1
|
Mohtasebi M, Huang C, Zhao M, Mazdeyasna S, Liu X, Haratbar SR, Fathi F, Sun J, Pittman T, Yu G. A Wearable Fluorescence Imaging Device for Intraoperative Identification of Human Brain Tumors. IEEE J Transl Eng Health Med 2023; 12:225-232. [PMID: 38196823 PMCID: PMC10776094 DOI: 10.1109/jtehm.2023.3338564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 11/02/2023] [Accepted: 11/27/2023] [Indexed: 01/11/2024]
Abstract
Malignant glioma (MG) is the most common type of primary malignant brain tumors. Surgical resection of MG remains the cornerstone of therapy and the extent of resection correlates with patient survival. A limiting factor for resection, however, is the difficulty in differentiating the tumor from normal tissue during surgery. Fluorescence imaging is an emerging technique for real-time intraoperative visualization of MGs and their boundaries. However, most clinical grade neurosurgical operative microscopes with fluorescence imaging ability are hampered by low adoption rates due to high cost, limited portability, limited operation flexibility, and lack of skilled professionals with technical knowledge. To overcome the limitations, we innovatively integrated miniaturized light sources, flippable filters, and a recording camera to the surgical eye loupes to generate a wearable fluorescence eye loupe (FLoupe) device for intraoperative imaging of fluorescent MGs. Two FLoupe prototypes were constructed for imaging of Fluorescein and 5-aminolevulinic acid (5-ALA), respectively. The wearable FLoupe devices were tested on tumor-simulating phantoms and patients with MGs. Comparable results were observed against the standard neurosurgical operative microscope (PENTERO® 900) with fluorescence kits. The affordable and wearable FLoupe devices enable visualization of both color and fluorescence images with the same quality as the large and expensive stationary operative microscopes. The wearable FLoupe device allows for a greater range of movement, less obstruction, and faster/easier operation. Thus, it reduces surgery time and is more easily adapted to the surgical environment than unwieldy neurosurgical operative microscopes. Clinical and Translational Impact Statement-The affordable and wearable fluorescence imaging device developed in this study enables neurosurgeons to observe brain tumors with the same clarity and greater flexibility compared to bulky and costly operative microscopes.
Collapse
Affiliation(s)
- Mehrana Mohtasebi
- Department of Biomedical EngineeringUniversity of KentuckyLexingtonKY40506USA
| | - Chong Huang
- Department of Biomedical EngineeringUniversity of KentuckyLexingtonKY40506USA
| | - Mingjun Zhao
- Department of Biomedical EngineeringUniversity of KentuckyLexingtonKY40506USA
| | - Siavash Mazdeyasna
- Department of Biomedical EngineeringUniversity of KentuckyLexingtonKY40506USA
| | - Xuhui Liu
- Department of Biomedical EngineeringUniversity of KentuckyLexingtonKY40506USA
| | | | - Faraneh Fathi
- Department of Biomedical EngineeringUniversity of KentuckyLexingtonKY40506USA
| | | | - Thomas Pittman
- Department of NeurosurgeryUniversity of KentuckyLexingtonKY40506USA
| | - Guoqiang Yu
- Department of Biomedical EngineeringUniversity of KentuckyLexingtonKY40506USA
| |
Collapse
|
2
|
Shmuylovich L, O’Brien CM, Nwosu K, Achilefu S. Low-cost augmented reality goggles enable precision fluorescence-guided cancer surgery. Res Sq 2023:rs.3.rs-3084024. [PMID: 37503288 PMCID: PMC10371110 DOI: 10.21203/rs.3.rs-3084024/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Disparities in surgical outcomes often result from subjective than objective decisions dictated by surgical training, experience, and available resources. To improve outcomes, surgeons have adopted advancements in robotics, endoscopy, and intra-operative imaging including fluorescence-guided surgery (FGS), which highlight tumors in real-time without using ionizing radiation. However, like many medical innovations, technical, economic, and logistic challenges have hindered widespread adoption of FGS beyond high-resource centers. To overcome these impediments, we developed the fully-wearable and battery-powered fluorescence imaging augmented reality Raspberry Pi-based goggle system (FAR-Pi). Novel device design ensures distance-independent coalignment between real and augmented FAR-Pi views and offers higher spatial resolution, depth of focus, and fluorescence detection sensitivity than existing bulkier, pricier, and wall-powered technologies. When paired with pan-tumor targeting fluorescent agents such as LS301, FAR-Pi objectively identifies tumors in vivo. As an open-source, affordable, and adaptable system, FAR-Pi is poised to democratize access to FGS and improve health outcomes worldwide.
Collapse
Affiliation(s)
- Leonid Shmuylovich
- Biophotonics Research Center, Department of Radiology, Washington University in Saint Louis School of Medicine, Saint Louis, MO
- Division of Dermatology, Department of Medicine, Washington University in Saint Louis School of Medicine, Saint Louis, MO
| | - Christine M. O’Brien
- Biophotonics Research Center, Department of Radiology, Washington University in Saint Louis School of Medicine, Saint Louis, MO
- Department of Biomedical Engineering, Washington University in Saint Louis, St. Louis, MO, USA
| | - Karen Nwosu
- Biophotonics Research Center, Department of Radiology, Washington University in Saint Louis School of Medicine, Saint Louis, MO
| | - Samuel Achilefu
- Biophotonics Research Center, Department of Radiology, Washington University in Saint Louis School of Medicine, Saint Louis, MO
- Department of Biomedical Engineering, Washington University in Saint Louis, St. Louis, MO, USA
- Department of Medicine, Washington University in Saint Louis School of Medicine, St. Louis, MO, USA
- Department of Biochemistry & Molecular Biophysics, Washington University, St. Louis, MO, USA
| |
Collapse
|
3
|
Abdelrahman H, El-Menyar A, Peralta R, Al-Thani H. Application of indocyanine green in surgery: A review of current evidence and implementation in trauma patients. World J Gastrointest Surg 2023; 15:757-775. [PMID: 37342859 PMCID: PMC10277941 DOI: 10.4240/wjgs.v15.i5.757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 01/18/2023] [Accepted: 03/27/2023] [Indexed: 05/26/2023] Open
Abstract
Background: Modern surgical medicine strives to manage trauma while improving outcomes using functional imaging. Identification of viable tissues is crucial for the surgical management of polytrauma and burn patients presenting with soft tissue and hollow viscus injuries. Bowel anastomosis after trauma-related resection is associated with a high rate of leakage. The ability of the surgeon’s bare eye to determine bowel viability remains limited, and the need for a more standardized objective assessment has not yet been fulfilled. Hence, there is a need for more precise diagnostic tools to enhance surgical evaluation and visualization to aid early diagnosis and timely management to minimize trauma-associated complications. Indocyanine green (ICG) coupled with fluorescence angiography is a potential solution for this problem. ICG is a fluorescent dye that responds to near-infrared irradiation. Methods: We conducted a narrative review to address the utility of ICG in the surgical management of patients with trauma as well as elective surgery. Discussion: ICG has many applications in different medical fields and has recently become an important clinical indicator for surgical guidance. However, there is a paucity of information regarding the use of this technology to treat traumas. Recently, angiography with ICG has been introduced in clinical practice to visualize and quantify organ perfusion under several conditions, leading to fewer cases of anastomotic insufficiency. This has great potential to bridge this gap and enhance the clinical outcomes of surgery and patient safety. However, there is no consensus on the ideal dose, time, and manner of administration nor the indications that ICG provides a genuine advantage through greater safety in trauma surgical settings. Conclusions: There is a scarcity of publications describing the use of ICG in trauma patients as a potentially useful strategy to facilitate intraoperative decisions and to limit the extent of surgical resection. This review will improve our understanding of the utility of intraoperative ICG fluorescence in guiding and assisting trauma surgeons to deal with the intraoperative challenges and thus improve the patients’ operative care and safety in the field of trauma surgery.
Collapse
Affiliation(s)
| | - Ayman El-Menyar
- Trauma and Vascular Surgery, Hamad Medical Corporation, Doha 3050, Qatar
| | - Ruben Peralta
- Trauma Surgery, Hamad Medical Corporation, Doha 3050, Qatar
| | - Hassan Al-Thani
- Trauma and Vascular Surgery, Hamad Medical Corporation, Doha 3050, Qatar
| |
Collapse
|
4
|
Galema HA, Faber RA, Tange FP, Hilling DE, van der Vorst JR, Hartgrink HH, Vahrmeijer AL, Hutteman M, Mieog JSD, Lagarde SM, van der Sluis PC, Wijnhoven BP, Verhoef C, Burggraaf J, Keereweer S. A quantitative assessment of perfusion of the gastric conduit after oesophagectomy using near-infrared fluorescence with indocyanine green. Eur J Surg Oncol 2023; 49:990-995. [PMID: 36914531 DOI: 10.1016/j.ejso.2023.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 01/20/2023] [Accepted: 02/26/2023] [Indexed: 03/06/2023]
Abstract
INTRODUCTION Anastomotic leakage is a severe complication after oesophageal resection with gastric conduit reconstruction. Poor perfusion of the gastric conduit plays an important role in the development of anastomotic leakage. Quantitative near-infrared (NIR) fluorescence angiography with indocyanine green (ICG-FA) is an objective technique that can be used for perfusion assessment. This study aims to assess perfusion patterns of the gastric conduit with quantitative ICG-FA. METHODS In this exploratory study, 20 patients undergoing oesophagectomy with gastric conduit reconstruction were included. A standardized NIR ICG-FA video of the gastric conduit was recorded. Postoperatively, the videos were quantified. Primary outcomes were the time-intensity curves and nine perfusion parameters from contiguous regions of interest on the gastric conduit. A secondary outcome was the inter-observer agreement of subjective interpretation of the ICG-FA videos between six surgeons. The inter-observer agreement was tested with an intraclass correlation coefficient (ICC). RESULTS In a total of 427 curves, three distinct perfusion patterns were recognized: pattern 1 (steep inflow, steep outflow); pattern 2 (steep inflow, minor outflow); and pattern 3 (slow inflow, no outflow). All perfusion parameters were significantly different between the perfusion patterns. The inter-observer agreement was poor - moderate (ICC:0.345,95%CI:0.164-0.584). DISCUSSION This was the first study to describe perfusion patterns of the complete gastric conduit after oesophagectomy. Three distinct perfusion patterns were observed. The poor inter-observer agreement of the subjective assessment underlines the need for quantification of ICG-FA of the gastric conduit. Further studies should evaluate the predictive value of perfusion patterns and parameters on anastomotic leakage.
Collapse
Affiliation(s)
- Hidde A Galema
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Doctor Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands; Department of Otorhinolaryngology, Head and Neck Surgery, Erasmus MC Cancer Institute, Doctor Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - Robin A Faber
- Department of Surgery, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
| | - Floris P Tange
- Department of Surgery, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
| | - Denise E Hilling
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Doctor Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands; Department of Surgery, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
| | - Joost R van der Vorst
- Department of Surgery, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Hardy NP, Epperlein JP, Dalli J, Robertson W, Liddy R, Aird JJ, Mulligan N, Neary PM, McEntee GP, Conneely JB, Cahill RA. Real-time administration of indocyanine green in combination with computer vision and artificial intelligence for the identification and delineation of colorectal liver metastases. Surg Open Sci 2023; 12:48-54. [PMID: 36936453 PMCID: PMC10017420 DOI: 10.1016/j.sopen.2023.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 02/26/2023] [Accepted: 03/01/2023] [Indexed: 03/06/2023] Open
Abstract
Introduction Fluorescence guided surgery for the identification of colorectal liver metastases (CRLM) can be better with low specificity and antecedent dosing impracticalities limiting indocyanine green (ICG) usefulness currently. We investigated the application of artificial intelligence methods (AIM) to demonstrate and characterise CLRMs based on dynamic signalling immediately following intraoperative ICG administration. Methods Twenty-five patients with liver surface lesions (24 CRLM and 1 benign cyst) undergoing open/laparoscopic/robotic procedures were studied. ICG (0.05 mg/kg) was administered with near-infrared recording of fluorescence perfusion. User-selected region-of-interest (ROI) perfusion profiles were generated, milestones relating to ICG inflow/outflow extracted and used to train a machine learning (ML) classifier. 2D heatmaps were constructed in a subset using AIM to depict whole screen imaging based on dynamic tissue-ICG interaction. Fluorescence appearances were also assessed microscopically (using H&E and fresh-frozen preparations) to provide tissue-level explainability of such methods. Results The ML algorithm correctly classified 97.2 % of CRLM ROIs (n = 132) and all benign lesion ROIs (n = 6) within 90-s of ICG administration following initial mathematical curve analysis identifying ICG inflow/outflow differentials between healthy liver and CRLMs. Time-fluorescence plots extracted for each pixel in 10 lesions enabled creation of 2D characterising heatmaps using flow parameters and through unsupervised ML. Microscopy confirmed statistically less CLRM fluorescence vs adjacent liver (mean ± std deviation signal/area 2.46 ± 9.56 vs 507.43 ± 160.82 respectively p < 0.001) with H&E diminishing ICG signal (n = 4). Conclusion ML accurately identifies CRLMs from surrounding liver tissue enabling representative 2D mapping of such lesions from their fluorescence perfusion patterns using AIM. This may assist in reducing positive margin rates at metastatectomy and in identifying unexpected/occult malignancies.
