An Integrated Widefield Imaging and Spectroscopy System for Contrast-Enhanced, Image-Guided Resection of Tumors

• Type of Material: Article
• Authors: Aaron M. Mohs, Wake Forest University; Michael C Mancini, Emory University; James Provenzale, Emory University; Corey F Saba, University of Georgia; Karen K Cornell, University of Georgia; Elizabeth W. Howerth, University of Georgia; Shuming Nie, Emory University
• Language: English
• Date: 2015-05-01
• Publisher: Institute of Electrical and Electronics Engineers (IEEE)
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 1964-2012 IEEE.
• Final Published Version (URL): http://dx.doi.org/10.1109/TBME.2015.2389626
• Title of Journal or Parent Work: IEEE Transactions on Biomedical Engineering
• ISSN: 0018-9294
• Volume: 62
• Issue: 5
• Start Page: 1416
• End Page: 1424
• Grant/Funding Information: This work was supported in part by grants from the Centers of Cancer Nanotechnology Excellence (CCNE) Program (U54 CA119338) and the U.S. National Institutes of Health Grand Opportunity (GO) grant (RC2 CA148265) to S. Nieand an NCI Alliance in Nanotechnology for a Pathway to Independence Award (R00 CA153916) to A. Mohs.
• Keywords: POSITIVE SURGICAL MARGINS; CERVICAL-CANCER; optical spectroscopy; Image; Engineering; LIVER CANCERS; Technology; Science & Technology; surgical oncology; SURGERY; RECURRENCE; indocyanine green (ICG); tumors; IDENTIFICATION; Engineering, Biomedical; IN-VIVO; IMPACT; optical imaging; guided surgery
• Research Categories: Health Sciences, Medicine and Surgery; Engineering, Biomedical; Health Sciences, Oncology

Abstract

Tumor recurrence following surgery is a common and unresolved medical problem of great importance since surgery is the most widely used treatment for solid-mass tumors worldwide. A contributing factor to tumor recurrence is the presence of residual tumor remaining at or near the surgical site following surgery. Goal: The primary objective of this study was to develop and evaluate an image-guided surgery system based on a near-infrared, handheld excitation source and spectrograph in combination with a widefield video imaging system. Methods: This system was designed to detect the fluorescence of near-infrared contrast agents and, in particular, indocyanine green (ICG). The imaging system was evaluated for its optical performance and ability to detect the presence of ICG in tumors in an ectopic murine tumor model as well as in spontaneous tumors arising in canines. Results: In both settings, an intravenous ICG infusion provided tumor contrast. In both the murine models and surgical specimens from canines, ICG preferentially accumulated in tumor tissue compared to surrounding normal tissue. The resulting contrast was sufficient to distinguish neoplasia from normal tissue; in the canine surgical specimens, the contrast was sufficient to permit identification of neoplasia on the marginal surface of the specimen. Conclusion: These results demonstrate a unique concept in image-guided surgery by combining local excitation and spectroscopy with widefield imaging. Significance: The ability to readily detect ICG in canines with spontaneous tumors in a clinical setting exemplifies the potential for further clinical translation; the promising results of detecting neoplasia on the marginal specimen surface underscore the clinical utility.