Ultrasound-guided photoacoustic imaging for the selective detection of EGFR-expressing breast cancer and lymph node metastases

Photoacoustic Imaging with Attention-Guided Deep Learning for Predicting Axillary Lymph Node Status in Breast Cancer

RATIONALE AND OBJECTIVES

Preoperative assessment of axillary lymph node (ALN) status is essential for breast cancer management. This study explores the use of photoacoustic (PA) imaging combined with attention-guided deep learning (DL) for precise prediction of ALN status.

MATERIALS AND METHODS

This retrospective study included patients with histologically confirmed early-stage breast cancer from 2022 to 2024, randomly divided (8:2) into training and test cohorts. All patients underwent preoperative dual modal photoacoustic-ultrasound (PA-US) examination, were treated with surgery and sentinel lymph node biopsy or ALN dissection, and were pathologically examined to determine the ALN status. Attention-guided DL model was developed using PA-US images to predict ALN status. A clinical model, constructed via multivariate logistic regression, served as the baseline for comparison. Subsequently, a nomogram incorporating the DL model and independent clinical parameters was developed. The performance of the models was evaluated through discrimination, calibration, and clinical applicability.

RESULTS

A total of 324 patients (mean age ± standard deviation, 51.0 ± 10.9 years) were included in the study and were divided into a development cohort (n = 259 [79.9%]) and a test cohort (n = 65 [20.1%]). The clinical model incorporating three independent clinical parameters yielded an area under the curve (AUC) of 0.775 (95% confidence interval [CI], 0.711-0.829) in the training cohort and 0.783 (95% CI, 0.654-0.897) in the test cohort for predicting ALN status. In comparison, the nomogram showed superior predictive performance, with an AUC of 0.906 (95% CI, 0.867-0.940) in the training cohort and 0.868 (95% CI, 0.769-0.954) in the test cohort. Decision curve analysis further confirmed the nomogram's clinical applicability, demonstrating a better net benefit across relevant threshold probabilities.

CONCLUSION

This study highlights the effectiveness of attention-guided PA imaging in breast cancer patients, providing novel nomograms for individualized clinical decision-making in predicting ALN node status.

Ultrasound-guided photoacoustic image annotation toolkit in MATLAB (PHANTOM) for preclinical applications

Depth-dependent fluence-compensation in photoacoustic (PA) imaging is paramount for accurate quantification of chromophores from deep tissues. Here we present a user-friendly toolkit named PHANTOM (PHotoacoustic ANnotation TOolkit for MATLAB) that includes a graphical interface and assists in the segmentation of ultrasound-guided PA images. We modelled the light source configuration with Monte Carlo eXtreme and utilized 3D segmented tissues from ultrasound to generate fluence maps to depth compensate PA images. The methodology was used to analyze PA images of phantoms with varying blood oxygenation and results were validated with oxygen electrode measurements. Two preclinical models, a subcutaneous tumor and a calcified placenta, were imaged and fluence-compensated using the PHANTOM toolkit and the results were verified with immunohistochemistry. The PHANTOM toolkit provides scripts and auxiliary functions to enable biomedical researchers not specialized in optical imaging to apply fluence correction to PA images, enhancing accessibility of quantitative PAI for researchers in various fields.

Ultrasound-guided Photoacoustic image Annotation Toolkit in MATLAB (PHANTOM) for preclinical applications

Depth-dependent fluence-compensation in photoacoustic (PA) imaging is paramount for accurate quantification of chromophores from deep tissues. Here we present a user-friendly toolkit named PHANTOM (PHotoacoustic ANnotation TOolkit for MATLAB) that includes a graphical interface and assists in the segmentation of ultrasound-guided PA images. We modelled the light source configuration with Monte Carlo eXtreme and utilized 3D segmented tissues from ultrasound to generate fluence maps to depth compensate PA images. The methodology was used to analyze PA images of phantoms with varying blood oxygenation and results were validated with oxygen electrode measurements. Two preclinical models, a subcutaneous tumor and a calcified placenta, were imaged and fluence-compensated using the PHANTOM toolkit and the results were verified with immunohistochemistry. The PHANTOM toolkit provides scripts and auxiliary functions to enable biomedical researchers not specialized in optical imaging to apply fluence correction to PA images, enhancing accessibility of quantitative PAI for researchers in various fields.