Collapse
Affiliation(s)
- Niall P. Hardy
- UCD Centre for Precision Surgery, School of Medicine, UCD, Dublin, Ireland
| | | | - Jeffrey Dalli
- UCD Centre for Precision Surgery, School of Medicine, UCD, Dublin, Ireland
| | - William Robertson
- Department of Histopathology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Richard Liddy
- Department of Histopathology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - John J. Aird
- Department of Histopathology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Niall Mulligan
- Department of Histopathology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Peter M. Neary
- Department of General and Colorectal Surgery, University Hospital Waterford, University College Cork, Ireland
| | - Gerard P. McEntee
- Department of Hepatobiliary, Foregut and Bariatric Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - John B. Conneely
- Department of Hepatobiliary, Foregut and Bariatric Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Ronan A. Cahill
- UCD Centre for Precision Surgery, School of Medicine, UCD, Dublin, Ireland
- Department of General and Colorectal Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
- Corresponding author at: 47 Eccles Street, Dublin 7, Ireland. @Matersurgery
| |
Collapse
|
6
|
Azari F, Kennedy G, Bernstein E, Delikatny J, Lee JYK, Kucharczuk J, Low PS, Singhal S. Evaluation of OTL38-Generated Tumor-to-Background Ratio in Intraoperative Molecular Imaging-Guided Lung Cancer Resections. Mol Imaging Biol 2023; 25:85-96. [PMID: 34101106 PMCID: PMC8651846 DOI: 10.1007/s11307-021-01618-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 05/19/2021] [Accepted: 05/23/2021] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Cancer surgery has multiple challenges including localizing small lesions, ensuring negative margins, and identifying synchronous cancers. One of the tools proposed to address these issues is intraoperative molecular imaging (IMI). An important consideration in IMI is the quantification of the tumor fluorescence during the procedure and using that data to add clinical value. Currently, the most commonly cited measure of quantification is the tumor-to-background ratio (TBR). Our goal was to evaluate the clinical value of TBR measured with OTL38 NIR tracer during a lung cancer resection. METHODS Intraoperative data was retrospectively reviewed from a prospectively collected 5-year database. Between 2015 and 2020, 279 patients were included in the study. For standardization, all patients underwent infusion of the same targeted molecular optical contrast agent (OTL38) for lung cancer resections; then, the mean fluorescence intensity of the tumors and background tissues were calculated. To evaluate the clinical efficacy of the TBR calculation, the results were correlated with patient, biologic, tumor, and technological factors. RESULTS For pulmonary surgery, patient factors such as gender, age, smoking history, and time from infusion of OTL38 to surgery did not have any statistical significance in predicting the TBR during surgery. In addition, TBR measurements did not correlate with location of the tumor in the lung (p = 0.123). There was no statistical correlation of preoperative positron emission tomography measurements (standardized uptake value) with intraoperative TBR. However, there was statistically significant negative correlation of in situ TBR measurement and the distance of the lesion from the surface of the organ (p < 0.001). Adenocarcinoma spectrum lesions overall had statistically significant correlation with in situ fluorescence compared to other NSCLC malignancies (p < 0.01) but TBR measurements could not identify histopathologic subtype on univariate analysis (p = 0.089). There was a tendency for in situ fluorescence for moderately and well-differentiated adenocarcinoma spectrum lesions, but this was not statistically significant. When comparing the in situ TBR of benign to malignant nodules in the lung, there was no statistically significant association (p = 0.145). In subset analysis, adenocarcinoma spectrum lesions tend to fluoresce at brighter with OTL38 compared to other histologic subtypes. CONCLUSION In our various iterations, the results of our retrospective analysis did not show that TBR measurements during OTL38-guided surgery provide clinically useful information about the nature of the nodule or cancer. The true value of IMI is in the ability for the surgeon to use the fluorescence to guide the surgeon to the tumor and margins, but that sophisticated quantification of the amount of fluorescence may not have clinical utility.
Collapse
Affiliation(s)
- Feredun Azari
- Department of Thoracic Surgery, University of Pennsylvania Perelman School of Medicine, 3400 Spruce Street, 6 White Building, Philadelphia, PA, 19104, USA
| | - Gregory Kennedy
- Department of Thoracic Surgery, University of Pennsylvania Perelman School of Medicine, 3400 Spruce Street, 6 White Building, Philadelphia, PA, 19104, USA
| | - Elizabeth Bernstein
- Department of Thoracic Surgery, University of Pennsylvania Perelman School of Medicine, 3400 Spruce Street, 6 White Building, Philadelphia, PA, 19104, USA
| | - James Delikatny
- Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - John Y K Lee
- Department of Neurosurgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - John Kucharczuk
- Department of Thoracic Surgery, University of Pennsylvania Perelman School of Medicine, 3400 Spruce Street, 6 White Building, Philadelphia, PA, 19104, USA
| | - Phil S Low
- Department of Chemistry, Purdue University, West Lafayette, IN, USA
| | - Sunil Singhal
- Department of Thoracic Surgery, University of Pennsylvania Perelman School of Medicine, 3400 Spruce Street, 6 White Building, Philadelphia, PA, 19104, USA.
| |
Collapse
|
7
|
LaRochelle EPM, Streeter SS, Littler EA, Ruiz AJ. 3D-Printed Tumor Phantoms for Assessment of In Vivo Fluorescence Imaging Analysis Methods. Mol Imaging Biol 2023; 25:212-220. [PMID: 36307633 PMCID: PMC9970939 DOI: 10.1007/s11307-022-01783-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 10/05/2022] [Accepted: 10/13/2022] [Indexed: 12/30/2022]
Abstract
PURPOSE Interventional fluorescence imaging is increasingly being utilized to quantify cancer biomarkers in both clinical and preclinical models, yet absolute quantification is complicated by many factors. The use of optical phantoms has been suggested by multiple professional organizations for quantitative performance assessment of fluorescence guidance imaging systems. This concept can be further extended to provide standardized tools to compare and assess image analysis metrics. PROCEDURES 3D-printed fluorescence phantoms based on solid tumor models were developed with representative bio-mimicking optical properties. Phantoms were produced with discrete tumors embedded with an NIR fluorophore of fixed concentration and either zero or 3% non-specific fluorophore in the surrounding material. These phantoms were first imaged by two fluorescence imaging systems using two methods of image segmentation, and four assessment metrics were calculated to demonstrate variability in the quantitative assessment of system performance. The same analysis techniques were then applied to one tumor model with decreasing tumor fluorophore concentrations. RESULTS These anatomical phantom models demonstrate the ability to use 3D printing to manufacture anthropomorphic shapes with a wide range of reduced scattering (μs': 0.24-1.06 mm-1) and absorption (μa: 0.005-0.14 mm-1) properties. The phantom imaging and analysis highlight variability in the measured sensitivity metrics associated with tumor visualization. CONCLUSIONS 3D printing techniques provide a platform for demonstrating complex biological models that introduce real-world complexities for quantifying fluorescence image data. Controlled iterative development of these phantom designs can be used as a tool to advance the field and provide context for consensus-building beyond performance assessment of fluorescence imaging platforms, and extend support for standardizing how quantitative metrics are extracted from imaging data and reported in literature.
Collapse
Affiliation(s)
- Ethan P M LaRochelle
- QUEL Imaging, 85 N. Main Street Suite 142, White River Junction, VT, 05001, USA.
| | - Samuel S Streeter
- QUEL Imaging, 85 N. Main Street Suite 142, White River Junction, VT, 05001, USA.,Thayer School of Engineering at Dartmouth, 14 Engineering Drive, Hanover, NH, 03755, USA
| | - Eammon A Littler
- QUEL Imaging, 85 N. Main Street Suite 142, White River Junction, VT, 05001, USA
| | - Alberto J Ruiz
- QUEL Imaging, 85 N. Main Street Suite 142, White River Junction, VT, 05001, USA.,Thayer School of Engineering at Dartmouth, 14 Engineering Drive, Hanover, NH, 03755, USA
| |
Collapse
|
8
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
9
|
Ikeda N, Furuse M, Futamura G, Kimura S, Nonoguchi N, Kawabata S, Kameda M, Yokoyama K, Takami T, Kawanishi M, Kajimoto Y, Kuroiwa T, Wanibuchi M. The Characteristic of Light Sources and Fluorescence in the 3-Dimensional Digital Exoscope "ORBEYE" for 5-Aminolevulinic Acid-Induced Fluorescence-Guided Surgery Compared with a Conventional Microscope. World Neurosurg 2022; 167:e1268-74. [PMID: 36087910 DOI: 10.1016/j.wneu.2022.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 09/04/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND The ORBEYE (ORB), an innovative 3-dimensional digital exoscope, is an equipped system for fluorescence-guided surgery with 5-aminolevulinic acid. Therefore, this study aimed to verify the characteristics of fluorescence-guided surgery with 5-aminolevulinic acid and excitation light source with ORB. METHODS The same operative field of glioblastoma was recorded under blue light (BL) excitation using a conventional microscope (MS) and ORB. For in vitro studies, the energy of 405-nm wavelength light in white light and BL modes of each scope was examined in various focal lengths. To examine the degree of photobleaching with BL for each scope, protoporphyrin IX-soaked filter papers were continuously exposed with BL of an MS and ORB, and the video-recorded red fluorescence intensity was analyzed. RESULTS The color tone of tumor-induced red fluorescence was remarkably different under each scope. Furthermore, nonfluorescent normal structures without red fluorescence were well recognized under ORB. The energy of 405-nm wavelength light in BL was significantly higher in ORB than that in an MS, especially in the short focal length. With continuous BL excitation to filter papers, the relative red fluorescence intensity of filter papers was significantly decreased over time in ORB than in an MS. In low protoporphyrin IX concentration, the difference was more significant. CONCLUSIONS With ORB, the good visibility due to BL energy as compared with an MS might improve the surgical manipulation even in BL mode. However, the weak fluorescent tissue and short focal length should be carefully considered because photobleaching might be critical for FGS.
Collapse
|
10
|
Martinez-Onate ADJ, Martinez-Salas ADJ, Cazares-Garcia V. Fluorescence Guided Cholecystectomy by a Single Group: Initial 47 Procedures Experience in Mexico. JSLS 2022; 26:JSLS.2022.00043. [PMID: 36071995 DOI: 10.4293/jsls.2022.00043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction Fluorescence guided surgery (FGS) for biliary surgery uses indocyanine green (ICG), a specific dye that is eliminated almost exclusively by the liver and biliary system, making it very useful for an adequate and safe visualization of biliary tract structures. Methods We present our experience with FGS for cholecystectomy multiport and single port, including all patients older than 18 years of age, with diagnosis of cholecystitis (acute and chronic), from October 18, 2018 to December 30, 2021. Results A total of 47 patients were managed with FGS cholecystectomy, mean age was 61.2 (± 17.7) years, 31 (65.9%) were female and 16 (34.1%) males. Twenty-four (51.1%) were emergency procedures, due to acute cholecystitis, of which 10 (41.7%) presented with an infected gallbladder (Parkland 3 to 5) and three (12.5%) presented with related acute pancreatitis, the remaining 23 (48.9%) cases were elective surgeries, due to chronic cholecystitis. Visualization of laparoscopic fluorescence of the biliary ducts was achieved in 45 of the 47 patients (95.7%). Mean time for biliary tract structures visual identification was 8 minutes and 40 seconds (± 7 minutes, 20 seconds), fluorescence allowed the visualization of biliary tract anatomical variants in two patients. Discussion The reported rate of biliary structures visualization using ICG is relatively variable, ranging from 25% to 100%, in our group it was 95.7% due to our protocol. Conclusions ICG utilization for cholecystectomy is very useful and helps for a safe procedure even in difficult surgeries, we believe that it should be used in everyday practice.
