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Berehova N, van Meerbeek MP, Azargoshasb S, van Willigen DM, Slof LJ, Navaei Lavasani S, van Oosterom MN, van Leeuwen FWB, Buckle T. A Truncated 14-Amino-Acid Myelin Protein-Zero-Targeting Peptide for Fluorescence-Guided Nerve-Preserving Surgery. Biomolecules 2023; 13:942. [PMID: 37371522 DOI: 10.3390/biom13060942] [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: 03/31/2023] [Revised: 05/31/2023] [Accepted: 06/01/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND The occurrence of accidental nerve damage during surgery and the increasing application of image guidance during head-and-neck surgery have highlighted the need for molecular targeted nerve-sparing interventions. The implementation of such interventions relies on the availability of nerve-specific tracers. In this paper, we describe the development of a truncated peptide that has an optimized affinity for protein zero (P0), the most abundant protein in myelin. METHODS AND MATERIALS Further C- and N-terminal truncation was performed on the lead peptide Cy5-P0101-125. The resulting nine Cy5-labelled peptides were characterized based on their photophysical properties, P0 affinity, and in vitro staining. These characterizations were combined with evaluation of the crystal structure of P0, which resulted in the selection of the optimized tracer Cy5-P0112-125. A near-infrared Cy7-functionalized derivative (Cy7-P0112-125) was used to perform an initial evaluation of fluorescence-guided surgery in a porcine model. RESULTS Methodological truncation of the 26-amino-acid lead compound Cy5-P0101-125 resulted in a size reduction of 53.8% for the optimized peptide Cy5-P0112-125. The peptide design and the 1.5-fold affinity gain obtained after truncation could be linked to interactions observed in the crystal structure of the extracellular portion of P0. The near-infrared analogue Cy7-P0112-125 supported nerve illumination during fluorescence-guided surgery in the head-and-neck region in a porcine model. CONCLUSIONS Methodological truncation yielded a second-generation P0-specific peptide. Initial surgical evaluation suggests that the peptide can support molecular targeted nerve imaging.
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Affiliation(s)
- Nataliia Berehova
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Maarten P van Meerbeek
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Samaneh Azargoshasb
- Design and Prototyping, Department of Medical Technology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Danny M van Willigen
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Leon J Slof
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Design and Prototyping, Department of Medical Technology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Saaedeh Navaei Lavasani
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Matthias N van Oosterom
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Fijs W B van Leeuwen
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Department of Head and Neck Surgery, Division of Surgical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, The Netherlands
| | - Tessa Buckle
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Department of Head and Neck Surgery, Division of Surgical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, The Netherlands
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2
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Azargoshasb S, Boekestijn I, Roestenberg M, KleinJan GH, van der Hage JA, van der Poel HG, Rietbergen DDD, van Oosterom MN, van Leeuwen FWB. Quantifying the Impact of Signal-to-background Ratios on Surgical Discrimination of Fluorescent Lesions. Mol Imaging Biol 2023; 25:180-189. [PMID: 35711014 PMCID: PMC9971139 DOI: 10.1007/s11307-022-01736-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/28/2022] [Accepted: 04/21/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE Surgical fluorescence guidance has gained popularity in various settings, e.g., minimally invasive robot-assisted laparoscopic surgery. In pursuit of novel receptor-targeted tracers, the field of fluorescence-guided surgery is currently moving toward increasingly lower signal intensities. This highlights the importance of understanding the impact of low fluorescence intensities on clinical decision making. This study uses kinematics to investigate the impact of signal-to-background ratios (SBR) on surgical performance. METHODS Using a custom grid exercise containing hidden fluorescent targets, a da Vinci Xi robot with Firefly fluorescence endoscope and ProGrasp and Maryland forceps instruments, we studied how the participants' (N = 16) actions were influenced by the fluorescent SBR. To monitor the surgeon's actions, the surgical instrument tip was tracked using a custom video-based tracking framework. The digitized instrument tracks were then subjected to multi-parametric kinematic analysis, allowing for the isolation of various metrics (e.g., velocity, jerkiness, tortuosity). These were incorporated in scores for dexterity (Dx), decision making (DM), overall performance (PS) and proficiency. All were related to the SBR values. RESULTS Multi-parametric analysis showed that task completion time, time spent in fluorescence-imaging mode and total pathlength are metrics that are directly related to the SBR. Below SBR 1.5, these values substantially increased, and handling errors became more frequent. The difference in Dx and DM between the targets that gave SBR < 1.50 and SBR > 1.50, indicates that the latter group generally yields a 2.5-fold higher Dx value and a threefold higher DM value. As these values provide the basis for the PS score, proficiency could only be achieved at SBR > 1.55. CONCLUSION By tracking the surgical instruments we were able to, for the first time, quantitatively and objectively assess how the instrument positioning is impacted by fluorescent SBR. Our findings suggest that in ideal situations a minimum SBR of 1.5 is required to discriminate fluorescent lesions, a substantially lower value than the SBR 2 often reported in literature.
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Affiliation(s)
- Samaneh Azargoshasb
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Urology, Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Imke Boekestijn
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands.,Section of Nuclear Medicine, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Meta Roestenberg
- Department of Parasitology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Infectious Diseases, Leiden University Medical Center, Leiden, the Netherlands
| | - Gijs H KleinJan
- Department of Urology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jos A van der Hage
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Henk G van der Poel
- Department of Urology, Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Daphne D D Rietbergen
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands.,Section of Nuclear Medicine, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Matthias N van Oosterom
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Urology, Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Fijs W B van Leeuwen
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands. .,Department of Urology, Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital, Amsterdam, the Netherlands.
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3
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van Oosterom MN, van Leeuwen SI, Mazzone E, Dell’Oglio P, Buckle T, van Beurden F, Boonekamp M, van de Stadt H, Bauwens K, Simon H, van Leeuwen PJ, van der Poel HG, van Leeuwen FWB. Click-on fluorescence detectors: using robotic surgical instruments to characterize molecular tissue aspects. J Robot Surg 2023; 17:131-140. [PMID: 35397108 PMCID: PMC9939496 DOI: 10.1007/s11701-022-01382-0] [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: 12/23/2021] [Accepted: 01/29/2022] [Indexed: 11/24/2022]
Abstract
Fluorescence imaging is increasingly being implemented in surgery. One of the drawbacks of its application is the need to switch back-and-forth between fluorescence- and white-light-imaging settings and not being able to dissect safely under fluorescence guidance. The aim of this study was to engineer 'click-on' fluorescence detectors that transform standard robotic instruments into molecular sensing devices that enable the surgeon to detect near-infrared (NIR) fluorescence in a white-light setting. This NIR-fluorescence detector setup was engineered to be press-fitted onto standard forceps instruments of the da Vinci robot. Following system characterization in a phantom setting (i.e., spectral properties, sensitivity and tissue signal attenuation), the performance with regard to different clinical indocyanine green (ICG) indications (e.g., angiography and lymphatic mapping) was determined via robotic surgery in pigs. To evaluate in-human applicability, the setup was also used for ICG-containing lymph node specimens from robotic prostate cancer surgery. The resulting Click-On device allowed for NIR ICG signal identification down to a concentration of 4.77 × 10-6 mg/ml. The fully assembled system could be introduced through the trocar and grasping, and movement abilities of the instrument were preserved. During surgery, the system allowed for the identification of blood vessels and assessment of vascularization (i.e., bowel, bladder and kidney), as well as localization of pelvic lymph nodes. During human specimen evaluation, it was able to distinguish sentinel from non-sentinel lymph nodes. With this introduction of a NIR-fluorescence Click-On sensing detector, a next step is made towards using surgical instruments in the characterization of molecular tissue aspects.
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Affiliation(s)
- Matthias N. van Oosterom
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands ,Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Sven I. van Leeuwen
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Elio Mazzone
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy ,ORSI Academy, Melle, Belgium
| | - Paolo Dell’Oglio
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands ,Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands ,ORSI Academy, Melle, Belgium ,Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Tessa Buckle
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands ,Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Florian van Beurden
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands ,Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Michael Boonekamp
- Design & Prototyping, Department of Medical Technology, Leiden University Medical Center, Leiden, The Netherlands
| | - Huybert van de Stadt
- Design & Prototyping, Department of Medical Technology, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | - Pim J. van Leeuwen
- Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Henk G. van der Poel
- Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Fijs W. B. van Leeuwen
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands ,Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands ,ORSI Academy, Melle, Belgium
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4
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Sun C, Huang Y, Jiang C, Li Z. Updates on fluorescent probes and open-field imaging methods for fluorescence-guided cytoreductive surgery for epithelial ovarian cancer: A review. BJOG 2022; 129 Suppl 2:50-59. [PMID: 36485071 PMCID: PMC10107465 DOI: 10.1111/1471-0528.17332] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Fluorescence-guided surgery has emerged as a promising imaging technique for real-time intraoperative tumour delineation and visualisation of submillimetre tumour masses in cytoreductive surgery for epithelial ovarian cancer (EOC). Researchers have developed several EOC-targeted fluorescent probes, most of which are currently in the preclinical stage. Interestingly, imaging devices designed for open surgery are proof of concept. This review summarises the recent advances in EOC-targeted fluorescent probes and open-field fluorescence imaging strategies and discusses the challenges and potential solutions for clinical translation.