Review on ultrasound-guided photoacoustic imaging for complementary analyses of biological systems in vivo

Photoacoustic imaging has been developed as a new biomedical molecular imaging modality. Due to its similarity to conventional ultrasound imaging in terms of signal detection and image generation, dual-modal photoacoustic and ultrasound imaging has been applied to visualize physiological and morphological information in biological systems in vivo. By complementing each other, dual-modal photoacoustic and ultrasound imaging showed synergistic advances in photoacoustic imaging with the guidance of ultrasound images. In this review, we introduce our recent progresses in dual-modal photoacoustic and ultrasound imaging systems at various scales of study, from preclinical small animals to clinical humans. A summary of the works reveals various strategies for combining the structural information of ultrasound images with the molecular information of photoacoustic images.

Combinatorial Polydopamine-Liposome Nanoformulation as an Effective Anti-Breast Cancer Therapy

Introduction

Drug delivery systems (DDSs) based on liposomes are potential tools to minimize the side effects and substantially enhance the therapeutic efficacy of chemotherapy. However, it is challenging to achieve biosafe, accurate, and efficient cancer therapy of liposomes with single function or single mechanism. To solve this problem, we designed a multifunctional and multimechanism nanoplatform based on polydopamine (PDA)-coated liposomes for accurate and efficient combinatorial cancer therapy of chemotherapy and laser-induced PDT/PTT.

Methods

ICG and DOX were co-incorporated in polyethylene glycol modified liposomes, which were further coated with PDA by a facile two-step method to construct PDA-liposome nanoparticles (PDA@Lipo/DOX/ICG). The safety of nanocarriers was investigated on normal HEK-293 cells, and the cellular uptake, intracellular ROS production capacity, and combinatorial treatment effect of the nanoparticles were assessed on human breast cancer cells MDA-MB-231. In vivo biodistribution, thermal imaging, biosafety assessment, and combination therapy effects were estimated based on MDA-MB-231 subcutaneous tumor model.

Results

Compared with DOX·HCl and Lipo/DOX/ICG, PDA@Lipo/DOX/ICG showed higher toxicity on MDA-MB-231 cells. After endocytosis by target cells, PDA@Lipo/DOX/ICG produced a large amount of ROS for PDT by 808 nm laser irradiation, and the cell inhibition rate of combination therapy reached up to 80.4%. After the tail vein injection (DOX equivalent of 2.5 mg/kg) in mice bearing MDA-MB-231 tumors, PDA@Lipo/DOX/ICG significantly accumulated at the tumor site at 24 h post injection. After 808 nm laser irradiation (1.0 W/cm², 2 min) at this timepoint, PDA@Lipo/DOX/ICG efficiently suppressed the proliferation of MDA-MB-231 cell and even thoroughly ablated tumors. Negligible cardiotoxicity and no treatment-induced side effects were observed.

Conclusion

PDA@Lipo/DOX/ICG is a multifunctional nanoplatform based on PDA-coated liposomes for accurate and efficient combinatorial cancer therapy of chemotherapy and laser-induced PDT/PTT.

Nano-diagnostics as an emerging platform for oral cancer detection: Current and emerging trends