Collapse
Affiliation(s)
| | | | - Vania Cazares-Garcia
- Department of Surgery, Hospital Santa Coleta, Hospital Angeles del Pedregal, Mexico City, Mexico
| |
Collapse
|
11
|
Nerup N, Svendsen MBS, Rønn JH, Konge L, Svendsen LB, Achiam MP. Quantitative fluorescence angiography aids novice and experienced surgeons in performing intestinal resection in well-perfused tissue. Surg Endosc 2021; 36:2373-2381. [PMID: 33942183 PMCID: PMC8921116 DOI: 10.1007/s00464-021-08518-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 04/17/2021] [Indexed: 02/07/2023]
Abstract
Background Anastomotic leakage (AL) after gastrointestinal resection is a devastating complication with huge consequences for the patient. As AL is associated with poor blood supply, tools for objective assessment of perfusion are in high demand. Indocyanine green angiography (ICG-FA) and quantitative analysis of ICG-FA (q-ICG) seem promising. This study aimed to investigate whether ICG-FA and q-ICG could improve perfusion assessment performed by surgeons of different experience levels. Methods Thirteen small bowel segments with a varying degree of devascularization, including two healthy sham segments, were constructed in a porcine model. We recruited students, residents, and surgeons to perform perfusion assessment of the segments in white light (WL), with ICG-FA, and after q-ICG, all blinded to the degree of devascularization. Results Forty-five participants fulfilled the study (18 novices, 12 intermediates, and 15 experienced). ICG and q-ICG helped the novices correctly detect the healthy bowel segments to experienced surgeons’ level. ICG and q-ICG also helped novice surgeons to perform safer resections in healthy tissue compared with normal WL. The relative risk (RR) of leaving ischemic tissue in WL and ICG compared with q-ICG, even for experienced surgeons was substantial, intermediates (RR = 8.9, CI95% [4.0;20] and RR = 6.2, CI95% [2.7;14.1]), and experienced (RR = 4.7, CI95% [2.6;8.7] and RR = 4.0, CI95% [2.1;7.5]). Conclusion Q-ICG seems to guide surgeons, regardless of experience level, to safely perform resection in healthy tissue, compared with standard WL. Future research should focus on this novel tool’s clinical impact.
Collapse
Affiliation(s)
- Nikolaj Nerup
- Department of Surgical Gastroenterology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9 DK-2100, Copenhagen Ø, Denmark.
| | - Morten Bo Søndergaard Svendsen
- Copenhagen Academy for Medical Education and Simulation, Center for Human Resources and Education, Copenhagen, Capital Region of Denmark, Denmark
| | - Jonas Hedelund Rønn
- Department of Surgical Gastroenterology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9 DK-2100, Copenhagen Ø, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation, Center for Human Resources and Education, Copenhagen, Capital Region of Denmark, Denmark
| | - Lars Bo Svendsen
- Department of Surgical Gastroenterology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9 DK-2100, Copenhagen Ø, Denmark
| | - Michael Patrick Achiam
- Department of Surgical Gastroenterology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9 DK-2100, Copenhagen Ø, Denmark
| |
Collapse
|
12
|
House BJ, Kwon MJ, Schaefer JM, Barth CW, Solanki A, Davis SC, Gibbs SL. Clinically relevant dual probe difference specimen imaging (DDSI) protocol for freshly resected breast cancer specimen staining. BMC Cancer 2021; 21:440. [PMID: 33882909 PMCID: PMC8059239 DOI: 10.1186/s12885-021-08179-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 04/05/2021] [Indexed: 11/12/2022] Open
Abstract
Background Re-excision rates following breast conserving surgery (BCS) remain as high as ~ 35%, with positive margins detected during follow-up histopathology. Additional breast cancer resection surgery is not only taxing on the patient and health care system, but also delays adjuvant therapies, increasing morbidity and reducing the likelihood of a positive outcome. The ability to precisely resect and visualize tumor margins in real time within the surgical theater would greatly benefit patients, surgeons and the health care system. Current tumor margin assessment technologies utilized during BCS involve relatively lengthy and labor-intensive protocols, which impede the surgical work flow. Methods In previous work, we have developed and validated a fluorescence imaging method termed dual probe difference specimen imaging (DDSI) to accurately detect benign and malignant tissue with direct correlation to the targeted biomarker expression levels intraoperatively. The DDSI method is currently on par with touch prep cytology in execution time (~ 15-min). In this study, the main goal was to shorten the DDSI protocol by decreasing tissue blocking and washing times to optimize the DDSI protocol to < 10-min whilst maintaining robust benign and malignant tissue differentiation. Results We evaluated the utility of the shortened DDSI staining methodology using xenografts grown from cell lines with varied epidermal growth factor receptor (EGFR) expression levels, comparing accuracy through receiver operator characteristic (ROC) curve analyses across varied tissue blocking and washing times. An optimized 8-min DDSI methodology was developed for future clinical translation. Conclusions Successful completion of this work resulted in substantial shortening of the DDSI methodology for use in the operating room, that provided robust, highly receptor specific, sensitive diagnostic capabilities between benign and malignant tissues.
Collapse
Affiliation(s)
- Broderick J House
- Biomedical Engineering Department, Oregon Health & Science University, 2730 S Moody Ave, Mail Code: CL3SG, Portland, OR, 97201, USA
| | - Marcus J Kwon
- Biomedical Engineering Department, Oregon Health & Science University, 2730 S Moody Ave, Mail Code: CL3SG, Portland, OR, 97201, USA
| | - Jasmin M Schaefer
- Biomedical Engineering Department, Oregon Health & Science University, 2730 S Moody Ave, Mail Code: CL3SG, Portland, OR, 97201, USA
| | - Connor W Barth
- Biomedical Engineering Department, Oregon Health & Science University, 2730 S Moody Ave, Mail Code: CL3SG, Portland, OR, 97201, USA
| | - Allison Solanki
- Biomedical Engineering Department, Oregon Health & Science University, 2730 S Moody Ave, Mail Code: CL3SG, Portland, OR, 97201, USA
| | - Scott C Davis
- Thayer School of Engineering, Dartmouth College, Hanover, NH, 03755, USA
| | - Summer L Gibbs
- Biomedical Engineering Department, Oregon Health & Science University, 2730 S Moody Ave, Mail Code: CL3SG, Portland, OR, 97201, USA. .,Knight Cancer Institute, Oregon Health & Science University, 2730 S Moody Ave, Mail Code: CL3SG, Portland, OR, 97201, USA.
| |
Collapse
|
13
|
Baiocchi GL, Guercioni G, Vettoretto N, Scabini S, Millo P, Muratore A, Clementi M, Sica G, Delrio P, Longo G, Anania G, Barbieri V, Amodio P, Di Marco C, Baldazzi G, Garulli G, Patriti A, Pirozzi F, De Luca R, Mancini S, Pedrazzani C, Scaramuzzi M, Scatizzi M, Taglietti L, Motter M, Ceccarelli G, Totis M, Gennai A, Frazzini D, Di Mauro G, Capolupo GT, Crafa F, Marini P, Ruffo G, Persiani R, Borghi F, de Manzini N, Catarci M. ICG fluorescence imaging in colorectal surgery: a snapshot from the ICRAL study group. BMC Surg 2021; 21:190. [PMID: 33838677 PMCID: PMC8035779 DOI: 10.1186/s12893-021-01191-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 03/24/2021] [Indexed: 01/19/2023] Open
Abstract
Background Fluorescence-guided visualization is a recently proposed technology in colorectal surgery. Possible uses include evaluating perfusion, navigating lymph nodes and searching for hepatic metastases and peritoneal spread. Despite the absence of high-level evidence, this technique has gained considerable popularity among colorectal surgeons due to its significant reliability, safety, ease of use and relatively low cost. However, the actual use of this technique in daily clinical practice has not been reported to date. Methods This survey was conducted on April 2020 among 44 centers dealing with colorectal diseases and participating in the Italian ColoRectal Anastomotic Leakage (iCral) study group. Surgeons were approximately equally divided based on geographical criteria from multiple Italian regions, with a large proportion based in public (89.1%) and nonacademic (75.7%) centers. They were invited to answer an online survey to snapshot their current behaviors regarding the use of fluorescence-guided visualization in colorectal surgery. Questions regarding technological availability, indications and techniques, personal approaches and feelings were collected in a 23-item questionnaire. Results Questionnaire replies were received from 37 institutions and partially answered by 8, as this latter group of centers do not implement fluorescence technology (21.6%). Out of the remaining 29 centers (78,4%), fluorescence is utilized in all laparoscopic colorectal resections by 72.4% of surgeons and only for selected cases by the remaining 27.6%, while 62.1% of respondents do not use fluorescence in open surgery (unless the perfusion is macroscopically uncertain with the naked eye, in which case 41.4% of them do). The survey also suggests that there is no agreement on dilution, dosing and timing, as many different practices are adopted based on personal judgment. Only approximately half of the surgeons reported a reduced leak rate with fluorescence perfusion assessment, but 65.5% of them strongly believe that this technique will become a minimum requirement for colorectal surgery in the future. Conclusion The survey confirms that fluorescence is becoming a widely used technique in colorectal surgery. However, both the indications and methods still vary considerably; furthermore, the surgeons' perceptions of the results are insufficient to consider this technology essential. This survey emphasizes the need for further research to reach recommendations based on solid scientific evidence.
Collapse
Affiliation(s)
- Gian Luca Baiocchi
- Department of Clinical and Experimental Sciences, University of Brescia, ASST Spedali Civili, Brescia, Italy.
| | | | - Nereo Vettoretto
- General Surgery Unit, ASST Spedali Civili, Montichiari, BS, Italy
| | - Stefano Scabini
- General & Oncologic Surgery Unit, National Cancer Center "San Martino", Genova, Italy
| | - Paolo Millo
- General Surgery Unit, Aosta Regional Hospital, Aosta, Italy
| | | | - Marco Clementi
- General Surgery Unit, University Hospital, L'Aquila, Italy
| | - Giuseppe Sica
- General Surgery Unit, Policlinico Tor Vergata University Hospital, Roma, Italy
| | - Paolo Delrio
- Colorectal Surgical Oncology Unit, IRCCS G. Pascale Foundation, Napoli, Italy
| | | | | | - Vittoria Barbieri
- General Surgery Unit, Cardinale G. Panico Hospital, Tricase, LE, Italy
| | - Pietro Amodio
- General Surgery Unit, Belcolle Hospital, Viterbo, Italy
| | - Carlo Di Marco
- General Surgery Unit, Conegliano Hospital (TV) ULSS2 Marca Trevigiana, Conegliano, Italy
| | | | | | - Alberto Patriti
- General Surgery Unit, Marche Nord Hospital, Pesaro e Fano, PU, Italy
| | - Felice Pirozzi
- General Surgery Unit, ASL Napoli2 Hospital, Pozzuoli, NA, Italy
| | - Raffaele De Luca
- General Surgery Unit, IRCCS Istituto Giovanni Paolo II, Bari, Italy
| | - Stefano Mancini
- General & Oncologic Surgery Unit, San Filippo Neri Hospital, Roma, Italy
| | | | - Matteo Scaramuzzi
- General Surgery Unit, IRCCS Casa Sollievo Della Sofferenza, San Giovanni Rotondo, FG, Italy
| | - Marco Scatizzi
- General Surgery Unit, Santa Maria Annunziata Hospital, Firenze, Italy
| | | | - Michele Motter
- General Surgery Unit 1, Santa Chiara Hospital, Trento, Italy
| | | | - Mauro Totis
- General Surgery Unit, San Gerardo Hospital, Monza, Italy
| | - Andrea Gennai
- General Surgery Unit, Sant'Andrea Hospital, La Spezia, Italy
| | - Diletta Frazzini
- General Surgery Unit, Ospedale Civile Di Pescara, Pescara, Italy
| | | | | | - Francesco Crafa
- General & Oncologic Surgery Unit, San Giuseppe Moscati Hospital, Avellino, Italy
| | | | - Giacomo Ruffo
- General Surgery Unit, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, VR, Italy
| | - Roberto Persiani
- Minimally Invasive Oncologic Surgery Unit, IRCCS Policlinico Gemelli Foundation, Roma, Italy
| | - Felice Borghi
- General Surgery Unit, Santa Croce E Carle Hospital, Cuneo, Italy
| | | | - Marco Catarci
- General Surgery Unit, CG Mazzoni Hospital, Ascoli Piceno, Italy
| |
Collapse
|
14
|
Usama SM, Thapaliya ER, Luciano MP, Schnermann MJ. Not so innocent: Impact of fluorophore chemistry on the in vivo properties of bioconjugates. Curr Opin Chem Biol 2021; 63:38-45. [PMID: 33684856 DOI: 10.1016/j.cbpa.2021.01.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 01/22/2021] [Accepted: 01/28/2021] [Indexed: 12/11/2022]
Abstract
The combination of targeting ligands and fluorescent dyes is a powerful strategy to observe cell types and tissues of interest. Conjugates of peptides, proteins, and, in particular, monoclonal antibodies (mAbs) exhibit excellent tumor targeting in various contexts. This approach has been translated to a clinical setting to provide real-time molecular insights during the surgical resection of solid tumors. A critical element of this approach is the generation of highly fluorescent bioconjugates that maintain the properties of the parent targeting ligand. A number of studies have found that fluorophores can dramatically impact the pharmacokinetic and tumor-targeting properties of the bioconjugates they are meant to only innocently observe. In this review, we summarize several examples of these effects and highlight strategies that have been used to mitigate them. These include the application of site-specific labeling chemistries, modulating label density, and altering the structure of the fluorescent probe itself. In particular, we point out the significant potential of fluorophores with hydrophilic but net-neutral structures. Overall, this review highlights recent progress in refining the in vivo properties of fluorescent bioconjugates, and we hope, will inform future efforts in this area.