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Affiliation(s)
- Chongen Sun
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Obstetrics and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Yue Huang
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Obstetrics and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Caixia Jiang
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Obstetrics and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Zhengyu Li
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Obstetrics and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
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5
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Boekestijn I, van Oosterom MN, Dell'Oglio P, van Velden FHP, Pool M, Maurer T, Rietbergen DDD, Buckle T, van Leeuwen FWB. The current status and future prospects for molecular imaging-guided precision surgery. Cancer Imaging 2022; 22:48. [PMID: 36068619 PMCID: PMC9446692 DOI: 10.1186/s40644-022-00482-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 08/21/2022] [Indexed: 01/19/2023] Open
Abstract
Molecular imaging technologies are increasingly used to diagnose, monitor, and guide treatment of i.e., cancer. In this review, the current status and future prospects of the use of molecular imaging as an instrument to help realize precision surgery is addressed with focus on the main components that form the conceptual basis of intraoperative molecular imaging. Paramount for successful interventions is the relevance and accessibility of surgical targets. In addition, selection of the correct combination of imaging agents and modalities is critical to visualize both microscopic and bulk disease sites with high affinity and specificity. In this context developments within engineering/imaging physics continue to drive the growth of image-guided surgery. Particularly important herein is enhancement of sensitivity through improved contrast and spatial resolution, features that are critical if sites of cancer involvement are not to be overlooked during surgery. By facilitating the connection between surgical planning and surgical execution, digital surgery technologies such as computer-aided visualization nicely complement these technologies. The complexity of image guidance, combined with the plurality of technologies that are becoming available, also drives the need for evaluation mechanisms that can objectively score the impact that technologies exert on the performance of healthcare professionals and outcome improvement for patients.
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Affiliation(s)
- Imke Boekestijn
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands.,Section of Nuclear Medicine, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Matthias N van Oosterom
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Paolo Dell'Oglio
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Floris H P van Velden
- Medical Physics, Department of Radiology , Leiden University Medical Center, Leiden, the Netherlands
| | - Martin Pool
- Department of Clinical Farmacy and Toxicology, Leiden University Medical Center, Leiden, the Netherlands
| | - Tobias Maurer
- Martini-Klinik Prostate Cancer Centre Hamburg, Hamburg, Germany
| | - Daphne D D Rietbergen
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands.,Section of Nuclear Medicine, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Tessa Buckle
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Fijs W B van Leeuwen
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands.
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6
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Budner O, Cwalinski T, Skokowski J, Marano L, Resca L, Cwalina N, Kalinowski L, Hoveling R, Roviello F, Polom K. Methylene Blue Near-Infrared Fluorescence Imaging in Breast Cancer Sentinel Node Biopsy. Cancers (Basel) 2022; 14:cancers14071817. [PMID: 35406588 PMCID: PMC8997777 DOI: 10.3390/cancers14071817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 03/31/2022] [Indexed: 01/25/2023] Open
Abstract
Simple Summary Currently the gold standard for sentinel node biopsy in breast cancer patients is radioactive nanocolloid and a blue dye. In the age of fluorescence guided surgery new fluorophores are used and methylene blue presents some fluorescent properties. This study is the first in a clinical series presenting the possible use of methylene blue as a fluorescent dye for the identification of sentinel nodes in breast cancer sentinel node biopsy. We presented a feasibility of this new method and also in additional experiments because of the quenching effect limitation, found possible dilution of methylene blue presenting improved fluorescence. Abstract Introduction: Fluorescence-based navigation for breast cancer sentinel node biopsy is a novel method that uses indocyanine green as a fluorophore. However, methylene blue (MB) also has some fluorescent properties. This study is the first in a clinical series presenting the possible use of MB as a fluorescent dye for the identification of sentinel nodes in breast sentinel node biopsy. Material and methods: Forty-nine patients with breast cancer who underwent sentinel node biopsy procedures were enrolled in the study. All patients underwent standard simultaneous injection of nanocolloid and MB. We visualized and assessed the sentinel nodes and the lymphatic channels transcutaneously, with and without fluorescence, and calculated the signal-to-background ratio (SBR). We also analyzed the corresponding fluorescence intensity of various dilutions of MB. Results: In twenty-three patients (46.9%), the location of the sentinel node, or the end of the lymphatic path, was visible transcutaneously. The median SBR for transcutaneous sentinel node location was 1.69 (range 1.66–4.35). Lymphatic channels were visible under fluorescence in 14 patients (28.6%) prior to visualization by the naked eye, with an average SBR of 2.01 (range 1.14–5.6). The sentinel node was visible under fluorescence in 25 patients (51%). The median SBR for sentinel node visualization with MB fluorescence was 2.54 (range 1.34–6.86). Sentinel nodes were visualized faster under fluorescence during sentinel node preparation. Factors associated with the rate of visualization included diabetes (p = 0.001), neoadjuvant chemotherapy (p = 0.003), and multifocality (p = 0.004). The best fluorescence was obtained using 40 μM (0.0128 mg/mL) MB, but we also observed a clinically relevant dilution range between 20 μM (0.0064 mg/mL) and 100 μM (0.032 mg/mL). Conclusions: For the first time, we propose the clinical usage of MB as a fluorophore for fluorescence-guided sentinel node biopsy in breast cancer patients. The quenching effect of the dye may be the reason for its poor detection rate. Our analysis of different concentrations of MB suggests a need for a detailed clinical analysis to highlight the practical usefulness of the dye.
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Affiliation(s)
- Oliver Budner
- Frauenheilkunde und Geburtshilfe, HELIOS Kliniken Schwerin, Wissmarsche Street 393-397, 19-055 Schwerin, Germany;
| | - Tomasz Cwalinski
- Department of Surgical Oncology, Faculty of Medicine, Medical University of Gdansk, Marii Sklodowskiej-Curie Street 3a, 80-217 Gdansk, Poland; (T.C.); (J.S.)
| | - Jarosław Skokowski
- Department of Surgical Oncology, Faculty of Medicine, Medical University of Gdansk, Marii Sklodowskiej-Curie Street 3a, 80-217 Gdansk, Poland; (T.C.); (J.S.)
- Department of Medical Laboratory Diagnostics–Biobank Fahrenheit BBMRI.pl, Medical University of Gdansk, Debinki Street 7, 80-211 Gdańsk, Poland;
- Biobanking and Biomolecular Resources Research Infrastructure Poland (BBMRI.pl), 80-210 Gdańsk, Poland
| | - Luigi Marano
- Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, Viale Bracci 16, 53-100 Siena, Italy; (L.M.); (L.R.); (F.R.)
| | - Luca Resca
- Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, Viale Bracci 16, 53-100 Siena, Italy; (L.M.); (L.R.); (F.R.)
| | - Natalia Cwalina
- Department of Pediatrics Ascension, St. John Children’s Hospital, Detroit, MI 48236, USA;
| | - Leszek Kalinowski
- Department of Medical Laboratory Diagnostics–Biobank Fahrenheit BBMRI.pl, Medical University of Gdansk, Debinki Street 7, 80-211 Gdańsk, Poland;
- Biobanking and Biomolecular Resources Research Infrastructure Poland (BBMRI.pl), 80-210 Gdańsk, Poland
- BioTechMed/Department of Mechanics of Materials and Structures, Gdansk University of Technology, Gabriela Narutowicza Street 11/12, 80-233 Gdansk, Poland
| | - Richelle Hoveling
- Quest Medical Imagining, Industrieweg 41, 1775 PW Middenmeer, The Netherlands;
| | - Franco Roviello
- Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, Viale Bracci 16, 53-100 Siena, Italy; (L.M.); (L.R.); (F.R.)
| | - Karol Polom
- Department of Surgical Oncology, Faculty of Medicine, Medical University of Gdansk, Marii Sklodowskiej-Curie Street 3a, 80-217 Gdansk, Poland; (T.C.); (J.S.)
- Correspondence: ; Tel.: +48-58-349-31-90
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Zhu S, Deng B, Liu F, Li J, Lin L, Ye J. Surface-Enhanced Raman Scattering Bioimaging with an Ultrahigh Signal-to-Background Ratio under Ambient Light. ACS APPLIED MATERIALS & INTERFACES 2022; 14:8876-8887. [PMID: 35157434 DOI: 10.1021/acsami.2c01063] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Surface-enhanced Raman scattering (SERS) nanoprobes have attracted particular interests in the field of bioimaging owing to their high sensitivity and specificity of the fingerprint spectrum. However, the limited signal-to-background ratio (SBR) in SERS imaging and the requirement to perform imaging in a dark environment have largely hindered its biomedical application. To circumvent this, we have developed a type of bio-orthogonal nanoprobes for SERS imaging with an ultrahigh SBR and ambient light anti-interference ability. The core-shell nanoprobes exhibit strongly enhanced Raman signals and depress the background from photoluminescence of metallic nanoparticles by off-resonance excitation and from the Raman scattering and auto-fluorescence of tissues by near-infrared laser excitation. Such nanoprobes have achieved an SBR of over 100 in SERS bioimaging, 5 times higher than the traditional on-resonant nanoprobes, and their bio-orthogonal signal in the Raman-silent region renders the anti-interference capability under ambient light. The development of these SERS probes opens up a new era for the future applications of Raman imaging in clinical medicine.