Globally, oral cancer kills an estimated 150,000 individuals per year, with 300,000 new cases being diagnosed annually. The high incidence rate of oral cancer among the South-Asian and American populations is majorly due to overuse of tobacco, alcohol, and poor dental hygiene. Additionally, socio-economic issues and lack of general awareness delay the primary screening of the disease. The availability of early screening techniques for oral cancer can help in carving out a niche for accurate disease prognosis and also its prevention. However, conventional diagnostic approaches and therapeutics are still far from optimal. Thus, enhancing the analytical performance of diagnostic platforms in terms of specificity and precision can help in understanding the disease progression paradigm. Fabrication of efficient nanoprobes that are sensitive, noninvasive, cost-effective, and less labor-intensive can reduce the global cancer burden. Recent advances in optical, electrochemical, and spectroscopy-based nano biosensors that employ noble and superparamagnetic nanoparticles, have been proven to be extremely efficient. Further, these sensitive nanoprobes can also be employed for predicting disease relapse after chemotherapy, when the majority of the biomarker load is eliminated. Herein, we provide the readers with a brief summary of conventional and new-age oral cancer detection techniques. A comprehensive understanding of the inherent challenges associated with conventional oral cancer detection techniques is discussed. We also elaborate on how nanoparticles have shown tremendous promise and effectiveness in radically transforming the approach toward oral cancer detection. This article is categorized under: Diagnostic Tools > Biosensing Diagnostic Tools > Diagnostic Nanodevices Diagnostic Tools > In Vitro Nanoparticle-Based Sensing.

Clinical photoacoustic/ultrasound dual-modal imaging: Current status and future trends

Photoacoustic tomography (PAT) is an emerging biomedical imaging modality that combines optical and ultrasonic imaging, providing overlapping fields of view. This hybrid approach allows for a natural integration of PAT and ultrasound (US) imaging in a single platform. Due to the similarities in signal acquisition and processing, the combination of PAT and US imaging creates a new hybrid imaging for novel clinical applications. Over the recent years, particular attention is paid to the development of PAT/US dual-modal systems highlighting mutual benefits in clinical cases, with an aim of substantially improving the specificity and sensitivity for diagnosis of diseases. The demonstrated feasibility and accuracy in these efforts open an avenue of translating PAT/US imaging to practical clinical applications. In this review, the current PAT/US dual-modal imaging systems are discussed in detail, and their promising clinical applications are presented and compared systematically. Finally, this review describes the potential impacts of these combined systems in the coming future.

Exogenous Contrast Agents in Photoacoustic Imaging: An In Vivo Review for Tumor Imaging

The field of cancer theranostics has grown rapidly in the past decade and innovative 'biosmart' theranostic materials are being synthesized and studied to combat the fast growth of cancer metastases. While current state-of-the-art oncology imaging techniques have decreased mortality rates, patients still face a diminished quality of life due to treatment. Therefore, improved diagnostics are needed to define in vivo tumor growths on a molecular level to achieve image-guided therapies and tailored dosage needs. This review summarizes in vivo studies that utilize contrast agents within the field of photoacoustic imaging-a relatively new imaging modality-for tumor detection, with a special focus on imaging and transducer parameters. This paper also details the different types of contrast agents used in this novel diagnostic field, i.e., organic-based, metal/inorganic-based, and dye-based contrast agents. We conclude this review by discussing the challenges and future direction of photoacoustic imaging.

Application of Nanomaterials in Biomedical Imaging and Cancer Therapy

Nanomaterials, such as nanoparticles, nanorods, nanosphere, nanoshells, and nanostars, are very commonly used in biomedical imaging and cancer therapy. They make excellent drug carriers, imaging contrast agents, photothermal agents, photoacoustic agents, and radiation dose enhancers, among other applications. Recent advances in nanotechnology have led to the use of nanomaterials in many areas of functional imaging, cancer therapy, and synergistic combinational platforms. This review will systematically explore various applications of nanomaterials in biomedical imaging and cancer therapy. The medical imaging modalities include magnetic resonance imaging, computed tomography, positron emission tomography, single photon emission computerized tomography, optical imaging, ultrasound, and photoacoustic imaging. Various cancer therapeutic methods will also be included, including photothermal therapy, photodynamic therapy, chemotherapy, and immunotherapy. This review also covers theranostics, which use the same agent in diagnosis and therapy. This includes recent advances in multimodality imaging, image-guided therapy, and combination therapy. We found that the continuous advances of synthesis and design of novel nanomaterials will enhance the future development of medical imaging and cancer therapy. However, more resources should be available to examine side effects and cell toxicity when using nanomaterials in humans.