Collapse
|
15
|
Labib PL. Timing of administration of indocyanine green for fluorescence-guided surgery in pancreatic cancer: response to Shirakawa et al. BMC Surg 2020; 20:225. [PMID: 33028281 DOI: 10.1186/s12893-020-00881-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 09/23/2020] [Indexed: 11/10/2022] Open
|
16
|
Sagoo K, Cumberbatch N, Holland A, Hungerford G. Rapid (FLASH-FLIM) imaging of protoporphyrin IX in a lipid mixture using a CMOS based widefield fluorescence lifetime imaging camera in real time for margin demarcation applications. Methods Appl Fluoresc 2020; 9. [PMID: 32992309 DOI: 10.1088/2050-6120/abbcc6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 09/29/2020] [Indexed: 01/23/2023]
Abstract
The fluorescence from protoporphyrin IX (PpIX) has been employed to characterise cellular activity and assist in the visualisation of tumour cells. Its formation can be induced by 5-aminolevulonic acid (5-ALA) which is metabolised by tumour cells to form PpIX. The PpIX is localised within the cells, rather than spreading into the vascular system. This, plus its photophysics, exhibits potential in photodynamic therapy. Hence its study and the ability to rapidly image its localisation is of importance, especially in the field of fluorescence guided surgery. This has led to investigations using tissue phantoms and widefield intensity imaging. Aggregation or the presence of photoproducts can alter PpIX emission, which has implications using widefield imaging and a broad wavelength range detection. The use of the fluorescence lifetime imaging (FLIM) is therefore advantageous as it can distinguish between the emissive species as they exhibit different fluorescence lifetimes. Here we use PpIX in a construct consisting of lipid mixture (Intralipid), employed to simulate fat content and optical scattering, in a gellan gum matrix. PpIX in intralipid in aqueous solution was injected into the gellan host to form inclusions. The samples are imaged using commercial widefield TCSPC camera based on a sensor chip with 192 x 128 pixels. Each pixel contains both detection and photon timing enabling the Fluorescence Lifetime Acquisition by Simultaneous Histogramming (FLASH). This "FLASH-FLIM" approach enables widefield fluorescence lifetime images, displayed in real time to be acquired, which has potential for use in visualising tumour boundaries.
Collapse
Affiliation(s)
- Kulwinder Sagoo
- Horiba Jobin Yvon, Glasgow, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
| | - Nathan Cumberbatch
- HORIBA UK Ltd, Northampton, London, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
| | - Adam Holland
- HORIBA UK Ltd, Northampton, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
| | - Graham Hungerford
- Horiba Jobin Yvon, 133 Finnieston Street, Glasgow, G3 8HB, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
| |
Collapse
|
17
|
Roberts DW, Bravo JJ, Olson JD, Hickey WF, Harris BT, Nguyen LN, Hong J, Evans LT, Fan X, Wirth D, Wilson BC, Paulsen KD. 5-Aminolevulinic Acid-Induced Fluorescence in Focal Cortical Dysplasia: Report of 3 Cases. Oper Neurosurg (Hagerstown) 2020; 16:403-414. [PMID: 29920583 DOI: 10.1093/ons/opy116] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 04/20/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Three patients enrolled in a clinical trial of 5-aminolevulinic-acid (5-ALA)-induced fluorescence-guidance, which has been demonstrated to facilitate intracranial tumor resection, were found on neuropathological examination to have focal cortical dysplasia (FCD). OBJECTIVE To evaluate in this case series visible fluorescence and quantitative levels of protoporphyrin IX (PpIX) during surgery and correlate these findings with preoperative magnetic resonance imaging (MRI) and histopathology. METHODS Patients were administered 5-ALA (20 mg/kg) approximately 3 h prior to surgery and underwent image-guided, microsurgical resection of their MRI- and electrophysiologically identified lesions. Intraoperative visible fluorescence was evaluated using an operating microscope adapted with a commercially available blue light module. Quantitative PpIX levels were assessed using a handheld fiber-optic probe and a wide-field imaging spectrometer. Sites of fluorescence measurements were co-registered with both preoperative MRI and histopathological analysis. RESULTS Three patients with a pathologically confirmed diagnosis of FCD (Types 1b, 2a, and 2b) underwent surgery. All patients demonstrated some degree of visible fluorescence (faint or moderate), and all patients had quantitatively elevated concentrations of PpIX. No evidence of neoplasia was identified on histopathology, and in 1 patient, the highest concentrations of PpIX were found at a tissue site with marked gliosis but no typical histological features of FCD. CONCLUSION FCD has been found to be associated with intraoperative 5-ALA-induced visible fluorescence and quantitatively confirmed elevated concentrations of the fluorophore PpIX in 3 patients. This finding suggests that there may be a role for fluorescence-guidance during surgical intervention for epilepsy-associated FCD.
Collapse
Affiliation(s)
- David W Roberts
- Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.,Geisel School Medicine, Dartmouth College, Hanover, New Hampshire.,Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.,Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire
| | - Jaime J Bravo
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire
| | - Jonathan D Olson
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire
| | - William F Hickey
- Department of Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Brent T Harris
- Departments of Pathology and Neurology, Georgetown University Medical Center, Washington, District of Columbia
| | - Lananh N Nguyen
- Department of Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Jennifer Hong
- Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Linton T Evans
- Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Xiaoyao Fan
- Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.,Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire
| | - Dennis Wirth
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire
| | - Brian C Wilson
- Princess Margaret Cancer Centre, University Health Network, Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Keith D Paulsen
- Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.,Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.,Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire
| |
Collapse
|
18
|
Jeremiasse B, van den Bosch CH, Wijnen MWHA, Terwisscha van Scheltinga CEJ, Fiocco MF, van der Steeg AFW. Systematic review and meta-analysis concerning near-infrared imaging with fluorescent agents to identify the sentinel lymph node in oncology patients. Eur J Surg Oncol 2020; 46:2011-2022. [PMID: 32826112 DOI: 10.1016/j.ejso.2020.07.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/03/2020] [Accepted: 07/09/2020] [Indexed: 02/05/2023] Open
Abstract
Sentinel node procedures (SNP) are performed with the use of tracer-agents, mainly radio-colloid and/or blue dye. Fluorescent agents have emerged as a new tracer-agent to identify the SLN intra-operatively with near-infrared imaging. Our aim is to compare the detection rate of fluorescent agents to current "golden standards" (blue dye and/or radio-colloid) for the SNP by means of a systematic review and meta-analysis without any restrictions based on tumor type. A systematic search in PubMed, Embase and The Cochrane Library was performed. Articles that compared the detection rates of fluorescent agents with radio-colloid and/or blue dye were included. Meta-analyses were performed for breast, gynecological and dermatological cancer using a random effects model. In total 6195 articles were screened which resulted in a final inclusion of 55 articles. All studies used indocyanine green (ICG) as fluorescent agent. Meta-analyses comparing ICG with blue dye showed a significant and clinically relevant difference in detection rate in favor of ICG, for both breast, dermatological and gynecological cancer. Meta-analyses comparing ICG with radio-colloid did not show any significant differences, with the exception of ICG versus radio-colloid + blue dye for the bilateral SLN detection in gynecological cancer. Near-infrared fluorescence imaging using ICG provides a higher detection rate compared to blue dye for the SNP in a range of different tumor types. SLN detection rates of ICG are comparable to radio-colloid. Due to their complementary characteristics in terms of spatial resolution and transdermal sensitivity, we suggest to use a combination of both ICG and a radio-colloid.
Collapse
Affiliation(s)
- B Jeremiasse
- Department of Surgery, Princess Maxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, the Netherlands.
| | - C H van den Bosch
- Department of Surgery, Princess Maxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, the Netherlands.
| | - M W H A Wijnen
- Department of Surgery, Princess Maxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, the Netherlands.
| | | | - M F Fiocco
- Trial and Data Center, Princess Maxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, the Netherlands; Institute of Mathematics, Leiden University, Niels Bohrweg 1, 2333CA, Leiden, the Netherlands; Department of Biomedical Data Science, Section Medical Statistics, Leiden University Medical Center, Albinusdreef 2, 2300RC, Leiden, the Netherlands.
| | - A F W van der Steeg
- Department of Surgery, Princess Maxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, the Netherlands.
| |
Collapse
|
19
|
Schilling C, Gnanasegaran G, Thavaraj S, Vojnovic B, Ngu R, McGurk M. Development of sentinel lymph node biopsy technique in patients with salivary gland cancer using the IDEAL framework. Eur J Surg Oncol 2020; 46:2029-34. [PMID: 32576478 DOI: 10.1016/j.ejso.2020.05.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/26/2020] [Accepted: 05/14/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Salivary cancer is rare and comprises a variety of histological subtypes and clinical behaviors. There is no agreed method of estimating the risk of occult metastasis or managing the clinically N0 neck.Sentinel node biopsy (SNB) may offer a solution but previous studies have not produced a reliable imaging protocol. This study uses novel technology and trial methodology to develop a reliable SNB technique, with primary aim to identify peri-and intraglandular sentinel nodes. METHODS IDEAL framework was used to undertake SNB in clinically node negative salivary gland cancer. Patients with cT1-2 N0 salivary cancer were eligible. Lymphoscintigraphy was undertaken using Tc-99 m labelled nanocoll. Injection technique as well as adjunctive use of freehand SPECT (fhSPECT), near-infrared (NIR) fluorescence imaging, and navigation-guided surgery were used and optimisied during the study protocol. RESULTS 10 patients were recruited. Initial protocol of peritumoural injection of Tc99 m nanocoll showed poor image resolution. Subsequent adjustment to single intratumoural injection allowed identification of intraglandular sentinel nodes. Fh/SPECT and NIR fluorescence imaging found intraglandular lymph nodes otherwise not recognizable to the naked eye. In two cases occult lymph node metastasis were identified. CONCLUSION This study has shown the IDEAL framework is vital in allowing iterative changes in surgical protocol in the light of experience. This study has produced a reliable method for detection of sentinel nodes, in particular the ability to identify intra- and periglandular nodes with diagnosis of occult metastatic deposits and no false negative results. Our protocol can be readily transferred in to larger scale studies.