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Affiliation(s)
- Shuo Zhu
- State Key Laboratory of Oncogenes and Related Genes, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200030, P. R. China
| | - Binge Deng
- State Key Laboratory of Oncogenes and Related Genes, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200030, P. R. China
| | - Fugang Liu
- State Key Laboratory of Oncogenes and Related Genes, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200030, P. R. China
| | - Jin Li
- State Key Laboratory of Oncogenes and Related Genes, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200030, P. R. China
| | - Li Lin
- State Key Laboratory of Oncogenes and Related Genes, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200030, P. R. China
| | - Jian Ye
- State Key Laboratory of Oncogenes and Related Genes, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200030, P. R. China
- Shanghai Key Laboratory of Gynecologic Oncology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, P. R. China
- Institute of Medical Robotics, Shanghai Jiao Tong University, Shanghai 200127, P. R. China
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8
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Benson JR, van Leeuwen FWB, Sugie T. Editorial: State-Of-The-Art Fluorescence Image-Guided Surgery: Current and Future Developments. Front Oncol 2021; 11:776832. [PMID: 34746016 PMCID: PMC8569518 DOI: 10.3389/fonc.2021.776832] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 10/04/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- John R Benson
- Cambridge Breast Unit, Addenbrooke's Hospital, Cambridge and School of Medicine, Anglia Ruskin University, Cambridge, United Kingdom
| | - Fijs W B van Leeuwen
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - Tomoharu Sugie
- Breast Surgery, Kansai Medical University Hospital, Hirakata, Japan
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9
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The impact of drainage pathways on the detection of nodal metastases in prostate cancer: a phase II randomized comparison of intratumoral vs intraprostatic tracer injection for sentinel node detection. Eur J Nucl Med Mol Imaging 2021; 49:1743-1753. [PMID: 34748059 DOI: 10.1007/s00259-021-05580-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 09/30/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Previous studies indicated that location and amount of detected sentinel lymph nodes (SLNs) in prostate cancer (PCa) are influenced where SLN-tracer is deposited within the prostate. To validate whether intratumoral (IT) tracer injection helps to increase identification of tumor-positive lymph nodes (LNs) better than intraprostatic (IP) tracer injection, a prospective randomized phase II trial was performed. METHODS PCa patients with a > 5% risk of lymphatic involvement were randomized between ultrasound-guided transrectal injection of indocyanine green-[99mTc]Tc-nanocolloid in 2 depots of 1 mL in the tumor (n = 55, IT-group) or in 4 depots of 0.5 mL in the peripheral zone of the prostate (n = 58, IP-group). Preoperative lymphoscintigraphy and SPECT/CT were used to define the location of the SLNs. SLNs were dissected using combination of radio- and fluorescence-guidance, followed by extended pelvic LN dissection and robot-assisted radical prostatectomy. Outcome measurements were number of tumor-bearing SNs, tumor-bearing LNs, removed nodes, number of patients with nodal metastases, and metastasis-free survival (MFS) of 4-7-year follow-up data. RESULTS IT-injection did not result in significant difference of removed SLNs (5.0 vs 6.0, p = 0.317) and histologically positive SLNs (28 vs 22, p = 0.571). However, in IT-group, the SLN-positive nodes were 73.7% of total positive nodes compared to 37.3% in IP-group (p = 0.015). Moreover, significantly more node-positive patients were found in IT-group (42% vs 24%, p = 0.045), which did not result in worse MFS. In two patients (3.6%) from whom the IT-tracer injection only partly covered intraprostatic tumor spread, nodal metastases in ePLND without tumor-positive SNs were yielded. CONCLUSIONS The percentage-positive SLNs found after IT-injection were significantly higher compared to IP-injection. Significantly more node-positive patients were found using IT-injection, which did not affect MFS. IT-injection failed to detect nodal metastases from non-index satellite lesions. Therefore, we suggest to combine IT- and IP-tracer injections in men with visible tumor on imaging.
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Berger DMS, van den Berg NS, van der Noort V, van der Hiel B, Valdés Olmos RA, Buckle TA, KleinJan GH, Brouwer OR, Vermeeren L, Karakullukçu B, van den Brekel MWM, van de Wiel BA, Nieweg OE, Balm AJM, van Leeuwen FWB, Klop WMC. Technologic (R)Evolution Leads to Detection of More Sentinel Nodes in Patients with Melanoma in the Head and Neck Region. J Nucl Med 2021; 62:1357-1362. [PMID: 33637591 PMCID: PMC8724899 DOI: 10.2967/jnumed.120.246819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 01/28/2021] [Indexed: 11/16/2022] Open
Abstract
Sentinel lymph node (SN) biopsy (SNB) has proven to be a valuable tool for staging melanoma patients. Since its introduction in the early 1990s, this procedure has undergone several technologic refinements, including the introduction of SPECT/CT, as well as radioguidance and fluorescence guidance. The purpose of the current study was to evaluate the effect of this technologic evolution on SNB in the head and neck region. The primary endpoint was the false-negative (FN) rate. Secondary endpoints were number of harvested SNs, overall operation time, operation time per harvested SN, and postoperative complications. Methods: A retrospective database was queried for cutaneous head and neck melanoma patients who underwent SNB at The Netherlands Cancer Institute between 1993 and 2016. The implementation of new detection techniques was divided into 4 groups: 1993-2005, with preoperative lymphoscintigraphy and intraoperative use of both a γ-ray detection probe and patent blue (n = 30); 2006-2007, with addition of preoperative road maps based on SPECT/CT (n = 15); 2008-2009, with intraoperative use of a portable γ-camera (n = 40); and 2010-2016, with addition of near-infrared fluorescence guidance (n = 192). Results: In total, 277 patients were included. At least 1 SN was identified in all patients. A tumor-positive SN was found in 59 patients (21.3%): 10 in group 1 (33.3%), 3 in group 2 (20.0%), 6 in group 3 (15.0%), and 40 in group 4 (20.8%). Regional recurrences in patients with tumor-negative SNs resulted in an overall FN rate of 11.9% (group 1, 16.7%; group 2, 0%; group 3, 14.3%; group 4, 11.1%). The number of harvested nodes increased with advancing technologies (P = 0.003), whereas Breslow thickness and operation time per harvested SN decreased (P = 0.003 and P = 0.017, respectively). There was no significant difference in percentage of tumor-positive SNs, overall operation time, and complication rate between the different groups. Conclusion: The use of advanced detection technologies led to a higher number of identified SNs without an increase in overall operation time, possibly indicating an improved surgical efficiency. Operation time per harvested SN decreased; the average FN rate remained 11.9% and was unchanged over 23 y. There was no significant change in postoperative complication rate.
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Affiliation(s)
- Danique M S Berger
- Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands;
| | - Nynke S van den Berg
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Vincent van der Noort
- Department of Biometrics, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Bernies van der Hiel
- Department of Nuclear Medicine, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Renato A Valdés Olmos
- Department of Nuclear Medicine, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Tessa A Buckle
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Gijs H KleinJan
- Department of Urology, Leiden University Medical Center, Leiden, The Netherlands
| | - Oscar R Brouwer
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Lenka Vermeeren
- Department of Otorhinolaryngology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Baris Karakullukçu
- Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Michiel W M van den Brekel
- Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Bart A van de Wiel
- Department of Pathology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands; and
| | - Omgo E Nieweg
- Melanoma Institute Australia and Central Medical School, University of Sydney, Sydney, Australia
| | - Alfons J M Balm
- Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Fijs W B van Leeuwen
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - W Martin C Klop
- Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
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11
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Stewart HL, Birch DJS. Fluorescence Guided Surgery. Methods Appl Fluoresc 2021; 9. [PMID: 34399409 DOI: 10.1088/2050-6120/ac1dbb] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/16/2021] [Indexed: 01/22/2023]
Abstract
Fluorescence guided surgery (FGS) is an imaging technique that allows the surgeon to visualise different structures and types of tissue during a surgical procedure that may not be as visible under white light conditions. Due to the many potential advantages of fluorescence guided surgery compared to more traditional clinical imaging techniques such as its higher contrast and sensitivity, less subjective use, and ease of instrument operation, the research interest in fluorescence guided surgery continues to grow over various key aspects such as fluorescent probe development and surgical system development as well as its potential clinical applications. This review looks to summarise some of the emerging opportunities and developments that have already been made in fluorescence guided surgery in recent years while highlighting its advantages as well as limitations that need to be overcome in order to utilise the full potential of fluorescence within the surgical environment.