Noninvasive Photoacoustic Imaging of Dendritic Cell Stimulated with Tumor Cell-Derived Exosome

PURPOSE

The tools to trigger dendritic cell (DC) activation and to verify DC migration in vivo are important for directing DC immunotherapy toward successful treatment. We evaluated whether tumor cell-derived exosome (TEX)-stimulated DC migration into lymph node (LN) in mouse could be tracked using gold nanoparticle (GN)-labeling and ultrasound (US)-guided photoacoustic imaging (PAI).

PROCEDURES

GFP-transduced DC2.4 cells were used. RFP-tagged TEXs were purified from a stable 4T1 cell line overexpressing the exosomal CD63-RFP fusion protein. The TEX uptake by DCs was visualized using confocal laser scanning microscopy. GNs with surface plasmon resonance at 808 nm were used for DC-labeling. DCs that migrated into axillary LN were longitudinally monitored by US-guided PAI and analyzed by silver staining and immunohistochemistry.

RESULTS

TEXs were easily internalized in DCs, increased proliferation and migration capacities, and upregulated co-stimulatory molecules, CCR7 and TNF-α without cytotoxicity. The GN-labeling exerted no adverse effects on the biological functions of DCs. US-guided PAI and DC-labeling allowed for sensitive and longitudinal monitoring of TEX-stimulated DC migration toaxillary LN.

CONCLUSIONS

TEXs efficiently activated DCs and GN-labeled DC migration into LN was successfully monitored using US-guided PAI, suggesting that TEXs are a good source for DC activation and US-guided PAI is a cost-effective and easy-to-use imaging modality for noninvasive tracking of DCs.

Photoacoustic imaging in the second near-infrared window: a review

Photoacoustic (PA) imaging is an emerging medical imaging modality that combines optical excitation and ultrasound detection. Because ultrasound scatters much less than light in biological tissues, PA generates high-resolution images at centimeters depth. In recent years, wavelengths in the second near-infrared (NIR-II) window (1000 to 1700 nm) have been increasingly explored due to its potential for preclinical and clinical applications. In contrast to the conventional PA imaging in the visible (400 to 700 nm) and the first NIR-I (700 to 1000 nm) window, PA imaging in the NIR-II window offers numerous advantages, including high spatial resolution, deeper penetration depth, reduced optical absorption, and tissue scattering. Moreover, the second window allows a fivefold higher light excitation energy density compared to the visible window for enhancing the imaging depth significantly. We highlight the importance of the second window for PA imaging and discuss the various NIR-II PA imaging systems and contrast agents with strong absorption in the NIR-II spectral region. Numerous applications of NIR-II PA imaging, including whole-body animal imaging and human imaging, are also discussed.

Non-Platinum Metal Complexes as Potential Anti-Triple Negative Breast Cancer Agents

Breast cancer (BC) is the most common cancer in women worldwide, with a mortality rate that has been forecasted to rise in the next decade. This is especially worrying for people with triple-negative BC (TNBC), because of its unresponsiveness to current therapies. Different drugs to treat TNBC have been assessed, and, although platinum chemotherapy drugs seem to offer some hope, their drawbacks have motivated extensive investigations into alternative metal-based BC therapies. This paper aims to: (i) describe the preliminary in vitro and in vivo anticancer properties of non-platinum metal-based complexes (NPMBC) against TNBC; and (ii) analyze the likely molecular targets involved in their anticancer activity.

Nanotechnology: a promising method for oral cancer detection and diagnosis

Oral cancer is a common and aggressive cancer with high morbidity, mortality, and recurrence rate globally. Early detection is of utmost importance for cancer prevention and disease management. Currently, tissue biopsy remains the gold standard for oral cancer diagnosis, but it is invasive, which may cause patient discomfort. The application of traditional noninvasive methods-such as vital staining, exfoliative cytology, and molecular imaging-is limited by insufficient sensitivity and specificity. Thus, there is an urgent need for exploring noninvasive, highly sensitive, and specific diagnostic techniques. Nano detection systems are known as new emerging noninvasive strategies that bring the detection sensitivity of biomarkers to nano-scale. Moreover, compared to current imaging contrast agents, nanoparticles are more biocompatible, easier to synthesize, and able to target specific surface molecules. Nanoparticles generate localized surface plasmon resonances at near-infrared wavelengths, providing higher image contrast and resolution. Therefore, using nano-based techniques can help clinicians to detect and better monitor diseases during different phases of oral malignancy. Here, we review the progress of nanotechnology-based methods in oral cancer detection and diagnosis.