Collapse
|
20
|
Tichauer KM, Wang C, Xu X, Samkoe KS. Task-based evaluation of fluorescent-guided cancer surgery as a means of identifying optimal imaging agent properties in the context of variability in tumor- and healthy-tissue physiology. Proc SPIE Int Soc Opt Eng 2020; 11222. [PMID: 33568879 DOI: 10.1117/12.2546700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Fluorescent molecular-guided surgery (FGS) is at a tipping point in terms of clinical approval and adoption in a number cancer applications, with ongoing phase 0 and phase 1 clinical trials being carried out in a wide range of cancers using a wide range of agents. The pharmacokinetics of each of these agents and the physiology of these cancers can differ vastly on a patient-to-patient basis, bringing to question: how can one fairly compare different methodologies (defined as the combination of imaging agent, system, and protocol) and how can existing methodologies be further optimized? To this point, little methodology comparison has been carried out, and the majority of FGS optimization has concerned system development-on the level of maximizing signal-to-noise, dynamic detection range, and sensitivity-independently from traditional agent development-in terms of fluorophore brightness, toxicity, solubility, and binding affinity and specificity. Here we propose an inclusion of tumor and healthy tissue physiology (blood flow, vascular permeability, specific and nonspecific binding sites, extracellular matrix, interstitial pressure, etc…) variability into the optimization process and re-establish well-described task-based metrics for methodology optimization and comparing quality of one methodology to another. Two salient conclusions were identified: (1) contrast-to-background variability is a simple metric that correlates with difficult-to-carry-out task-based metrics for comparing methodologies, and (2) paired-agent imaging protocols offer unique advantages over single-imaging-agent studies for mitigating confounding tumor and background physiology variability.
Collapse
Affiliation(s)
| | - Cheng Wang
- Thayer School of Engineering, Dartmouth College, Hanover, NH
| | - Xiaochun Xu
- Department of Surgery, Dartmouth Geisel School of Medicine, Hanover, NH
| | - Kimberley S Samkoe
- Thayer School of Engineering, Dartmouth College, Hanover, NH.,Department of Surgery, Dartmouth Geisel School of Medicine, Hanover, NH
| |
Collapse
|
21
|
Huisman BW, Burggraaf J, Vahrmeijer AL, Schoones JW, Rissmann RA, Sier CFM, van Poelgeest MIE. Potential targets for tumor-specific imaging of vulvar squamous cell carcinoma: A systematic review of candidate biomarkers. Gynecol Oncol 2020; 156:734-743. [PMID: 31928804 DOI: 10.1016/j.ygyno.2019.12.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 12/18/2019] [Accepted: 12/20/2019] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Vulvar squamous cell carcinoma (VSCC) is a rare malignancy with an increasing incidence, especially in young women. Surgical treatment of VSCC is associated with significant morbidity and high recurrence rates, which is related to the limited ability to distinguish (pre)malignant from healthy tissue. There is a need for new tools for specific real-time detection of occult tumor lesions and localization of cancer margins in patients with VSCC. Several tumor-specific imaging techniques are developed to recognize malignant tissue by targeting tumor markers. We present a systematic review to identify, evaluate, and summarize potential markers for tumor-specific imaging of VSCC. METHODS Relevant papers were identified by a systematic cross-database literature search developed with assistance of an experienced librarian. Data were extracted from eligible papers and reported based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. VSCC-specific tumor markers were valued based on a weighted scoring system, in which each biomarker was granted points based on ranked eligibility criteria: I) percentage expression, II) sample size, and III) in vivo application. RESULTS In total 627 papers were included of which 22 articles met the eligibility criteria. Twelve VSCC-specific tumor markers were identified and of these 7 biomarkers were considered most promising: EGFR, CD44v6, GLUT1, MRP1, MUC1, CXCR-4 and VEGF-A. DISCUSSION This overview identified 7 potential biomarkers that can be used in the development of VSCC-specific tracers for real-time and precise localization of tumor tissue before, during, and after treatment. These biomarkers were identified in a small number of samples, without discriminating for VSCC-specific hallmarks such as HPV-status. Before clinical development, experimental studies should first aim at validation of these biomarkers using immunohistochemistry and cell line-based examination, discriminating for HPV-status and the expression rate in lymph nodes and precursor lesions.
Collapse
Affiliation(s)
- B W Huisman
- Centre for Human Drug Research, Zernikedreef 8, 2333CL Leiden, the Netherlands; Department of Gynecology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands.
| | - J Burggraaf
- Centre for Human Drug Research, Zernikedreef 8, 2333CL Leiden, the Netherlands; Leiden Academic Center for Drug Research, Leiden University, Einstein weg 55, 2333 CC Leiden, the Netherlands; Department of Surgery, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands.
| | - A L Vahrmeijer
- Department of Surgery, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands.
| | - J W Schoones
- Walaeus Library, Leiden University Medical Center, Leiden, PO Box 9600, 2300 RC, the Netherlands.
| | - R A Rissmann
- Centre for Human Drug Research, Zernikedreef 8, 2333CL Leiden, the Netherlands; Leiden Academic Center for Drug Research, Leiden University, Einstein weg 55, 2333 CC Leiden, the Netherlands.
| | - C F M Sier
- Department of Surgery, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands.
| | - M I E van Poelgeest
- Centre for Human Drug Research, Zernikedreef 8, 2333CL Leiden, the Netherlands; Department of Gynecology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands.
| |
Collapse
|
22
|
Jones PS, Yekula A, Lansbury E, Small JL, Ayinon C, Mordecai S, Hochberg FH, Tigges J, Delcuze B, Charest A, Ghiran I, Balaj L, Carter BS. Characterization of plasma-derived protoporphyrin-IX-positive extracellular vesicles following 5-ALA use in patients with malignant glioma. EBioMedicine 2019; 48:23-35. [PMID: 31628025 PMCID: PMC6838454 DOI: 10.1016/j.ebiom.2019.09.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 09/11/2019] [Accepted: 09/13/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Malignant gliomas are rapidly progressive brain tumors with high mortality. Fluorescence guided surgery (FGS) with 5-aminolevulinic acid (5-ALA) provides fluorescent delineation of malignant tissue, which helps achieve maximum safe resection. 5-ALA-based fluorescence is due to preferential accumulation of the fluorophore protoporphyrin-IX (PpIX) in malignant glioma tissue. Additionally, gliomas cells release extracellular vesicles (EVs) which carry biomarkers of disease. Herein, we performed animal and human studies to investigate whether 5-ALA dosed glioma cells, in vitro and in vivo, release PpIX positive EVs in circulation which can be captured and analyzed. METHODS We used imaging flow cytometry (IFC) to characterize PpIX-positive EVs released from 5-ALA-dosed glioma cells, glioma-bearing xenograft models, as well as patients with malignant glioma undergoing FGS. FINDINGS We first show that glioma cells dosed with 5-ALA release 247-fold higher PpIX positive EVs compared to mock dosed glioma cells. Second, we demonstrate that the plasma of glioma-bearing mice (n = 2) dosed with 5-ALA contain significantly higher levels of circulating PpIX-positive EVs than their pre-dosing background (p = 0.004). Lastly, we also show that the plasma of patients with avidly fluorescent tumors (n = 4) undergoing FGS contain circulating PpIX-positive EVs at levels significantly higher than their pre-dosing background (p = 0.00009) and this rise in signal correlates with enhancing tumor volumes (r 2 = 0.888). INTERPRETATION Our findings highlight the potential of plasma-derived PpIX-positive EV-based diagnostics for malignant gliomas, offering a novel liquid biopsy platform for confirming and monitoring tumor status.
Collapse
Affiliation(s)
- Pamela S Jones
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Anudeep Yekula
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Elizabeth Lansbury
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Julia L Small
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Caroline Ayinon
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Scott Mordecai
- Department of Pathology, Flow Cytometry Core, Massachusetts General Hospital, Boston, MA, United States
| | | | - John Tigges
- Flow Cytometry Core, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Bethany Delcuze
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Alain Charest
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Ionita Ghiran
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Leonora Balaj
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.
| | - Bob S Carter
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.
| |
Collapse
|
23
|
Hollandsworth HM, Lwin TM, Amirfakhri S, Filemoni F, Batra SK, Hoffman RM, Dhawan P, Bouvet M. Anti-Claudin-1 Conjugated to a Near-Infrared Fluorophore Targets Colon Cancer in PDOX Mouse Models. J Surg Res 2019; 242:145-150. [PMID: 31077946 DOI: 10.1016/j.jss.2019.04.048] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 03/23/2019] [Accepted: 04/10/2019] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Claudins are tight-junction proteins, which maintain an epithelial barrier in normal colon cells. Overexpression of Claudin-1 has been implicated for development of colon cancer. We postulated that Claudin-1 may be a useful target in near-infrared imaging and fluorescence-guided surgery. METHODS We conjugated Claudin-1 antibody to LI-COR IR800DyeCW (Claudin-1-IRDye800CW). Western blotting of 9 human colon cancer cell lysates was performed. Animal imaging was performed with the LI-COR Pearl Trilogy Fluorescence Imaging System. A dose-response study was carried out with subcutaneous LS174T colon cancer cell line models. Increasing doses of Claudin-1-IRDye800CW via tail vein injection were administered to three groups of mice. Two groups of mice were used as controls (antibody alone, and dye alone). In vivo imaging was performed at 24, 48, and 72 h after administration of the conjugated dye. Orthotopic implantation of patient-derived tumors and cell lines was performed and peritoneal carcinomatosis models were created. After tumor growth, mice were administered Claudin-1-IRDye800CW and imaged in vivo 48 h later. The mice were euthanized and laparotomy was performed to assess internal organs and toxicity. RESULTS Western blotting revealed that all colon cancer cell lysates expressed varying amounts of Claudin-1. All tumors demonstrated strong and specific fluorescence labeling at 800 nm, even with the lowest dose of 12.5 μg of Claudin-1-IRDye800CW. CONCLUSIONS Claudin-1 is a useful target for near-infrared antibody-based imaging for visualization of colorectal tumors for future use in fluorescence-guided surgery.
Collapse
Affiliation(s)
- Hannah M Hollandsworth
- Department of Surgery, University of California San Diego, La Jolla, California; Moores Cancer Center, University of California San Diego, La Jolla, California; Department of Surgery, VA San Diego Healthcare System, San Diego, California
| | - Thinzar M Lwin
- Department of Surgery, University of California San Diego, La Jolla, California; Moores Cancer Center, University of California San Diego, La Jolla, California; Department of Surgery, VA San Diego Healthcare System, San Diego, California
| | - Siamak Amirfakhri
- Department of Surgery, University of California San Diego, La Jolla, California; Moores Cancer Center, University of California San Diego, La Jolla, California; Department of Surgery, VA San Diego Healthcare System, San Diego, California
| | - Filemoni Filemoni
- Department of Surgery, University of California San Diego, La Jolla, California; Moores Cancer Center, University of California San Diego, La Jolla, California; Department of Surgery, VA San Diego Healthcare System, San Diego, California; AntiCancer, Inc, San Diego, California
| | - Surinder K Batra
- Department of Biochemistry, University of Nebraska Medical Center, Omaha, Nebraska
| | - Robert M Hoffman
- Department of Surgery, University of California San Diego, La Jolla, California; Moores Cancer Center, University of California San Diego, La Jolla, California; Department of Surgery, VA San Diego Healthcare System, San Diego, California; AntiCancer, Inc, San Diego, California
| | - Punita Dhawan
- Department of Biochemistry, University of Nebraska Medical Center, Omaha, Nebraska
| | - Michael Bouvet
- Department of Surgery, University of California San Diego, La Jolla, California; Moores Cancer Center, University of California San Diego, La Jolla, California; Department of Surgery, VA San Diego Healthcare System, San Diego, California.
| |
Collapse
|
24
|
Framery B, Gutowski M, Dumas K, Evrard A, Muller N, Dubois V, Quinonero J, Scherninski F, Pèlegrin A, Cailler F. Toxicity and pharmacokinetic profile of SGM-101, a fluorescent anti-CEA chimeric antibody for fluorescence imaging of tumors in patients. Toxicol Rep 2019; 6:409-415. [PMID: 31080749 PMCID: PMC6506861 DOI: 10.1016/j.toxrep.2019.04.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 04/18/2019] [Accepted: 04/28/2019] [Indexed: 12/26/2022] Open
Abstract
Fluorescence guided surgery represents a considerable advance for oncology surgeons. SGM-101 is an innovative antibody-dye conjugate targeting carcinoembryonic antigen on digestive tumors. Pre-clinical toxicology, pharmacology and pharmacokinetic results are in favor of clinical use of SGM-101.