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Affiliation(s)
- Hazel L Stewart
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh BioQuarter, 47 Little France Crescent, Edinburgh, EH16 4TJ, United Kingdom
| | - David J S Birch
- Department of Physics, The Photophysics Research Group, University of Strathclyde, SUPA, John Anderson Building, 107 Rottenrow East, Glasgow G4 0NG, United Kingdom
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12
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Chen Y, Xiao Q, Zou W, Xia C, Yin H, Pu Y, Wang Y, Zhang K. Sentinel lymph node biopsy in oral cavity cancer using indocyanine green: A systematic review and meta-analysis. Clinics (Sao Paulo) 2021; 76:e2573. [PMID: 34287476 PMCID: PMC8266175 DOI: 10.6061/clinics/2021/e2573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 06/03/2021] [Indexed: 11/18/2022] Open
Abstract
This meta-analysis was conducted to evaluate the value of indocyanine green (ICG) in guiding sentinel lymph node biopsy (SLNB) for patients with oral cavity cancer. An electronic database search (PubMed, MEDLINE, Cochrane Library, Embase, and Web of Science) was performed from their inception to June 2020 to retrieve clinical studies of ICG applied to SLNB for oral cavity cancer. Data were extracted from 14 relevant articles (226 patients), and 9 studies (134 patients) were finally included in the meta-analysis according to the inclusion and exclusion criteria. The pooled sentinel lymph node (SLN) sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 88.0% (95% confidence interval [CI], 74.0-96.0), 64.0% (95% CI, 61.0-66.0), 2.45 (95% CI, 1.31-4.60), 0.40 (95% CI, 0.17-0.90), and 7.30 (95% CI, 1.74-30.68), respectively. The area under the summary receiver operating characteristic curve was 0.8805. In conclusion, ICG applied to SLNB can effectively predict the status of regional lymph nodes in oral cavity cancer.
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Affiliation(s)
- Yongfeng Chen
- Department of Stomatology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Qi Xiao
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Weina Zou
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Chengwan Xia
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Hongling Yin
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yumei Pu
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yuxin Wang
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
- Corresponding authors. E-mails: /
| | - Kai Zhang
- Department of Stomatology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
- Corresponding authors. E-mails: /
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13
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Mondal SB, Achilefu S. Virtual and Augmented Reality Technologies in Molecular and Anatomical Imaging. Mol Imaging 2021. [DOI: 10.1016/b978-0-12-816386-3.00066-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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14
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van Beurden F, van Willigen DM, Vojnovic B, van Oosterom MN, Brouwer OR, der Poel HGV, Kobayashi H, van Leeuwen FWB, Buckle T. Multi-Wavelength Fluorescence in Image-Guided Surgery, Clinical Feasibility and Future Perspectives. Mol Imaging 2020; 19:1536012120962333. [PMID: 33125289 PMCID: PMC7607779 DOI: 10.1177/1536012120962333] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
With the rise of fluorescence-guided surgery, it has become evident that different types of fluorescence signals can provide value in the surgical setting. Hereby a different range of targets have been pursued in a great variety of surgical indications. One of the future challenges lies in combining complementary fluorescent readouts during one and the same surgical procedure, so-called multi-wavelength fluorescence guidance. In this review we summarize the current clinical state-of-the-art in multi-wavelength fluorescence guidance, basic technical concepts, possible future extensions of existing clinical indications and impact that the technology can bring to clinical care.
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Affiliation(s)
- Florian van Beurden
- Interventional Molecular Imaging Laboratory, Department of Radiology, 4501Leiden University Medical Center, Leiden, The Netherlands.,Department of Urology, 1228The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Danny M van Willigen
- Interventional Molecular Imaging Laboratory, Department of Radiology, 4501Leiden University Medical Center, Leiden, The Netherlands
| | - Borivoj Vojnovic
- Department of Oncology, Cancer Research UK/MRC Oxford Institute for Radiation Oncology, 6396University of Oxford, Oxford, United Kingdom
| | - Matthias N van Oosterom
- Interventional Molecular Imaging Laboratory, Department of Radiology, 4501Leiden University Medical Center, Leiden, The Netherlands.,Department of Urology, 1228The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Oscar R Brouwer
- Interventional Molecular Imaging Laboratory, Department of Radiology, 4501Leiden University Medical Center, Leiden, The Netherlands.,Department of Urology, 1228The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Henk G van der Poel
- Department of Urology, 1228The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Hisataka Kobayashi
- Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, 2511National Institutes of Health, Bethesda, MD, USA
| | - Fijs W B van Leeuwen
- Interventional Molecular Imaging Laboratory, Department of Radiology, 4501Leiden University Medical Center, Leiden, The Netherlands.,Department of Urology, 1228The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.,Orsi Academy, Melle, Belgium
| | - Tessa Buckle
- Interventional Molecular Imaging Laboratory, Department of Radiology, 4501Leiden University Medical Center, Leiden, The Netherlands.,Department of Urology, 1228The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
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15
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van Oosterom MN, Meershoek P, Welling MM, Pinto F, Matthies P, Simon H, Wendler T, Navab N, van de Velde CJH, van der Poel HG, van Leeuwen FWB. Extending the Hybrid Surgical Guidance Concept With Freehand Fluorescence Tomography. IEEE TRANSACTIONS ON MEDICAL IMAGING 2020; 39:226-235. [PMID: 31247546 DOI: 10.1109/tmi.2019.2924254] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Within image-guided surgery, 'hybrid' guidance technologies have been used to integrate the complementary features of radioactive guidance and fluorescence guidance. Here, we explore how the generation of a novel freehand fluorescence (fhFluo) imaging approach complements freehand SPECT (fhSPECT) in a hybrid setup. Near-infrared optical tracking was used to register the position and the orientation of a hybrid opto-nuclear detection probe while recording its readings. Dedicated look-up table models were used for 3D reconstruction. In phantom and excised tissue settings (i.e., flat-surface human skin explants), fhSPECT and fhFluo were investigated for image resolution and in-tissue signal penetration. Finally, the combined potential of these freehand technologies was evaluated on prostate and lymph node specimens of prostate cancer patients receiving prostatectomy and sentinel lymph node dissection (tracers: indocyanine green (ICG) +99m Tc-nanocolloid or ICG-99mTc-nanocolloid). After hardware and software integration, the hybrid setup created 3D nuclear and fluorescence tomography scans. The imaging resolution of fhFluo (1 mm) was superior to that of fhSPECT (6 mm). Fluorescence modalities were confined to a maximum depth of 0.5 cm, while nuclear modalities were usable at all evaluated depths (<2 cm). Both fhSPECT and fhFluo enabled augmented- and virtual-reality navigation toward segmented image hotspots, including relative hotspot quantification with an accuracy of 3.9% and 4.1%. Imaging in surgical specimens confirmed these trends (fhSPECT: in-depth detectability, low resolution, and fhFluo: superior resolution, superficial detectability). Overall, when radioactive and fluorescent tracer signatures are used, fhFluo has complementary value to fhSPECT. Combined the freehand technologies render a unique hybrid imaging and navigation modality.
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16
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Hart ZP, Nishio N, Krishnan G, Lu G, Zhou Q, Fakurnejad S, Wormald PJ, van den Berg NS, Rosenthal EL, Baik FM. Endoscopic Fluorescence-Guided Surgery for Sinonasal Cancer Using an Antibody-Dye Conjugate. Laryngoscope 2019; 130:2811-2817. [PMID: 31854462 PMCID: PMC7754277 DOI: 10.1002/lary.28483] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 12/08/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Endoscopic resection of sinonasal squamous cell carcinoma has become the standard of care, but challenges remain in obtaining clear resection margins. The current study evaluated the feasibility of endoscopic fluorescence-guided surgery (FGS) to improve surgical resection in a human sinus surgical model. METHODS A fluorescence endoscope optimized for near-infrared (NIR) fluorescence detection was evaluated in a phantom study. Various endoscope diameters (4 and 10 mm) and viewing angles (0, 30, and 45 degrees) were evaluated to determine the sensitivity of the system for IRDye800CW detection at various working distances (1-5 cm). Endoscopic FGS was then validated in a three-dimensional human sinus surgical model to which squamous cell tumors derived from mice were inserted. Mice had received intravenous panitumumab-IRDye800CW and upon fluorescence-guided tumor resection, mean fluorescence intensity (MFI) and tumor-to-background ratio (TBR) were calculated in in situ and ex vivo settings. RESULTS A significantly higher fluorescence intensity was found when using the 10-mm diameter endoscope compared to the 4mm diameter endoscope (P < .001). No significant difference in MFI was found among the viewing angles of the 4-mm diameter endoscope. Using the human sinus model, the highest MFI and TBR were obtained at a 1-cm working distance compared to longer working distances. CONCLUSION We demonstrate that clinically acceptable TBRs were obtained with several working distances to discriminate tumor tissue from adjacent normal tissue in a human sinus model, and that endoscopic FGS may have great potential in identifying residual tumor tissue regions during surgery. Laryngoscope, 2019.