Breast cancer cell-derived exosomes and macrophage polarization are associated with lymph node metastasis

Crosstalk between breast cancer and macrophages has potential implications for tumor metastasis. This study investigates macrophage polarization induced by triple-negative breast cancer (TNBC) cell-derived exosomes that promote lymph node (LN) metastasis in orthotopic TNBC models. The MDA-MB-231 cancer cell line expressing the exosomal CD63-red fluorescence (RFP) fusion protein was generated to noninvasively visualize exosome transfer into cancer cells and macrophages. Administration of RFP-tagged exosomes enhanced migration of macrophages and induced macrophage polarization in vitro. In orthotopic TNBC models, noninvasive bioluminescent imaging, ultrasound-guided photoacoustic imaging, and histological analysis revealed that intravenous injection of RFP-tagged exosomes promoted primary tumor growth and axillary LN metastasis in which expression of CD206, a marker or alternatively activated type 2 (M2) macrophages, was significantly higher than expression of NOS2, a marker of classically activated type 1 (M1) macrophages. These results suggest breast cancer cell-derived exosomes stimulate macrophage polarization that creates favorable conditions for LN metastatic processes in TNBC.

Breakthroughs in modern cancer therapy and elusive cardiotoxicity: Critical research-practice gaps, challenges, and insights

To date, five cancer treatment modalities have been defined. The three traditional modalities of cancer treatment are surgery, radiotherapy, and conventional chemotherapy, and the two modern modalities include molecularly targeted therapy (the fourth modality) and immunotherapy (the fifth modality). The cardiotoxicity associated with conventional chemotherapy and radiotherapy is well known. Similar adverse cardiac events are resurging with the fourth modality. Aside from the conventional and newer targeted agents, even the most newly developed, immune-based therapeutic modalities of anticancer treatment (the fifth modality), e.g., immune checkpoint inhibitors and chimeric antigen receptor (CAR) T-cell therapy, have unfortunately led to potentially lethal cardiotoxicity in patients. Cardiac complications represent unresolved and potentially life-threatening conditions in cancer survivors, while effective clinical management remains quite challenging. As a consequence, morbidity and mortality related to cardiac complications now threaten to offset some favorable benefits of modern cancer treatments in cancer-related survival, regardless of the oncologic prognosis. This review focuses on identifying critical research-practice gaps, addressing real-world challenges and pinpointing real-time insights in general terms under the context of clinical cardiotoxicity induced by the fourth and fifth modalities of cancer treatment. The information ranges from basic science to clinical management in the field of cardio-oncology and crosses the interface between oncology and onco-pharmacology. The complexity of the ongoing clinical problem is addressed at different levels. A better understanding of these research-practice gaps may advance research initiatives on the development of mechanism-based diagnoses and treatments for the effective clinical management of cardiotoxicity.

Compressed Sensing With a Gaussian Scale Mixture Model for Limited View Photoacoustic Computed Tomography In Vivo

