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Wang C, Xu X, Hodge S, Chen EY, Hoopes PJ, Tichauer KM, Samkoe KS. Identification of a Suitable Untargeted Agent for the Clinical Translation of ABY-029 Paired-Agent Imaging in Fluorescence-Guided Surgery. Mol Imaging Biol 2023; 25:97-109. [PMID: 34642897 PMCID: PMC9413473 DOI: 10.1007/s11307-021-01642-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 08/05/2021] [Accepted: 08/12/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Non-specific uptake and retention of molecular targeted agents and heterogeneous tissue optical properties diminish the ability to differentiate between tumor and normal tissues using molecular targeted fluorescent agents. Paired-agent imaging (PAI) can increase the diagnostic ability to detect tumor tissue by mitigating these non-specific effects and providing true molecular contrast by co-administration of an untargeted control imaging agent with a targeted agent. This study evaluates the suitability of available clinically translatable untargeted agents for the translation of PAI in fluorescence-guided surgery using an affibody-based targeted imaging agent (ABY-029). EXPERIMENTAL DESIGN: Three untargeted agents that fluoresce near 700 nm and exhibit good clinical safety profiles (methylene blue, IRDye 700DX, and IRDye 680LT) were tested in combination with the clinically tested IRDye 800CW-labeled anti-epidermal growth factor receptor (EGFR) affibody molecule, ABY-029 (eIND 122,681). Properties of the untargeted agent important for human use and integrity of PAI were tested: (1) plasma protein binding; (2) fluorescence signal linearity in in vitro whole blood dilution; (3) in vivo pharmacokinetic matching to targeted agent in negative control tissue; and (4) in vivo diagnostic accuracy of PAI vs single agent imaging (SAI) of ABY-029 alone in orthotopic oral head and neck squamous cell carcinomas. RESULTS IRDye 680LT outperformed IRDye 700DX and methylene blue with the highest signal linearity (R2 = 0.9998 ± 0.0002, 0.9995 ± 0.0004, 0.91 ± 0.02, respectively), the highest fluorescence yield in whole blood at 1 μM (104.42 ± 0.05, 103.68 ± 0.09, 101.9 ± 0.2, respectively), and the most closely matched ABY-029 pharmacokinetics in EGFR-negative tissues (binding potential error percentage = 0.31% ± 0.37%, 10.25% ± 1.30%, and 8.10% ± 5.37%, respectively). The diagnostic ability of PAI with ABY-029 and IRDye 680LT outperformed conventional SAI with an area-under-the-receiver-operating-characteristic curve (AUC) value of 0.964 vs. 0.854, and 0.978 vs. 0.925 in the Odyssey scanning system and Pearl wide field imaging system, respectively. CONCLUSION PAI is a highly promising methodology for increasing detection of tumors in fluorescence-guided surgery. Although not yet clinically approved, IRDye 680LT demonstrates promise as an untargeted agent when paired with ABY-029. The clinical translation of PAI to maximize tumor excision, while minimizing normal tissue removal, could improve both patient survival and life quality.
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Affiliation(s)
- Cheng Wang
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA
| | - Xiaochun Xu
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA
| | - Sassan Hodge
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA
| | - Eunice Y Chen
- Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - P Jack Hoopes
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA.,Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - Kenneth M Tichauer
- Biomedical Engineering, Illinois Institute of Technology, Chicago, IL, USA
| | - Kimberley S Samkoe
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA. .,Geisel School of Medicine, Dartmouth College, Hanover, NH, USA.
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2
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Hernandez Vargas S, Lin C, Tran Cao HS, Ikoma N, AghaAmiri S, Ghosh SC, Uselmann AJ, Azhdarinia A. Receptor-Targeted Fluorescence-Guided Surgery With Low Molecular Weight Agents. Front Oncol 2021; 11:674083. [PMID: 34277418 PMCID: PMC8279813 DOI: 10.3389/fonc.2021.674083] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 05/10/2021] [Indexed: 12/16/2022] Open
Abstract
Cancer surgery remains the primary treatment option for most solid tumors and can be curative if all malignant cells are removed. Surgeons have historically relied on visual and tactile cues to maximize tumor resection, but clinical data suggest that relapse occurs partially due to incomplete cancer removal. As a result, the introduction of technologies that enhance the ability to visualize tumors in the operating room represents a pressing need. Such technologies have the potential to revolutionize the surgical standard-of-care by enabling real-time detection of surgical margins, subclinical residual disease, lymph node metastases and synchronous/metachronous tumors. Fluorescence-guided surgery (FGS) in the near-infrared (NIRF) spectrum has shown tremendous promise as an intraoperative imaging modality. An increasing number of clinical studies have demonstrated that tumor-selective FGS agents can improve the predictive value of fluorescence over non-targeted dyes. Whereas NIRF-labeled macromolecules (i.e., antibodies) spearheaded the widespread clinical translation of tumor-selective FGS drugs, peptides and small-molecules are emerging as valuable alternatives. Here, we first review the state-of-the-art of promising low molecular weight agents that are in clinical development for FGS; we then discuss the significance, application and constraints of emerging tumor-selective FGS technologies.
