margaret Cancer Centre/University Health Network University of Toronto Canada
- Department of Otolaryngology‐Head and Neck Surgery National University Hospital System Singapore
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Emerging and future use of intra-surgical volumetric X-ray imaging and adjuvant tools for decision support in breast-conserving surgery. CURRENT OPINION IN BIOMEDICAL ENGINEERING 2022; 22. [DOI: 10.1016/j.cobme.2022.100382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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