Photoacoustic computed tomography using an ultrasonic array is an attractive noninvasive imaging modality for many biomedical applications. However, the potentially long data acquisition time of array-based photoacoustic computed tomography—usually due to the required time-multiplexing for multiple laser pulses—decreases its applicability for rapid disease diagnoses and the successive monitoring of physiological functions. Compressed sensing is used to improve the imaging speed of photoacoustic computed tomography by decreasing the amount of acquired data; however, the imaging quality can be limited when fewer measurements are used, as traditional compressed sensing considers only the sparsity of the signals in the imaging process. In this work, an advanced compressed sensing reconstruction framework with a Wiener linear estimation-based Gaussian scale mixture model was developed for limited view photoacoustic computed tomography. In this method, the structure dependencies of signals in the wavelet domain were incorporated into the imaging framework through the Gaussian scale mixture model, and an operator based on the Wiener linear estimation was designed to filter the reconstruction artifacts. Phantom and human forearm imaging were performed to verify the developed method. The results demonstrated that compressed sensing with a Wiener linear estimation-based Gaussian scale mixture model more effectively suppressed the reconstruction artifacts of sparse-sampling photoacoustic computed tomography and recovered photoacoustic images with a higher contrast-to-noise ratio and edge resolution than the traditional compressed sensing method. This work may promote the development of low-cost photoacoustic computed tomography techniques with rapid data acquisition and enhance the performance of photoacoustic computed tomography in various biomedical studies.

Near-infrared photothermal therapy using anti-EGFR-gold nanorod conjugates for triple negative breast cancer

Current EGFR-targeted therapy for triple negative breast cancer (TNBC) has produced disappointing results. A rational therapeutic strategy to improve EGFR-targeted treatment for TNBC is therefore needed. In this study we evaluated the feasibility of treating TNBC using photoacoustic imaging (PAI)-guided near-infrared photothermal therapy (NIR-PTT) with anti-EGFR-conjugated gold nanorods (anti-EGFR-GN). NIR-PTT combined with anti-EGFR-GN exerted synergistic anti-proliferative and apoptotic actions through upregulation of HSP70 and cleaved caspase-3, downregulation of Ki-67 and EGFR, and inhibition of several intracellular signaling molecules (mTOR, AKT, ERK1/2 and FAK). These combined effects give this approach significant efficacy. Our findings suggest PAI-guided NIR-PTT using anti-EGFR-GN represent a novel and effective strategy for EGFR-targeted therapy in TNBC.

Nanoparticles as Theranostic Vehicles in Experimental and Clinical Applications-Focus on Prostate and Breast Cancer

Prostate and breast cancer are the second most and most commonly diagnosed cancer in men and women worldwide, respectively. The American Cancer Society estimates that during 2016 in the USA around 430,000 individuals were diagnosed with one of these two types of cancers, and approximately 15% of them will die from the disease. In Europe, the rate of incidences and deaths are similar to those in the USA. Several different more or less successful diagnostic and therapeutic approaches have been developed and evaluated in order to tackle this issue and thereby decrease the death rates. By using nanoparticles as vehicles carrying both diagnostic and therapeutic molecular entities, individualized targeted theranostic nanomedicine has emerged as a promising option to increase the sensitivity and the specificity during diagnosis, as well as the likelihood of survival or prolonged survival after therapy. This article presents and discusses important and promising different kinds of nanoparticles, as well as imaging and therapy options, suitable for theranostic applications. The presentation of different nanoparticles and theranostic applications is quite general, but there is a special focus on prostate cancer. Some references and aspects regarding breast cancer are however also presented and discussed. Finally, the prostate cancer case is presented in more detail regarding diagnosis, staging, recurrence, metastases, and treatment options available today, followed by possible ways to move forward applying theranostics for both prostate and breast cancer based on promising experiments performed until today.

Lymph node dissection for melanoma: where do we stand?

The extent and timing of regional lymphadenectomy and its role in patients with clinically localized primary melanoma has been the subject of considerable debate. While therapeutic lymphadenectomy for clinically positive nodes is uniformly accepted, the benefit of regional lymphadenectomy in patients with clinically uninvolved lymph nodes potentially harboring micrometastatic disease is less clear. Efforts to better select patients for complete regional lymphadenectomy after sentinel lymph node biopsy are underway. The future holds the promise of more stringent selection criteria and perhaps the identification of subgroups of patients for which a therapeutic benefit may be realized. Moreover, novel sensitive radiological techniques for detecting in vivo micrometastatic nodal disease may improve surgical precision, further decreasing potential morbidities of lymphadenectomy.