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Affiliation(s)
- Zachary P Hart
- Department of Otolaryngology, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Naoki Nishio
- Department of Otolaryngology, Stanford University School of Medicine, Stanford, California, U.S.A.,Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Giri Krishnan
- Department of Otolaryngology, Stanford University School of Medicine, Stanford, California, U.S.A.,Department of Surgery-Otorhinolaryngology, Head and Neck Surgery, University of Adelaide, Adelaide, Australia
| | - Guolan Lu
- Department of Otolaryngology, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Quan Zhou
- Department of Otolaryngology, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Shayan Fakurnejad
- Department of Otolaryngology, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Peter John Wormald
- Department of Surgery-Otorhinolaryngology, Head and Neck Surgery, University of Adelaide, Adelaide, Australia
| | - Nynke S van den Berg
- Department of Otolaryngology, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Eben L Rosenthal
- Department of Otolaryngology, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Fred M Baik
- Department of Otolaryngology, Stanford University School of Medicine, Stanford, California, U.S.A
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17
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Meershoek P, Buckle T, van Oosterom MN, KleinJan GH, van der Poel HG, van Leeuwen FW. Can Intraoperative Fluorescence Imaging Identify All Lesions While the Road Map Created by Preoperative Nuclear Imaging Is Masked? J Nucl Med 2019; 61:834-841. [DOI: 10.2967/jnumed.119.235234] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 10/07/2019] [Indexed: 01/12/2023] Open
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18
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Mela C, Liu Y. Comprehensive characterization method for a fluorescence imaging system. APPLIED OPTICS 2019; 58:8237-8246. [PMID: 31674496 DOI: 10.1364/ao.58.008237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 09/05/2019] [Indexed: 06/10/2023]
Abstract
Fluorescence imaging systems are regularly characterized by their ability to distinguish varying concentrations of fluorophores in a solution or tissue phantom. However, there is inadequate standardization in the field for fluorescence characterization. In this study, we characterize a fluorescence imaging system developed for pathogen detection, regarding its ability to detect a near-infrared dye. During this process, we vary a number of key factors involved in fluorescence imaging, such as the excitation intensity, background level, working distance, volume of fluorescent solution, and type of container used to hold the fluorescent solution. We then analyze the results, with statistical rigor, to determine which factors result in significant changes in fluorescence detection. Notably, we found that using different types of containers to hold the dye solution can have a significant impact on fluorescence detection, while the effects of working distance and excitation intensity can vary. Based on our findings, greater standardization, or at least more thorough reporting of the experimental setup, is recommended to researchers when publishing characterization results of new imaging systems.
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19
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Colombé C, Le Guével X, Martin-Serrano A, Henry M, Porret E, Comby-Zerbino C, Antoine R, Atallah I, Busser B, Coll JL, Righini CA, Sancey L. Gold nanoclusters as a contrast agent for image-guided surgery of head and neck tumors. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2019; 20:102011. [PMID: 31103735 DOI: 10.1016/j.nano.2019.04.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 04/23/2019] [Accepted: 04/27/2019] [Indexed: 12/19/2022]
Abstract
With the objective to evaluate the potential of ultra-small gold (Au) nanoclusters (NCs) for optical image-guided surgery, we synthesized and characterized AuNCs shelled by zwitterionic or pegylated ligands. The toxicity of the different AuNCs was evaluated on the Head and Neck Squamous Cell Carcinoma (HNSCC) CAL-33 and SQ20B cell lines in vitro. The safer AuNCs were administrated intravenously to mice for the determination of the pharmacokinetic properties. Biodistributions were performed on orthotopic CAL-33 HNSCC-bearing mice. Finally, the AuNCs were used for image-guided surgery, allowing the increase of the survival time vs. control animals, and the number of animals without any local recurrence.
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Affiliation(s)
- Cindy Colombé
- Cancer Targets & Experimental Therapeutics, Institute for Advanced Biosciences (IAB), University of Grenoble Alpes- INSERM U1209 - CNRS UMR 5309, Grenoble, France; Grenoble Alpes University Hospital, Grenoble, France
| | - Xavier Le Guével
- Cancer Targets & Experimental Therapeutics, Institute for Advanced Biosciences (IAB), University of Grenoble Alpes- INSERM U1209 - CNRS UMR 5309, Grenoble, France
| | - Angela Martin-Serrano
- Research Laboratory and Allergy Service, IBIMA, Regional University Malaga Hospital, UMA, 29009 Malaga, Spain and Andalusian Center for Nanomedicine and Biotechnology - BIONAND, Málaga, Spain
| | - Maxime Henry
- Cancer Targets & Experimental Therapeutics, Institute for Advanced Biosciences (IAB), University of Grenoble Alpes- INSERM U1209 - CNRS UMR 5309, Grenoble, France
| | - Estelle Porret
- Cancer Targets & Experimental Therapeutics, Institute for Advanced Biosciences (IAB), University of Grenoble Alpes- INSERM U1209 - CNRS UMR 5309, Grenoble, France
| | - Clothilde Comby-Zerbino
- Institut lumière matière, UMR5306, Université Claude Bernard Lyon1-CNRS, Université de Lyon, Villeurbanne cedex, France
| | - Rodolphe Antoine
- Institut lumière matière, UMR5306, Université Claude Bernard Lyon1-CNRS, Université de Lyon, Villeurbanne cedex, France
| | - Ihab Atallah
- Grenoble Alpes University Hospital, Grenoble, France
| | - Benoit Busser
- Cancer Targets & Experimental Therapeutics, Institute for Advanced Biosciences (IAB), University of Grenoble Alpes- INSERM U1209 - CNRS UMR 5309, Grenoble, France; Grenoble Alpes University Hospital, Grenoble, France
| | - Jean-Luc Coll
- Cancer Targets & Experimental Therapeutics, Institute for Advanced Biosciences (IAB), University of Grenoble Alpes- INSERM U1209 - CNRS UMR 5309, Grenoble, France
| | - Christian Adrien Righini
- Cancer Targets & Experimental Therapeutics, Institute for Advanced Biosciences (IAB), University of Grenoble Alpes- INSERM U1209 - CNRS UMR 5309, Grenoble, France; Grenoble Alpes University Hospital, Grenoble, France
| | - Lucie Sancey
- Cancer Targets & Experimental Therapeutics, Institute for Advanced Biosciences (IAB), University of Grenoble Alpes- INSERM U1209 - CNRS UMR 5309, Grenoble, France.
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Abstract
Lymphatic surgery has become an integral and flourishing component of the field of plastic surgery. The diversity of ongoing technological innovations in perioperative imaging, including intraoperative dyes and cameras, allows plastic surgeons to work at the supermicrosurgical level. This study aims to highlight innovations that have shaped and will continue to revolutionize the perioperative management of the lymphatic surgery patient in the future. As additional advances emerge, we need a systematic and objective way to evaluate the efficacy and clinical integration readiness of such technologies. Undoubtedly, these technologies will help lymphatic surgery trend toward increasing objectivity, which will be critical for continued evolution and advancement.
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21
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Autofluorescence lifetime augmented reality as a means for real-time robotic surgery guidance in human patients. Sci Rep 2019; 9:1187. [PMID: 30718542 PMCID: PMC6362025 DOI: 10.1038/s41598-018-37237-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 11/27/2018] [Indexed: 01/15/2023] Open
Abstract
Due to loss of tactile feedback the assessment of tumor margins during robotic surgery is based only on visual inspection, which is neither significantly sensitive nor specific. Here we demonstrate time-resolved fluorescence spectroscopy (TRFS) as a novel technique to complement the visual inspection of oral cancers during transoral robotic surgery (TORS) in real-time and without the need for exogenous contrast agents. TRFS enables identification of cancerous tissue by its distinct autofluorescence signature that is associated with the alteration of tissue structure and biochemical profile. A prototype TRFS instrument was integrated synergistically with the da Vinci Surgical robot and the combined system was validated in swine and human patients. Label-free and real-time assessment and visualization of tissue biochemical features during robotic surgery procedure, as demonstrated here, not only has the potential to improve the intraoperative decision making during TORS but also other robotic procedures without modification of conventional clinical protocols.
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22
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van Leeuwen FWB, Winter A, van Der Poel HG, Eiber M, Suardi N, Graefen M, Wawroschek F, Maurer T. Technologies for image-guided surgery for managing lymphatic metastases in prostate cancer. Nat Rev Urol 2019; 16:159-171. [DOI: 10.1038/s41585-018-0140-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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23
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Giammarile F, Schilling C, Gnanasegaran G, Bal C, Oyen WJG, Rubello D, Schwarz T, Tartaglione G, Miller RN, Paez D, van Leeuwen FWB, Valdés Olmos RA, McGurk M, Delgado Bolton RC. The EANM practical guidelines for sentinel lymph node localisation in oral cavity squamous cell carcinoma. Eur J Nucl Med Mol Imaging 2018; 46:623-637. [PMID: 30564849 PMCID: PMC6351508 DOI: 10.1007/s00259-018-4235-5] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 12/03/2018] [Indexed: 01/09/2023]
Abstract
Purpose Sentinel lymph node biopsy is an essential staging tool in patients with clinically localized oral cavity squamous cell carcinoma. The harvesting of a sentinel lymph node entails a sequence of procedures with participation of specialists in nuclear medicine, radiology, surgery, and pathology. The aim of this document is to provide guidelines for nuclear medicine physicians performing lymphoscintigraphy for sentinel lymph node detection in patients with early N0 oral cavity squamous cell carcinoma. Methods These practice guidelines were written and have been approved by the European Association of Nuclear Medicine (EANM) and the International Atomic Energy Agency (IAEA) to promote high-quality lymphoscintigraphy. The final result has been discussed by distinguished experts from the EANM Oncology Committee, and national nuclear medicine societies. The document has been endorsed by the Society of Nuclear Medicine and Molecular Imaging (SNMMI). These guidelines, together with another two focused on Surgery and Pathology (and published in specialised journals), are part of the synergistic efforts developed in preparation for the “2018 Sentinel Node Biopsy in Head and Neck Consensus Conference”. Conclusion The present practice guidelines will help nuclear medicine practitioners play their essential role in providing high-quality lymphatic mapping for the care of early N0 oral cavity squamous cell carcinoma patients.