The real-time improvement of the intraoperative discrimination between different tissue types (particularly between tumor and adjacent normal tissue) using intraoperative imaging represents a considerable advance for oncology surgeons. However, the development of imaging agents is much slower than that of drug therapies, although surgery represents one of the few curative treatments for many solid tumors. SGM-101 is a recently described, innovative antibody conjugate in which the near-infrared fluorochrome BM-104 is covalently linked to a chimeric monoclonal antibody against carcinoembryonic antigen (CEA). SGM-101 was developed with the goal of providing oncology surgeons with an intraoperative imaging tool that allows the visualization of CEA-overexpressing tumors. This antigen is overexpressed in a wide range of human carcinomas, such as colorectal, gastric, pancreatic, non-small cell lung and breast carcinomas. Here we characterized SGM-101 safety prior to its clinical testing for real-time cancer mapping by oncology surgeons. Safety pharmacology and toxicology studies were performed after intravenous injection of SGM-101 in Wistar rats and in Beagle dogs. SGM-101 metabolism and pharmacokinetics were analyzed in rats and mice. Finally, the potential toxicity of the BM-104 dye and SGM-101 cross-reactivity were assessed in a panel of 42 human tissues. Our pre-clinical toxicology, pharmacology and pharmacokinetic results demonstrated the absence of significant adverse effects of both SGM-101 and BM-104 at doses well above the anticipated maximal human exposure. Taken together, the results of the pharmacology, pharmacokinetic and toxicology studies support the development of SGM-101 as a potentially useful and safe tumor-specific imaging tool that might improve the complete tumor resection rate.
Collapse
Key Words
- AUC, Area Under the Curve
- CEA, carcinoembryonic antigen
- Cancer
- Carcinoembryonic antigen
- FGS, fluorescence guided surgery
- Fluorescence guided surgery
- GLP, Good Laboratory Practices
- ICG, indocyanine green
- MRT, Mean Residence Time
- MTD, maximum tolerated dose
- NIR, near infra-red
- NOAEL, no observable adverse effect level (NOAEL)
- Near-infrared fluorochrome
- PK, pharmacokinetics
- Pharmacokinetics
- TMDD, target-mediated drug disposition
- Toxicity
- mAb, monoclonal antibody
Collapse
Affiliation(s)
- Bérénice Framery
- SurgiMAb, 10 Parc Club du Millénaire, 1025 Avenue Henri Becquerel, 34000, Montpellier, France
| | - Marian Gutowski
- Institut régional du Cancer de Montpellier, ICM, Montpellier, F-34298, France
| | - Karen Dumas
- SurgiMAb, 10 Parc Club du Millénaire, 1025 Avenue Henri Becquerel, 34000, Montpellier, France
| | - Alexandre Evrard
- Institut régional du Cancer de Montpellier, ICM, Montpellier, F-34298, France.,IRCM, Institut de Recherche en Cancérologie de Montpellier, Montpellier, F-34298, France.,INSERM, U1194, Montpellier, F-34298, France.,Université de Montpellier, Montpellier, F-34298, France
| | - Nathalie Muller
- Leads to Development, 3-5 Impasse Reille, 75014, Paris, France
| | - Vincent Dubois
- Leads to Development, 3-5 Impasse Reille, 75014, Paris, France
| | | | | | - André Pèlegrin
- Institut régional du Cancer de Montpellier, ICM, Montpellier, F-34298, France.,IRCM, Institut de Recherche en Cancérologie de Montpellier, Montpellier, F-34298, France.,INSERM, U1194, Montpellier, F-34298, France.,Université de Montpellier, Montpellier, F-34298, France
| | - Françoise Cailler
- SurgiMAb, 10 Parc Club du Millénaire, 1025 Avenue Henri Becquerel, 34000, Montpellier, France
| |
Collapse
|
25
|
Philp L, Chan H, Rouzbahman M, Overchuk M, Chen J, Zheng G, Bernardini MQ. Use of Porphysomes to detect primary tumour, lymph node metastases, intra-abdominal metastases and as a tool for image-guided lymphadenectomy: proof of concept in endometrial cancer. Am J Cancer Res 2019; 9:2727-2738. [PMID: 31131064 PMCID: PMC6525988 DOI: 10.7150/thno.31225] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 02/14/2019] [Indexed: 12/12/2022] Open
Abstract
Objective: To investigate Porphysome fluorescence image-guided resection (PYRO-FGR) for detection of uterine tumour, metastatic lymph nodes and abdominal metastases in a model of endometrial cancer. Methods: White New Zealand rabbits were inoculated with VX2 cells via intra-myometrial injection. At 30 days, Porphysomes were administered intravenously. At 24 h the abdomen was imaged and fluorescent tissue identified (PYRO-FGR). After complete resection of fluorescent tissue, fluorescence-negative lymph nodes and peritoneal biopsies were removed. Histopathology including ultra-staging and analysis by a pathologist was used to detect tumour. Fluorescence signal to background ratio (SBR) was calculated and VX2 (+) tissue compared to VX2 (-) tissue. Biodistribution was calculated and Porphysome accumulation in fluorescent VX2 (+) tissue compared to fluorescent VX2 (-) and non-fluorescent VX2 (-) tissue. Results: Of 17 VX2 models, 10 received 4 mg/kg of Porphysomes and 7 received 1 mg/kg. Seventeen tumours (UT), 81 lymph nodes (LN) and 54 abdominal metastases (AM) were fluorescence-positive and resected. Of these, 17 UT, 60 LN and 45 AM were VX2 (+), while 16 LN and 5 AM were VX2 (-). Nine specimens were excluded from analysis. Thirty-one LN and 53 peritoneal biopsies were fluorescence-negative and resected. Of these, all LN and 51/53 biopsies were VX2 (-) with only 2 false-negative biopsies. Sensitivity and specificity of PYRO-FGR for VX2 (+) tissue was 98.4% / 80.0% overall, 100% / 100% for UT, 100% / 66.0 % for LN and 95.7% / 91.4% for AM. Increased SBR and biodistribution was observed in VX2 (+) tissue vs. VX2 (-) tissue. Conclusions: Porphysomes are a highly sensitive imaging agent for intra-operative detection and resection of uterine tumour, metastatic lymph nodes and abdominal metastases.
Collapse
|
26
|
Chang SW, Donoho DA, Zada G. Use of optical fluorescence agents during surgery for pituitary adenomas: current state of the field. J Neurooncol 2018; 141:585-593. [PMID: 30523607 DOI: 10.1007/s11060-018-03062-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 11/24/2018] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Differentiation of normal pituitary from abnormal tumor tissue remains a surgical challenge despite improvements in optical visualization technology for pituitary adenoma (PA) surgery. During neurosurgical procedures for other tumor types, 5-aminolevulinic acid (5-ALA) has become a focus of investigation based on its high specificity in differentiating tumor tissue. However, the role of 5-ALA and other optical fluorescent agents in PA surgery remains less clear. OBJECTIVE To perform a systematic review on the use of various optical fluorescent agents in PA surgery. METHOD Using PRISMA guidelines, a systematic literature review to identify reports describing 5-ALA and other optical agents for fluorescence-guided surgery for PA was performed. Eleven research studies met inclusion criteria and were reviewed. RESULTS In two studies, 5-ALA was not shown to be effective in aiding PA resection using standard neurosurgical endoscopic/microscopic approaches. 5-ALA photodynamic therapy was evaluated in two in-vitro models with inconsistent results. Intraoperative use of indocyanine green (ICG) concluded with varying results, but showed a tendency towards improved differentiation of functional PA. OTL38 showed potential for intraoperative identification of nonfunctioning PA, particularly in tumors with high folate receptor expression. One study reported clinically useful fluorescence following sodium fluorescein administration. CONCLUSION We conclude that selected optical fluorescent agents, including ICG and folate receptors, are most likely to hold promise for clinical use in differentiating PA from normal tissue.
Collapse
Affiliation(s)
- Stephanie W Chang
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Daniel A Donoho
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Gabriel Zada
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| |
Collapse
|
27
|
Moreno RG, García LMB, Bastidas HI, Tirado CAM, Flores AM, Cabezas JPS, Artero JMC. Fluorescence Guided Surgery with 5-Aminolevulinic Acid for Resection of Spinal Cord Ependymomas. Asian Spine J 2018; 13:119-125. [PMID: 30347527 PMCID: PMC6365784 DOI: 10.31616/asj.2018.0165] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 08/15/2018] [Indexed: 11/23/2022] Open
Abstract
STUDY DESIGN A retrospective study. PURPOSE We report our experience with 5-aminolevulinic acid (5-ALA)-assisted resection of spinal cord ependymomas in adults. OVERVIEW OF LITERATURE Ependymoma is the most frequent primary spinal cord tumor in adults. Surgery is the treatment of choice in most cases. However, while complete resection is achieved in approximately 80% of cases, clinical improvement is achieved in 15% only. Five-ALA fluorescence-guided surgery seems to be useful for this tumor type. METHODS We studied 14 patients undergoing 5-ALA fluorescence-guided surgery for spinal cord ependymomas in our service. The modified McCormick classification was used to determine clinical status and the degree of resection was assessed with magnetic resonance imaging. RESULTS Of the 14 patients, the tumor showed an intense emission of fluorescence in 12 and the fluorescence was weak and nonuniform in two. Complete resection was achieved in 11 cases. According to the McCormick classification, 10 patients improved, two remained the same, and two deteriorated. CONCLUSIONS Our results confirm that 5-ALA fluorescence-guided resection is useful in spinal cord ependymoma resection. Although the rate of complete resections is similar to that in published series without 5-ALA, clinical results are better when using 5-ALA with a lower percentage of clinical deterioration.
Collapse
Affiliation(s)
- Rafael García Moreno
- Department of Neurosurgery, University Hospital Complex of Badajoz, Badajoz, Spain
| | | | | | | | - Aurora Moreno Flores
- Department of Neurosurgery, University Hospital Complex of Badajoz, Badajoz, Spain
| | | | | |
Collapse
|
28
|
Wu D, Daly HC, Conroy E, Li B, Gallagher WM, Cahill RA, O'Shea DF. PEGylated BF 2-Azadipyrromethene (NIR-AZA) fluorophores, for intraoperative imaging. Eur J Med Chem. 2019;161:343-353. [PMID: 30368132 DOI: 10.1016/j.ejmech.2018.10.046] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 10/18/2018] [Accepted: 10/19/2018] [Indexed: 12/12/2022]
Abstract
Clinical imaging utilising near-infrared fluorescence is growing as an intraoperative aid for the decision-making processes during complex surgical procedures. Existing uses include perfusion assessment and lymph node identification with many new applications currently being proposed and developed. While imaging hardware and software have significantly progressed in recent times, suitable NIR-fluorophores remain a limiting factor. In this report, we describe the design, synthesis, photophysical characterization and in vivo imaging assessment of new PEGylated NIR-fluorophores based on the BF2-azadipyrromethene fluorophore class. The synthetic route includes PEGylation as the final step, thereby allowing routine access to derivatives substituted with different molecular weights of PEG. Absorption and emission wavelength maxima in PBS lie at 690 and 720 nm respectively with quantum yields over 12%. They show excellent photostability and no light induced singlet oxygen production. A time-course of NIR-fluorescence imaging, post i.v. administration, in BALB/c mice showed a rapid and preferential accumulation in the renal excretion pathway within 20 min, indicative of potential clinical usage for intraoperative identification of vial structures along this pathway. Assessment with clinical imaging equipment showed the NIR-AZA fluorophores to be wavelength compatible and brighter than currently used methylene blue (MB), and that they have the ability to be imaged simultaneously with indocyanine green (ICG) offering a potential for dual colour clinical imaging.
Collapse
|
29
|
Dijkstra BM, Motekallemi A, den Dunnen WFA, Jeltema JR, van Dam GM, Kruyt FAE, Groen RJM. SSTR-2 as a potential tumour-specific marker for fluorescence-guided meningioma surgery. Acta Neurochir (Wien) 2018; 160:1539-1546. [PMID: 29858948 PMCID: PMC6060877 DOI: 10.1007/s00701-018-3575-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 05/23/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Meningiomas are the most frequently occurring primary intracranial tumours in adults. Surgical removal can only be curative by complete resection; however surgical access can be challenging due to anatomical localization and local invasion of bone and soft tissues. Several intraoperative techniques have been tried to improve surgical resection, including intraoperative fluorescence guided imaging; however, no meningioma-specific (fluorescent) targeting has been developed yet. Here, we aimed to identify the most promising biomarkers for targeted intra-operative fluorescence guided meningioma surgery. METHODS One hundred forty-eight meningioma specimens representing all meningioma grades were analysed using immunohistochemistry (IHC) on tissue microarrays (TMAs) to determine expression patterns of meningioma biomarkers epithelial membrane antigen (EMA), platelet-derived growth factor β (PDGF-β), vascular endothelial growth factor α (VEGF-α), and somatostatin receptor type 2 (SSTR-2). Subsequently, the most promising biomarker was selected based on TArget Selection Criteria (TASC). Marker expression was examined by IHC in 3D cell culture models generated from freshly resected tumour material. RESULTS TMA-IHC showed strongest staining for SSTR-2. All cases were positive, with 51.4% strong/diffuse, 30.4% moderate/diffuse and only 18.2% focal/weak staining patterns. All tested biomarkers showed at least weak positivity in all meningiomas, regardless of WHO grade. TASC analysis showed that SSTR-2 was the most promising target for fluorescence guided imaging, with a total score of 21 (out of 22). SSTR-2 expression was determined on original patient tumours and 3D cultures of three established cultures. CONCLUSIONS SSTR-2 expression was highly sensitive and specific in all 148 meningiomas, regardless of WHO grade. According to TASC analysis, SSTR-2 is the most promising receptor for meningioma targeting. After establishing in vitro meningioma models, SSTR-2 cell membrane expression was confirmed in two of three meningioma cultures as well. This indicates that specific fluorescence in an experimental setting can be performed for the further development of targeted fluorescence guided meningioma surgery and near-infrared fluorescent tracers targeting SSTR-2.
Collapse
Affiliation(s)
- B M Dijkstra
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
| | - A Motekallemi
- Department of Neurosurgery, University Medical Center Münster, Münster, Germany
| | - W F A den Dunnen
- Department of Pathology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - J R Jeltema
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
| | - G M van Dam
- Department of Surgery, Nuclear Medicine and Molecular Imaging and Intensive Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - F A E Kruyt
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - R J M Groen
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands.
| |
Collapse
|
30
|
Samkoe KS, Gunn JR, Marra K, Hull SM, Moodie KL, Feldwisch J, Strong TV, Draney DR, Hoopes PJ, Roberts DW, Paulsen K, Pogue BW. Toxicity and Pharmacokinetic Profile for Single-Dose Injection of ABY-029: a Fluorescent Anti-EGFR Synthetic Affibody Molecule for Human Use. Mol Imaging Biol 2018; 19:512-521. [PMID: 27909986 DOI: 10.1007/s11307-016-1033-y] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE ABY-029, a synthetic Affibody peptide, Z03115-Cys, labeled with a near-infrared fluorophore, IRDye® 800CW, targeting epidermal growth factor receptor (EGFR) has been produced under good manufacturing practices for a US Food and Drug Administration-approved first-in-use human study during surgical resection of glioma, as well as other tumors. Here, the pharmacology, phototoxicity, receptor activity, and biodistribution studies of ABY-029 were completed in rats, prior to the intended human use. PROCEDURES Male and female Sprague Dawley rats were administered a single intravenous dose of varying concentrations (0, 245, 2449, and 24,490 μg/kg corresponding to 10×, 100×, and 1000× an equivalent human microdose level) of ABY-029 and observed for up to 14 days. Histopathological assessment of organs and tissues, clinical chemistry, and hematology were performed. In addition, pharmacokinetic clearance and biodistribution of ABY-029 were studied in subgroups of the animals. Phototoxicity and ABY-029 binding to human and rat EGFR were assessed in cell culture and on immobilized receptors, respectively. RESULTS Histopathological assessment and hematological and clinical chemistry analysis demonstrated that single-dose ABY-029 produced no pathological evidence of toxicity at any dose level. No phototoxicity was observed in EGFR-positive and EGFR-negative glioma cell lines. Binding strength and pharmacokinetics of the anti-EGFR Affibody molecules were retained after labeling with the dye. CONCLUSION Based on the successful safety profile of ABY-029, the 1000× human microdose 24.5 mg/kg was identified as the no observed adverse effect level following intravenous administration. Conserved binding strength and no observed light toxicity also demonstrated ABY-029 safety for human use.
Collapse
Affiliation(s)
- Kimberley S Samkoe
- Department of Surgery, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, NH, 03755, USA. .,Thayer School of Engineering, Dartmouth College, Hanover, NH, 03755, USA.
| | - Jason R Gunn
- Thayer School of Engineering, Dartmouth College, Hanover, NH, 03755, USA
| | - Kayla Marra
- Thayer School of Engineering, Dartmouth College, Hanover, NH, 03755, USA
| | - Sally M Hull
- Thayer School of Engineering, Dartmouth College, Hanover, NH, 03755, USA
| | - Karen L Moodie
- Center for Comparative Medicine and Research, Dartmouth College, Hanover, NH, 03755, USA
| | | | - Theresa V Strong
- Department of Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL, 35294, USA
| | | | - P Jack Hoopes
- Department of Surgery, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, NH, 03755, USA.,Thayer School of Engineering, Dartmouth College, Hanover, NH, 03755, USA.,Center for Comparative Medicine and Research, Dartmouth College, Hanover, NH, 03755, USA
| | - David W Roberts
- Department of Surgery, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, NH, 03755, USA.,Thayer School of Engineering, Dartmouth College, Hanover, NH, 03755, USA
| | - Keith Paulsen
- Department of Surgery, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, NH, 03755, USA.,Thayer School of Engineering, Dartmouth College, Hanover, NH, 03755, USA
| | - Brian W Pogue
- Department of Surgery, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, NH, 03755, USA. .,Thayer School of Engineering, Dartmouth College, Hanover, NH, 03755, USA.
| |
Collapse
|
31
|
Chan DTM, Yi-Pin Sonia H, Poon WS. 5-Aminolevulinic acid fluorescence guided resection of malignant glioma: Hong Kong experience. Asian J Surg 2017; 41:467-472. [PMID: 28844780 DOI: 10.1016/j.asjsur.2017.06.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Revised: 06/19/2017] [Accepted: 06/28/2017] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND 5-Aminolevulinic Acid (5-ALA) induced fluorescence is useful in guiding glioma resection. The extent of 5-ALA accumulation is beyond gadolinium contrast enhancement.1,2 Supratotal resection may be achieved, potentially granting patients with better survival. We present our experience on 5-ALA guided glioma resection in Chinese ethnics. METHOD Sixteen Patients ingested 5-ALA (Gliolan, Medas Germany) 20 mg/kg·m2 4 h before surgery. The tumor resection was guided by fluorescence with neurosurgical microscope. Patient was monitored for general condition, especially for new neurological deficits. Postoperative MRI served as the assessment for extent of resection (EOR). RESULT High grade glioma was confirmed in 12 cases, low grade glioma in three and one inflammation. 5-ALA was used in ten patients with known malignant glioma, and in six patients with presumed diagnosis of malignant glioma. Fifteen cases had positive fluorescence. The intensity was strong in eight and moderate in seven cases. MRI suggested total resection was achieved in 9 patients, near total resection in two and five had subtotal resection. EOR was associated with duration between ingestion of 5-ALA and timing when microscope was brought in for visualization of fluorescence (p = 0.038). Two patients suffered from temporary visual field defects. One patient developed hemiparesis after surgery. CONCLUSION 5-ALA is a useful intra-operative guidance for resection. It increases the percentage of total removal of the tumor. It should be used within the window period of the action (4-12 h).
Collapse
Affiliation(s)
- Danny Tat Ming Chan
- CUHK Otto Wong Brain Tumor Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SAR.
| | - Hsieh Yi-Pin Sonia
- CUHK Otto Wong Brain Tumor Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SAR
| | - Wai Sang Poon
- CUHK Otto Wong Brain Tumor Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SAR
| |
Collapse
|
32
|
Daly HC, Sampedro G, Bon C, Wu D, Ismail G, Cahill RA, O'Shea DF. BF 2-azadipyrromethene NIR-emissive fluorophores with research and clinical potential. Eur J Med Chem 2017; 135:392-400. [PMID: 28460313 DOI: 10.1016/j.ejmech.2017.04.051] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 04/14/2017] [Accepted: 04/20/2017] [Indexed: 12/26/2022]
Abstract
The use of near-infrared fluorescence for in vivo research and intraoperative clinical imaging is rapidly expanding, with new applications being proposed and developed. While imaging hardware and software have significantly progressed in recent times, the molecular fluorescent agents remain a limiting factor. In this report, the design, synthesis, photophysical characterization and bio-medical imaging assessment of two new NIR-fluorophores based on the BF2-azadipyrromethene fluorophore class are described. Inclusion of dimethylamino substituents on these BF2-azadipyrromethene probes results in very large bathochromic shifts with photophysical measurements showing absorption and emission maxima between 757 and 818 nm within the desired NIR spectra region. Testing of the probes shows that they are suitable for fluorescence imaging with both research and clinical instrumentation. Preclinical imaging assessment shows their suitability as fluorescent markers (tattoos) of lesions for intraoperative identification and lymphatic mapping in ex vivo human colonic tissue. These new clinical wavelength-compatible fluorophores may contribute towards the on-going expansion of medical uses for NIR-fluorescence.
Collapse
|
33
|
Nerup N, Andersen HS, Ambrus R, Strandby RB, Svendsen MBS, Madsen MH, Svendsen LB, Achiam MP. Quantification of fluorescence angiography in a porcine model. Langenbecks Arch Surg 2016; 402:655-662. [PMID: 27848028 DOI: 10.1007/s00423-016-1531-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 10/30/2016] [Indexed: 12/26/2022]
Abstract
PURPOSE There is no consensus on how to quantify indocyanine green (ICG) fluorescence angiography. The aim of the present study was to establish and gather validity evidence for a method of quantifying fluorescence angiography, to assess organ perfusion. METHODS Laparotomy was performed on seven pigs, with two regions of interest (ROIs) marked. ICG and neutron-activated microspheres were administered and the stomach was illuminated in the near-infrared range, parallel to continuous recording of fluorescence signal. Tissue samples from the ROIs were sent for quantification of microspheres to calculate the regional blood flow. A software system was developed to assess the fluorescent recordings quantitatively, and each quantitative parameter was compared with the regional blood flow. The parameter with the strongest correlation was then compared with results from an independently developed algorithm, to evaluate reproducibility. RESULTS A strong correlation was found between regional blood flow and the slope of the fluorescence curves (ROI I: Pearson r = 0.97, p < 0.001; ROI II: 0.96, p < 0.001) as the normalized slope (ROI I: Pearson r = 0.92, p = 0.004; ROI II: r = 0.96, p = 0.001). There was acceptable correlation of the slope of the curve between two independently developed algorithms (ROI I+II: Pearson r = 0.83, p < 0.001), and good resemblance was found with the Bland-Altman method, with no proportional bias. CONCLUSIONS Perfusion assessment with quantitative indocyanine green fluorescence angiography is not only feasible but easy to perform with commercially available equipment and readily accessible software.