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Affiliation(s)
- Francesco Giammarile
- Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, International Atomic Energy Agency, PO Box 100, 1400, Vienna, Austria.
| | - Clare Schilling
- Department of Head and Neck Surgery, University College Hospital, 235 Euston Road, London, NW1, UK
| | - Gopinanth Gnanasegaran
- Department of Nuclear Medicine, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK
| | - Chandrasckhar Bal
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Wim J G Oyen
- Department of Nuclear Medicine, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - Domenico Rubello
- Department of Nuclear Medicine, Radiology, and Clinical Pathology, Rovigo Hospital, Rovigo, Italy
| | - Thomas Schwarz
- Division of Radiology, Department of Nuclear Medicine, Medical University Graz, Graz, Austria
| | | | - Rodolfo Nuñez Miller
- Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, International Atomic Energy Agency, PO Box 100, 1400, Vienna, Austria
| | - Diana Paez
- Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, International Atomic Energy Agency, PO Box 100, 1400, Vienna, Austria
| | - Fijis W B van Leeuwen
- Interventional Molecular Imaging Laboratory and Nuclear Medicine Section, Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Renato A Valdés Olmos
- Interventional Molecular Imaging Laboratory and Nuclear Medicine Section, Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Mark McGurk
- Department of Head and Neck Surgery, University College Hospital, 235 Euston Road, London, NW1, UK
| | - Roberto C Delgado Bolton
- University Hospital San Pedro and Centre for Biomedical Research of La Rioja (CIBIR), Logroño, La Rioja, Spain
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Perissinotti A, Rietbergen DDD, Vidal-Sicart S, Riera AA, Olmos RA. Melanoma & nuclear medicine: new insights & advances. Melanoma Manag 2018; 5:MMT06. [PMID: 30190932 PMCID: PMC6122522 DOI: 10.2217/mmt-2017-0022] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 03/29/2018] [Indexed: 12/16/2022] Open
Abstract
The contribution of nuclear medicine to management of melanoma patients is increasing. In intermediate-thickness N0 melanomas, lymphoscintigraphy provides a roadmap for sentinel node biopsy. With the introduction of single-photon emission computed tomography images with integrated computed tomography (SPECT/CT), 3D anatomic environments for accurate surgical planning are now possible. Sentinel node identification in intricate anatomical areas (pelvic cavity, head/neck) has been improved using hybrid radioactive/fluorescent tracers, preoperative lymphoscintigraphy and SPECT/CT together with modern intraoperative portable imaging technologies for surgical navigation (free-hand SPECT, portable gamma cameras). Furthermore, PET/CT today provides 3D roadmaps to resect 18F-fluorodeoxyglucose-avid melanoma lesions. Simultaneously, in advanced-stage melanoma and recurrences, 18F-fluorodeoxyglucose-PET/CT is useful in clinical staging and treatment decision as well as in the evaluation of therapy response. In this article, we review new insights and recent nuclear medicine advances in the management of melanoma patients.
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Affiliation(s)
- Andrés Perissinotti
- Department of Nuclear Medicine, Hospital Clinic, C/Villarroel 170, 08036 Barcelona, Spain
| | - Daphne DD Rietbergen
- Nuclear Medicine Section & Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Centre, Albinusdreef 2, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Sergi Vidal-Sicart
- Department of Nuclear Medicine, Hospital Clinic, C/Villarroel 170, 08036 Barcelona, Spain
| | - Ana A Riera
- Department of Nuclear Medicine, Hospital Universitario Nuestra Señora de la Candelaria, Carretera del Rosario 145, 08010 SC de Tenerife, Spain
| | - Renato A Valdés Olmos
- Nuclear Medicine Section & Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Centre, Albinusdreef 2, PO Box 9600, 2300 RC, Leiden, The Netherlands
- Department of Nuclear Medicine, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
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25
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KleinJan GH, van Werkhoven E, van den Berg NS, Karakullukcu MB, Zijlmans HJMAA, van der Hage JA, van de Wiel BA, Buckle T, Klop WMC, Horenblas S, Valdés Olmos RA, van der Poel HG, van Leeuwen FWB. The best of both worlds: a hybrid approach for optimal pre- and intraoperative identification of sentinel lymph nodes. Eur J Nucl Med Mol Imaging 2018; 45:1915-1925. [PMID: 29696442 PMCID: PMC6132545 DOI: 10.1007/s00259-018-4028-x] [Citation(s) in RCA: 104] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 04/16/2018] [Indexed: 02/05/2023]
Abstract
Purpose Hybrid image-guided surgery technologies such as combined radio- and fluorescence-guidance are increasingly gaining interest, but their added value still needs to be proven. In order to evaluate if and how fluorescence-guidance can help realize improvements beyond the current state-of-the-art in sentinel node (SN) biopsy procedures, use of the hybrid tracer indocyanine green (ICG)-99mTc-nancolloid was evaluated in a large cohort of patients. Patients and methods A prospective trial was conducted (n = 501 procedures) in a heterogeneous cohort of 495 patients with different malignancies (skin malignancies, oral cavity cancer, penile cancer, prostate cancer and vulva cancer). After injection of ICG-99mTc-nanocolloid, SNs were preoperatively identified based on lymphoscintigraphy and SPECT/CT. Intraoperatively, SNs were pursued via gamma tracing, visual identification (blue dye) and/or near-infrared fluorescence imaging during either open surgical procedures (head and neck, penile, vulvar cancer and melanoma) or robot assisted laparoscopic surgery (prostate cancer). As the patients acted as their own control, use of hybrid guidance could be compared to conventional radioguidance and the use of blue dye (n = 300). This was based on reported surgical complications, overall survival, LN recurrence free survival, and false negative rates (FNR). Results A total of 1,327 SN-related hotspots were identified on 501 preoperative SPECT/CT scans. Intraoperatively, a total number of 1,643 SNs were identified based on the combination of gamma-tracing (>98%) and fluorescence-guidance (>95%). In patients wherein blue dye was used (n = 300) fluorescence-based SN detection was superior over visual blue dye-based detection (22–78%). No adverse effects related to the use of the hybrid tracer or the fluorescence-guidance procedure were found and outcome values were not negatively influenced. Conclusion With ICG-99mTc-nanocolloid, the SN biopsy procedure has become more accurate and independent of the use of blue dye. With that, the procedure has evolved to be universal for different malignancies and anatomical locations. Electronic supplementary material The online version of this article (10.1007/s00259-018-4028-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- G H KleinJan
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Albinusdreef 2 (C2-S zone), PO BOX 9600, 2300 RC, Leiden, The Netherlands
- Department of Nuclear Medicine, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
- Department of Urology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - E van Werkhoven
- Department of Biostatistics, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - N S van den Berg
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Albinusdreef 2 (C2-S zone), PO BOX 9600, 2300 RC, Leiden, The Netherlands
- Department of Urology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
- Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - M B Karakullukcu
- Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - H J M A A Zijlmans
- Department of Gynecology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - J A van der Hage
- Department of Surgery, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - B A van de Wiel
- Department of Pathology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - T Buckle
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Albinusdreef 2 (C2-S zone), PO BOX 9600, 2300 RC, Leiden, The Netherlands
| | - W M C Klop
- Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - S Horenblas
- Department of Urology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - R A Valdés Olmos
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Albinusdreef 2 (C2-S zone), PO BOX 9600, 2300 RC, Leiden, The Netherlands
- Department of Nuclear Medicine, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - H G van der Poel
- Department of Urology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - F W B van Leeuwen
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Albinusdreef 2 (C2-S zone), PO BOX 9600, 2300 RC, Leiden, The Netherlands.
- Department of Urology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
- Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
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Geppert B, Lönnerfors C, Bollino M, Persson J. Sentinel lymph node biopsy in endometrial cancer-Feasibility, safety and lymphatic complications. Gynecol Oncol 2017; 148:491-498. [PMID: 29273307 DOI: 10.1016/j.ygyno.2017.12.017] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 12/01/2017] [Accepted: 12/12/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare the rate of lymphatic complications in women with endometrial cancer undergoing sentinel lymph node biopsy versus a full pelvic and infrarenal paraaortic lymphadenectomy, and to examine the overall feasibility and safety of the former. METHODS A prospective study of 188 patients with endometrial cancer planned for robotic surgery. Indocyanine green was used to identify the sentinel lymph nodes. In low-risk patients the lymphadenectomy was restricted to removal of sentinel lymph nodes whereas in high-risk patients also a full lymphadenectomy was performed. The impact of the extent of the lymphadenectomy on the rate of complications was evaluated. RESULTS The bilateral detection rate of sentinel lymph nodes was 96% after cervical tracer injection. No intraoperative complication was associated with the sentinel lymph node biopsy per se. Compared with hysterectomy alone, the additional average operative time for removal of sentinel lymph nodes was 33min whereas 91min were saved compared with a full pelvic and paraaortic lymphadenectomy. Sentinel lymph node biopsy alone resulted in a lower incidence of leg lymphedema than infrarenal paraaortic and pelvic lymphadenectomy (1.3% vs 18.1%, p=0.0003). CONCLUSION The high feasibility, the absence of intraoperative complications and the low risk of lymphatic complications supports implementing detection of sentinel lymph nodes in low-risk endometrial cancer patients. Given that available preliminary data on sensitivity and false negative rates in high-risk patients are confirmed in further studies, we also believe that the reduction in lymphatic complications and operative time strongly motivates the sentinel lymph node concept in high-risk endometrial cancer.
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Affiliation(s)
- Barbara Geppert
- Department of Obstetrics and Gynecology, Skane University Hospital, Lund University, Lund, Sweden
| | - Céline Lönnerfors
- Department of Obstetrics and Gynecology, Skane University Hospital, Lund University, Lund, Sweden
| | - Michele Bollino
- Department of Obstetrics and Gynecology, Skane University Hospital, Lund University, Lund, Sweden
| | - Jan Persson
- Department of Obstetrics and Gynecology, Skane University Hospital, Lund University, Lund, Sweden.
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KleinJan GH, Karakullukçu B, Klop WMC, Engelen T, van den Berg NS, van Leeuwen FWB. Introducing navigation during melanoma-related sentinel lymph node procedures in the head-and-neck region. EJNMMI Res 2017; 7:65. [PMID: 28819936 PMCID: PMC5560283 DOI: 10.1186/s13550-017-0312-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Accepted: 07/25/2017] [Indexed: 11/10/2022] Open
Abstract
Background Intraoperative sentinel node (SN) identification in patients with head-and-neck malignancies can be challenging due to unexpected drainage patterns and anatomical complexity. Here, intraoperative navigation-based guidance technologies may provide outcome. In this study, gamma camera-based freehandSPECT was evaluated in combination with the hybrid tracer ICG-99mTc-nanocolloid. Materials and methods Eight patients with melanoma located in the head-and-neck area were included. Indocyanine green (ICG)-99mTc-nanocolloid was injected preoperatively, whereafter lymphoscintigraphy and SPECT/CT imaging were performed in order to define the location of the SN(s). FreehandSPECT scans were generated in the operation room using a portable gamma camera. For lesion localization during surgery, freehandSPECT scans were projected in an augmented reality video-view that was used to spatially position a gamma-ray detection probe. Intraoperative fluorescence imaging was used to confirm the accuracy of the navigation-based approach and identify the exact location of the SNs. Results Preoperatively, 15 SNs were identified, of which 14 were identified using freehandSPECT. Navigation towards these nodes using the freehandSPECT approach was successful in 13 nodes. Fluorescence imaging provided optical confirmation of the navigation accuracy in all patients. In addition, fluorescence imaging allowed for the identification of (clustered) SNs that could not be identified based on navigation alone. Conclusions The use of gamma camera-based freehandSPECT aids intraoperative lesion identification and, with that, supports the transition from pre- to intraoperative imaging via augmented reality display and directional guidance.
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Affiliation(s)
- Gijs H KleinJan
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Hospital, Albinusdreef 2, C2-S zone, 9600, 2300 RC, Leiden, the Netherlands.,Department of Nuclear Medicine, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands
| | - Baris Karakullukçu
- Department of Head and Neck Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands
| | - W Martin C Klop
- Department of Head and Neck Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands
| | - Thijs Engelen
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Hospital, Albinusdreef 2, C2-S zone, 9600, 2300 RC, Leiden, the Netherlands
| | - Nynke S van den Berg
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Hospital, Albinusdreef 2, C2-S zone, 9600, 2300 RC, Leiden, the Netherlands.,Department of Head and Neck Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands
| | - Fijs W B van Leeuwen
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Hospital, Albinusdreef 2, C2-S zone, 9600, 2300 RC, Leiden, the Netherlands. .,Department of Head and Neck Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands.
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Bugby SL, Lees JE, Perkins AC. Hybrid intraoperative imaging techniques in radioguided surgery: present clinical applications and future outlook. Clin Transl Imaging 2017; 5:323-341. [PMID: 28804703 PMCID: PMC5532406 DOI: 10.1007/s40336-017-0235-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 06/10/2017] [Indexed: 12/26/2022]
Abstract
PURPOSE This review aims to summarise the hybrid modality radioguidance techniques currently in clinical use and development, and to discuss possible future avenues of research. Due to the novelty of these approaches, evidence of their clinical relevance does not yet exist. The purpose of this review is to inform nuclear medicine practitioners of current cutting edge research in radioguided surgery which may enter standard clinical practice within the next 5-10 years. Hybrid imaging is of growing importance to nuclear medicine diagnostics, but it is only with recent advances in technology that hybrid modalities are being investigated for use during radioguided surgery. These modalities aim to overcome some of the difficulties of surgical imaging while maintaining many benefits, or providing entirely new information unavailable to surgeons with traditional radioguidance. METHODS A literature review was carried out using online reference databases (Scopus, PubMed). Review articles obtained using this technique were citation mined to obtain further references. RESULTS In total, 2367 papers were returned, with 425 suitable for further assessment. 60 papers directly related to hybrid intraoperative imaging in radioguided surgery are reported on. Of these papers, 25 described the clinical use of hybrid imaging, 22 described the development of new hybrid probes and tracers, and 13 described the development of hybrid technologies for future clinical use. Hybrid gamma-NIR fluorescence was found to be the most common clinical technique, with 35 papers associated with these modalities. Other hybrid combinations include gamma-bright field imaging, gamma-ultrasound imaging, gamma-β imaging and β-OCT imaging. The combination of preoperative and intraoperative images is also discussed. CONCLUSION Hybrid imaging offers new possibilities for assisting clinicians and surgeons in localising the site of uptake in procedures such as in sentinel node detection.
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Affiliation(s)
- S L Bugby
- Space Research Centre, Michael Atiyah Building, University of Leicester, Leicester, LE1 7RH UK
| | - J E Lees
- Space Research Centre, Michael Atiyah Building, University of Leicester, Leicester, LE1 7RH UK
| | - A C Perkins
- Radiological Sciences, Division of Clinical Neuroscience, School of Medical, University of Nottingham, Nottingham, NG7 2UH UK.,Medical Physics and Clinical Engineering, Nottingham University Hospitals NHS Trust, Nottingham, NH7 2UH UK
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Guerrero Y, Singh SP, Mai T, Murali RK, Tanikella L, Zahedi A, Kundra V, Anvari B. Optical Characteristics and Tumor Imaging Capabilities of Near Infrared Dyes in Free and Nano-Encapsulated Formulations Comprised of Viral Capsids. ACS APPLIED MATERIALS & INTERFACES 2017; 9:19601-19611. [PMID: 28524652 DOI: 10.1021/acsami.7b03373] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Near infrared (NIR) fluorescent molecules and nanosized structures can serve as potential optical probes for image-guided removal of small tumor nodules (≲ 1 mm diameter). Although indocyanine green (ICG) remains as the only FDA-approved NIR dye, other organic dyes are under extensive development for enhanced imaging capabilities. One such dye is BrCy106-NHS where bromine is substituted for aromatic structures in cyanine dyes. Herein, we investigate the absorption and fluorescence characteristics of ICG and BrCy106-NHS, and quantitatively assess their tumor imaging capabilities in free (non-encapsulated) and a nano-encapsulated form that utilizes the capsid protein (CP) from genome-depleted plant-infecting brome mosaic virus as the encapsulating shell. We refer to these nanoconstructs as optical viral ghosts (OVGs). For example, when fabricated at CP to dye concentration ratio of 200, value of the spectrally integrated fluorescence emission for BrCy106-NHS-doped OVGs is ∼60 times higher than that of ICG-doped OVGs. Our analysis of homogenized mice intraperitoneal tumors indicate that the averaged total fluorescence emission associated with the use of BrCy106-NHS-doped can be at least about 44 times greater than that of ICG-doped OVGs. Our results suggest that OVGs containing BrCy106-NHS may potentially serve as effective optical probes for tumor imaging.
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Affiliation(s)
- Yadir Guerrero
- Department of Bioengineering, University of California , Riverside, California 92521, United States
| | | | - Turong Mai
- Department of Bioengineering, University of California , Riverside, California 92521, United States
| | | | - Leela Tanikella
- Department of Bioengineering, University of California , Riverside, California 92521, United States
| | - Atta Zahedi
- Department of Bioengineering, University of California , Riverside, California 92521, United States
| | | | - Bahman Anvari
- Department of Bioengineering, University of California , Riverside, California 92521, United States
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30
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Arigami T, Uenosono Y, Yanagita S, Okubo K, Kijima T, Matsushita D, Amatatsu M, Hagihara T, Haraguchi N, Mataki Y, Ehi K, Ishigami S, Natsugoe S. Clinical application and outcomes of sentinel node navigation surgery in patients with early gastric cancer. Oncotarget 2017; 8:75607-75616. [PMID: 29088895 PMCID: PMC5650450 DOI: 10.18632/oncotarget.17584] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Accepted: 04/11/2017] [Indexed: 12/23/2022] Open
Abstract
Sentinel node navigation surgery (SNNS) has been recognized as a minimally invasive tool for individualized lymphadenectomy in patients with early gastric cancer (EGC). The aim of this study was to compare clinicopathological factors, adverse events, and clinical outcomes between sentinel node mapping (SNM) and SN dissection (SND) groups and assess the clinical utility of SNNS in patients with EGC. The clinical data of 157 patients with EGC, diagnosed as clinical T1N0M0 with tumors ≤ 40 mm, undergoing SNNS between March 2004 and April 2016 were retrospectively reviewed. Twenty-seven patients were excluded from the analysis. In the remaining 130 patients, 59 and 71 patients underwent standard lymphadenectomy for SNM and SND, respectively. The sentinel node detection rate in the SNM and SND groups was 98.3% (58/59) and 100% (71/71), respectively. Two (3.5%), 15 (25.9%), and 41 (70.7%) patients having sentinel nodes underwent total gastrectomy, proximal gastrectomy (PG), and distal gastrectomy (DG), respectively, in the SNM group. One (1.4%), 5 (7.0%), 10 (14.1%), 39 (54.9%), and 16 (22.5%) patients underwent PG, DG, segmental gastrectomy, local resection, and endoscopic submucosal dissection, respectively, in the SND group. There was no significant difference in postoperative complications between the SNM and SND groups (P = 0.781). Survival did not differ between the both groups (P = 0.856). The present results suggest that personalized surgery with SND provides technical safety and curability related with a favorable survival outcome in patients with EGC.