Collapse
Affiliation(s)
- Nikolaj Nerup
- Department of Surgical Gastroenterology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark.
| | - Helene Schou Andersen
- Center for Surgical Science (CSS), Zealand University Hospital, Lykkebækvej 1, 4600, Køge, Denmark
| | - Rikard Ambrus
- Department of Surgical Gastroenterology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark
| | - Rune Broni Strandby
- Department of Surgical Gastroenterology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark
| | | | - Mads Holst Madsen
- Niels Bohr Institute, University of Copenhagen, Blegdamsvej 17, 2100, Copenhagen Ø, Denmark
| | - Lars Bo Svendsen
- Department of Surgical Gastroenterology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark
| | - Michael Patrick Achiam
- Department of Surgical Gastroenterology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark
| |
Collapse
|
34
|
Josserand V, Kéramidas M, Lavaud J, Righini C, Vollaire J, Bellard E, Rols MP, Teissié J, Coll JL, Golzio M. Electrochemotherapy guided by intraoperative fluorescence imaging for the treatment of inoperable peritoneal micro-metastases. J Control Release 2016; 233:81-7. [PMID: 27155365 DOI: 10.1016/j.jconrel.2016.05.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 04/25/2016] [Accepted: 05/01/2016] [Indexed: 01/15/2023]
Abstract
Surgery is often the first therapeutic indication in cancer. Patient survival essentially depends on the completeness of tumor resection. This is a major challenge, particularly in patients with peritoneal carcinomatosis (PC), where tumors are widely disseminated in the large peritoneal cavity. These small tumors can be difficult to visualize and are often positioned in delicate locations, further increasing the risk of producing serious tissue/organ damage during their ablation. We propose an innovative therapeutic approach based on intraoperative fluorescence (IF) guided electrochemotherapy (ECT) for the treatment of peritoneal micro-metastases. ECT combines the effects of tissue electro-permeabilization (EP) with the administration of an antimitotic agent (bleomycin) that has poor permeability across intact membranes. IF significantly improves the detection of small tumor lesions. ECT is clinically validated for the treatment of cutaneous tumors in animals and humans, but this is the first time that it has been used along with IF imaging for the targeted treatment of peritoneal metastases in a preclinical model. We set up a murine model of PC that develops secondarily to the resection of a distant primary tumor. Tumor growth and metastasis were finely monitored by non-invasive multimodal imaging (bioluminescence and 3D fluorescence/microCT). Once metastases were detected, mice were randomized into three groups: the ECT group (bleomycin injected intravenously followed by EP) and 2 control groups (bleomycin alone and EP alone). Twenty four hours after the intravenous injection of the tumor targeting agent Angiostamp™700, mice in all groups underwent an abdominal surgery for metastases exploration assisted by fluorescence imaging with the Fluobeam®700 portative device. EP was applied to every nodule detected by IF, except in the bleomycin control group. After surgery, the metastatic invasion was tracked by bioluminescence imaging. In mice treated with bleomycin or EP alone, the metastatic load progressed very rapidly and mice showed no significant difference in lifespan compared to non-operated mice (median lifespan: 27days vs. 25days, respectively). In contrast, the mice treated with ECT displayed a decreased metastatic load and an increased survival rate (median lifespan: 34days). These results provide evidence that IF guided ECT is an effective approach for the treatment of inoperable intraperitoneal micro-metastases.
Collapse
Affiliation(s)
- V Josserand
- INSERM U1209, Institut Albert Bonniot, F-38000 Grenoble, France; Univ. Grenoble Alpes, Institut Albert Bonniot, F-38000 Grenoble, France
| | - M Kéramidas
- INSERM U1209, Institut Albert Bonniot, F-38000 Grenoble, France; Univ. Grenoble Alpes, Institut Albert Bonniot, F-38000 Grenoble, France
| | - J Lavaud
- INSERM U1209, Institut Albert Bonniot, F-38000 Grenoble, France; Univ. Grenoble Alpes, Institut Albert Bonniot, F-38000 Grenoble, France
| | - C Righini
- INSERM U1209, Institut Albert Bonniot, F-38000 Grenoble, France; Univ. Grenoble Alpes, Institut Albert Bonniot, F-38000 Grenoble, France; CHU, Grenoble, France
| | - J Vollaire
- INSERM U1209, Institut Albert Bonniot, F-38000 Grenoble, France; Univ. Grenoble Alpes, Institut Albert Bonniot, F-38000 Grenoble, France
| | - E Bellard
- CNRS, IPBS, Toulouse, France; Université de Toulouse, UPS, IPBS, Toulouse, France
| | - M P Rols
- CNRS, IPBS, Toulouse, France; Université de Toulouse, UPS, IPBS, Toulouse, France
| | - J Teissié
- CNRS, IPBS, Toulouse, France; Université de Toulouse, UPS, IPBS, Toulouse, France
| | - J L Coll
- INSERM U1209, Institut Albert Bonniot, F-38000 Grenoble, France; Univ. Grenoble Alpes, Institut Albert Bonniot, F-38000 Grenoble, France.
| | - M Golzio
- CNRS, IPBS, Toulouse, France; Université de Toulouse, UPS, IPBS, Toulouse, France.
| |
Collapse
|
35
|
Hamamcıoğlu MK, Akçakaya MO, Göker B, Kasımcan MÖ, Kırış T. The use of the YELLOW 560 nm surgical microscope filter for sodium fluorescein-guided resection of brain tumors: Our preliminary results in a series of 28 patients. Clin Neurol Neurosurg 2016; 143:39-45. [PMID: 26895208 DOI: 10.1016/j.clineuro.2016.02.006] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 02/04/2016] [Accepted: 02/05/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Sodium fluorescein (Na-Fl) is a fluorescent dye that accumulates in tumoral tissues via disrupted blood-brain barrier. It has been used in fluorescence-guided surgery for various brain tumors. Herein, we report our initial experience and preliminary results for the first 28 patients who were operated on under Na-Fl guidance with the use of a special filter on the surgical microscope. PATIENT AND METHODS Between January and November 2015, 200 mg (2-4 mg/kg) of Na-Fl was administered in 28 patients (30 surgeries) after anesthesia induction. The clinical features, surgical observations, extent of resection on the postoperative magnetic resonance imaging (MRI) and histopathology of the tumors were retrospectively analyzed. The use of YELLOW 560 nm filter was found "helpful" if the discrimination of the pinkish brain tissue and bright yellow stained tumor tissue was clear. Otherwise, it was described as "not helpful. RESULTS There were 23 high-grade and 7 metastatic tumors in our study group. Na-Fl was found helpful by means of the tumor demarcation in 29 of 30 operations (97%). In 23 of these 29 operations (79%), a total resection was achieved regardless of the tumor pathology. No adverse events were encountered regarding the use of Na-Fl. CONCLUSION Na-Fl guidance with the use of a YELLOW 560 filter is safe and effective in high-grade glioma and metastatic tumor surgery. We think it is feasible for increasing the extent of resection in these tumors.
Collapse
Affiliation(s)
| | | | - Burcu Göker
- Department of Neurosurgery, Liv Hospital, Istanbul, Turkey
| | | | - Talat Kırış
- Department of Neurosurgery, Liv Hospital, Istanbul, Turkey
| |
Collapse
|
36
|
Okusanya OT, Madajewski B, Segal E, Judy BF, Venegas OG, Judy RP, Quatromoni JG, Wang MD, Nie S, Singhal S. Small portable interchangeable imager of fluorescence for fluorescence guided surgery and research. Technol Cancer Res Treat 2014; 14:213-20. [PMID: 24354756 DOI: 10.7785/tcrt.2012.500400] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 11/26/2013] [Indexed: 01/09/2023] Open
Abstract
Fluorescence guided surgery (FGS) is a developing field of surgical and oncologic research. Practically, FGS has shown useful applications in urologic surgery, benign biliary surgery, colorectal cancer liver metastasis resection, and ovarian cancer debulking. Most notably in in cancer surgery, FGS allows for the clear delineation of cancerous tissue from benign tissue. FGS requires the utilization of a fluorescent contrast agent and an intraoperative fluorescence imaging device (IFID). Currently available IFIDs are expensive, unable to work with multiple fluorophores, and can be cumbersome. This study aims to describe the development and utility of a small, cost-efficient, and interchangeable IFID made from commercially available components. Extensive research was done to design and construct a light-weight, portable, and cost-effective IFID. We researched the capabilities, size, and cost of several camera types and eventually decided on a near-infrared (NIR) charged couple device (CCD) camera for its overall profile. The small portable interchangeable imager of fluorescence (SPIIF) is a "scout" IFID system for FGS. The main components of the SPIIF are a NIR CCD camera with an articulating light filter. These components and a LED light source with an attached heat sink are mounted on a small metal platform. The system is connected to a laptop by a USB 2.0 cable. Pixielink © software on the laptop runs the system by controlling exposure time, gain, and image capture. After developing the system, we evaluated its utility as an IFID. The system weighs less than two pounds and can cover a large area. Due to its small size, it is easily made sterile by covering it with any sterile plastic sheet. To determine the system's ability to detect fluorescent signal, we used the SPIIF to detect indocyanine green under ex and in-vivo conditions and fluorescein under ex-vivo conditions. We found the SPIIF was able to detect both ICG and fluorescein under different depths of a semi-opaque colloid. Second, we found that a concentration as low as 0.5 g/ml of indocyanine green dissolved in plasma was detectable. Lastly, in a murine and human cancer model, the SPIIF was able to detect indocyanine green signal within tumors and generate a signal-to-background ratio (SBR) of 3.75. This study shows that a low-cost IFID can be made from commercially available parts. Second, this IFID is capable of in and ex-vivo detection of multiple fluorophores without sacrificing its small size or favorable ergonomics.
Collapse
Affiliation(s)
- Olugbenga T Okusanya
- Thoracic Surgery Research Laboratory, Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
| | - Brian Madajewski
- Thoracic Surgery Research Laboratory, Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
| | - Erin Segal
- Thoracic Surgery Research Laboratory, Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
| | - Brendan F Judy
- Thoracic Surgery Research Laboratory, Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
| | - Ollin G Venegas
- Thoracic Surgery Research Laboratory, Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
| | - Ryan P Judy
- Thoracic Surgery Research Laboratory, Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
| | - Jon G Quatromoni
- Thoracic Surgery Research Laboratory, Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
| | - May D Wang
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia
| | - Shuming Nie
- Departments of Biomedical Engineering and Chemistry, Emory University, Atlanta, Georgia
| | - Sunil Singhal
- Thoracic Surgery Research Laboratory, Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
| |
Collapse
|
37
|
Hussain T, Nguyen QT. Molecular imaging for cancer diagnosis and surgery. Adv Drug Deliv Rev 2014; 66:90-100. [PMID: 24064465 DOI: 10.1016/j.addr.2013.09.007] [Citation(s) in RCA: 210] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 09/07/2013] [Accepted: 09/13/2013] [Indexed: 12/11/2022]
Abstract
Novel molecular imaging techniques have the potential to significantly enhance the diagnostic and therapeutic approaches for cancer treatment. For solid tumors in particular, novel molecular enhancers for imaging modalities such as US, CT, MRI and PET may facilitate earlier and more accurate diagnosis and staging which are prerequisites for successful surgical therapy. Enzymatically activatable "smart" molecular MRI probes seem particularly promising because of their potential to image tumors before and after surgical removal without re-administration of the probe to evaluate completeness of surgical resection. Furthermore, the use of "smart" MR probes as part of screening programs may enable detection of small tumors throughout the body in at-risk patient populations. Dual labeling of molecular MR probes with fluorescent dyes can add real time intraoperative guidance facilitating complete tumor resection and preservation of important structures. A truly theranostic approach with the further addition of therapeutic agents to the molecular probe for adjuvant therapy is conceivable for the future.
Collapse
|
38
|
Song SW, Kim YH, Park SH, Park CK. 5-aminolevulinic Acid fluorescence discriminates the histological grade of extraventricular neurocytoma. Brain Tumor Res Treat 2013; 1:45-9. [PMID: 24904890 PMCID: PMC4027114 DOI: 10.14791/btrt.2013.1.1.45] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2013] [Revised: 04/19/2013] [Accepted: 04/20/2013] [Indexed: 11/20/2022] Open
Abstract
Extraventricular neurocytomas are rare brain tumors that have a diverse range of clinical characteristics. We describe two cases involving fluorescence-guided resection of extraventricular neurocytoma using 5-aminolevulinic acid (5-ALA) and evaluate the efficacy of the technique. We found that the tumor reactions to 5-ALA differed depending on the histologic grade. This finding shows that the 5-ALA fluorescence reaction may potentially be used as a biomarker of the clinical behavior of these tumors. To our knowledge, this is the first report in which fluorescence-guided resection was utilized for the resection of extraventricular neurocytomas.
Collapse
Affiliation(s)
- Sang Woo Song
- Department of Neurosurgery, Konkuk University Hospital, Seoul, Korea
| | - Young-Hoon Kim
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - Sung-Hye Park
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - Chul-Kee Park
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|