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Affiliation(s)
- Takaaki Arigami
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.,Molecular Frontier Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Yoshikazu Uenosono
- Molecular Frontier Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Shigehiro Yanagita
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Keishi Okubo
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Takashi Kijima
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Daisuke Matsushita
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Masahiko Amatatsu
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Takahiko Hagihara
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Naoto Haraguchi
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Yuko Mataki
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Katsuhiko Ehi
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Sumiya Ishigami
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Shoji Natsugoe
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.,Molecular Frontier Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
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Madu M, Wouters M, van Akkooi A. Sentinel node biopsy in melanoma: Current controversies addressed. Eur J Surg Oncol 2017; 43:517-533. [DOI: 10.1016/j.ejso.2016.08.007] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 08/11/2016] [Accepted: 08/12/2016] [Indexed: 12/17/2022] Open
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Mondal SB, Gao S, Zhu N, Habimana-Griffin L, Akers WJ, Liang R, Gruev V, Margenthaler J, Achilefu S. Optical See-Through Cancer Vision Goggles Enable Direct Patient Visualization and Real-Time Fluorescence-Guided Oncologic Surgery. Ann Surg Oncol 2017; 24:1897-1903. [PMID: 28213790 DOI: 10.1245/s10434-017-5804-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND The inability to visualize the patient and surgical site directly, limits the use of current near infrared fluorescence-guided surgery systems for real-time sentinel lymph node biopsy and tumor margin assessment. METHODS We evaluated an optical see-through goggle augmented imaging and navigation system (GAINS) for near-infrared, fluorescence-guided surgery. Tumor-bearing mice injected with a near infrared cancer-targeting agent underwent fluorescence-guided, tumor resection. Female Yorkshire pigs received hind leg intradermal indocyanine green injection and underwent fluorescence-guided, popliteal lymph node resection. Four breast cancer patients received 99mTc-sulfur colloid and indocyanine green retroareolarly before undergoing sentinel lymph node biopsy using radioactive tracking and fluorescence imaging. Three other breast cancer patients received indocyanine green retroareolarly before undergoing standard-of-care partial mastectomy, followed by fluorescence imaging of resected tumor and tumor cavity for margin assessment. RESULTS Using near-infrared fluorescence from the dyes, the optical see-through GAINS accurately identified all mouse tumors, pig lymphatics, and four pig popliteal lymph nodes with high signal-to-background ratio. In 4 human breast cancer patients, 11 sentinel lymph nodes were identified with a detection sensitivity of 86.67 ± 0.27% for radioactive tracking and 100% for GAINS. Tumor margin status was accurately predicted by GAINS in all three patients, including clear margins in patients 1 and 2 and positive margins in patient 3 as confirmed by paraffin-embedded section histopathology. CONCLUSIONS The optical see-through GAINS prototype enhances near infrared fluorescence-guided surgery for sentinel lymph node biopsy and tumor margin assessment in breast cancer patients without disrupting the surgical workflow in the operating room.
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Affiliation(s)
- Suman B Mondal
- Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA.,Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, USA
| | - Shengkui Gao
- Department of Computer Science and Engineering, Washington University in St. Louis, St. Louis, MO, USA
| | - Nan Zhu
- College of Optical Science, The University of Arizona, Tucson, AZ, USA
| | - LeMoyne Habimana-Griffin
- Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA.,Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, USA
| | - Walter J Akers
- Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Rongguang Liang
- College of Optical Science, The University of Arizona, Tucson, AZ, USA
| | - Viktor Gruev
- Department of Computer Science and Engineering, Washington University in St. Louis, St. Louis, MO, USA
| | - Julie Margenthaler
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Samuel Achilefu
- Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA. .,Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, USA. .,Department of Biochemistry and Molecular Biophysics, Washington University School of Medicine, St. Louis, MO, USA. .,Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA.
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Image-guided surgery: Transistor-like pH nanoprobes. Nat Biomed Eng 2017. [DOI: 10.1038/s41551-016-0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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KleinJan GH, Hellingman D, van den Berg NS, van Oosterom MN, Hendricksen K, Horenblas S, Valdes Olmos RA, van Leeuwen FWB. Hybrid Surgical Guidance: Does Hardware Integration of γ- and Fluorescence Imaging Modalities Make Sense? J Nucl Med 2016; 58:646-650. [DOI: 10.2967/jnumed.116.177154] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 09/08/2016] [Indexed: 12/31/2022] Open
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van Oosterom MN, Engelen MA, van den Berg NS, KleinJan GH, van der Poel HG, Wendler T, van de Velde CJH, Navab N, van Leeuwen FWB. Navigation of a robot-integrated fluorescence laparoscope in preoperative SPECT/CT and intraoperative freehand SPECT imaging data: a phantom study. JOURNAL OF BIOMEDICAL OPTICS 2016; 21:86008. [PMID: 27548770 DOI: 10.1117/1.jbo.21.8.086008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 07/25/2016] [Indexed: 06/06/2023]
Abstract
Robot-assisted laparoscopic surgery is becoming an established technique for prostatectomy and is increasingly being explored for other types of cancer. Linking intraoperative imaging techniques, such as fluorescence guidance, with the three-dimensional insights provided by preoperative imaging remains a challenge. Navigation technologies may provide a solution, especially when directly linked to both the robotic setup and the fluorescence laparoscope. We evaluated the feasibility of such a setup. Preoperative single-photon emission computed tomography/X-ray computed tomography (SPECT/CT) or intraoperative freehand SPECT (fhSPECT) scans were used to navigate an optically tracked robot-integrated fluorescence laparoscope via an augmented reality overlay in the laparoscopic video feed. The navigation accuracy was evaluated in soft tissue phantoms, followed by studies in a human-like torso phantom. Navigation accuracies found for SPECT/CT-based navigation were 2.25 mm (coronal) and 2.08 mm (sagittal). For fhSPECT-based navigation, these were 1.92 mm (coronal) and 2.83 mm (sagittal). All errors remained below the <1-cm detection limit for fluorescence imaging, allowing refinement of the navigation process using fluorescence findings. The phantom experiments performed suggest that SPECT-based navigation of the robot-integrated fluorescence laparoscope is feasible and may aid fluorescence-guided surgery procedures.
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Affiliation(s)
- Matthias Nathanaël van Oosterom
- Leiden University Medical Center, Department of Surgery, Albinusdreef 2, Leiden 2333 ZA, The NetherlandsbLeiden University Medical Center, Department of Radiology, Interventional Molecular Imaging Laboratory, Albinusdreef 2, Leiden 2333 ZA, The Netherlands
| | - Myrthe Adriana Engelen
- Leiden University Medical Center, Department of Radiology, Interventional Molecular Imaging Laboratory, Albinusdreef 2, Leiden 2333 ZA, The Netherlands
| | - Nynke Sjoerdtje van den Berg
- Leiden University Medical Center, Department of Radiology, Interventional Molecular Imaging Laboratory, Albinusdreef 2, Leiden 2333 ZA, The NetherlandscThe Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Department of Urology, Plesmanlaan 121, Amsterdam 1066 CX, The Netherlands
| | - Gijs Hendrik KleinJan
- Leiden University Medical Center, Department of Radiology, Interventional Molecular Imaging Laboratory, Albinusdreef 2, Leiden 2333 ZA, The NetherlandscThe Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Department of Urology, Plesmanlaan 121, Amsterdam 1066 CX, The Netherlands
| | - Henk Gerrit van der Poel
- The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Department of Urology, Plesmanlaan 121, Amsterdam 1066 CX, The Netherlands
| | - Thomas Wendler
- Technische Universität München, Computer Aided Medical Procedures, Institut für Informatik, I16, Boltzmannstr. 3, Garching bei München 85748, GermanyeSurgicEye GmbH, Friedenstraße 18A, München 81671, Germany
| | | | - Nassir Navab
- Technische Universität München, Computer Aided Medical Procedures, Institut für Informatik, I16, Boltzmannstr. 3, Garching bei München 85748, GermanyfJohns Hopkins University, Computer Aided Medical Procedures, 3400 North Charles Street, Hackerman 200, Baltimore, Maryland 21218, United States
| | - Fijs Willem Bernhard van Leeuwen
- Leiden University Medical Center, Department of Radiology, Interventional Molecular Imaging Laboratory, Albinusdreef 2, Leiden 2333 ZA, The NetherlandscThe Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Department of Urology, Plesmanlaan 121, Amsterdam 1066 CX, The Netherlands
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Hybrid tracers and devices for intraoperative imaging: the future for radioguided surgery? Clin Transl Imaging 2016. [DOI: 10.1007/s40336-016-0198-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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