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Affiliation(s)
- Servando Hernandez Vargas
- The Brown Foundation Institute of Molecular Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States.,Therapeutics & Pharmacology Program, The University of Texas MD Anderson UTHealth Graduate School of Biomedical Sciences, Houston, TX, United States
| | | | - Hop S Tran Cao
- Department of Surgical Oncology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Naruhiko Ikoma
- Department of Surgical Oncology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Solmaz AghaAmiri
- The Brown Foundation Institute of Molecular Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Sukhen C Ghosh
- The Brown Foundation Institute of Molecular Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | | | - Ali Azhdarinia
- The Brown Foundation Institute of Molecular Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States.,Therapeutics & Pharmacology Program, The University of Texas MD Anderson UTHealth Graduate School of Biomedical Sciences, Houston, TX, United States
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3
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Hernandez Vargas S, Lin C, Voss J, Ghosh SC, Halperin DM, AghaAmiri S, Cao HST, Ikoma N, Uselmann AJ, Azhdarinia A. Development of a drug-device combination for fluorescence-guided surgery in neuroendocrine tumors. JOURNAL OF BIOMEDICAL OPTICS 2020; 25:JBO-200129R. [PMID: 33300316 PMCID: PMC7725236 DOI: 10.1117/1.jbo.25.12.126002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 11/06/2020] [Indexed: 05/13/2023]
Abstract
SIGNIFICANCE The use of cancer-targeted contrast agents in fluorescence-guided surgery (FGS) has the potential to improve intraoperative visualization of tumors and surgical margins. However, evaluation of their translational potential is challenging. AIM We examined the utility of a somatostatin receptor subtype-2 (SSTR2)-targeted fluorescent agent in combination with a benchtop near-infrared fluorescence (NIRF) imaging system to visualize mouse xenografts under conditions that simulate the clinical FGS workflow for open surgical procedures. APPROACH The dual-labeled somatostatin analog, Ga67-MMC(IR800)-TOC, was injected into mice (n = 24) implanted with SSTR2-expressing tumors and imaged with the customized OnLume NIRF imaging system (Madison, Wisconsin). In vivo and ex vivo imaging were performed under ambient light. The optimal dose (0.2, 0.5, and 2 nmol) and imaging time point (3, 24, 48, and 72 h) were determined using contrast-to-noise ratio (CNR) as the image quality parameter. Video captures of tumor resections were obtained to provide an FGS readout that is representative of clinical utility. Finally, a log-transformed linear regression model was fitted to assess congruence between fluorescence readouts and the underlying drug distribution. RESULTS The drug-device combination provided high in vivo and ex vivo contrast (CNRs > 3, except lung at 3 h) at all time points with the optimal dose of 2 nmol. The optimal imaging time point was 24-h post-injection, where CNRs > 6.5 were achieved in tissues of interest (i.e., pancreas, small intestine, stomach, and lung). Intraoperative FGS showed excellent utility for examination of the tumor cavity pre- and post-resection. The relationship between fluorescence readouts and gamma counts was linear and strongly correlated (n = 334, R2 = 0.71; r = 0.84; P < 0.0001). CONCLUSION The innovative OnLume NIRF imaging system enhanced the evaluation of Ga67-MMC(IR800)-TOC in tumor models. These components comprise a promising drug-device combination for FGS in patients with SSTR2-expressing tumors.
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Affiliation(s)
- Servando Hernandez Vargas
- The University of Texas Health Science Center at Houston, The Brown Foundation Institute of Molecular Medicine, McGovern Medical School, Houston, Texas, United States
| | | | - Julie Voss
- The University of Texas Health Science Center at Houston, The Brown Foundation Institute of Molecular Medicine, McGovern Medical School, Houston, Texas, United States
| | - Sukhen C. Ghosh
- The University of Texas Health Science Center at Houston, The Brown Foundation Institute of Molecular Medicine, McGovern Medical School, Houston, Texas, United States
| | - Daniel M. Halperin
- The University of Texas MD Anderson Cancer Center, Department of Gastrointestinal Medical Oncology, Division of Cancer Medicine, Houston, Texas, United States
| | - Solmaz AghaAmiri
- The University of Texas Health Science Center at Houston, The Brown Foundation Institute of Molecular Medicine, McGovern Medical School, Houston, Texas, United States
| | - Hop S. Tran Cao
- The University of Texas MD Anderson Cancer Center, Department of Surgical Oncology, Division of Surgery, Houston, Texas, United States
| | - Naruhiko Ikoma
- The University of Texas MD Anderson Cancer Center, Department of Surgical Oncology, Division of Surgery, Houston, Texas, United States
| | | | - Ali Azhdarinia
- The University of Texas Health Science Center at Houston, The Brown Foundation Institute of Molecular Medicine, McGovern Medical School, Houston, Texas, United States
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Barth CW, Gibbs SL. Fluorescence Image-Guided Surgery - a Perspective on Contrast Agent Development. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2020; 11222:112220J. [PMID: 32255887 PMCID: PMC7115043 DOI: 10.1117/12.2545292] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
In the past several decades, a number of novel fluorescence image-guided surgery (FGS) contrast agents have been under development, with many in clinical translation and undergoing clinical trials. In this review, we have identified and summarized the contrast agents currently undergoing clinical translation. In total, 39 novel FGS contrast agents are being studied in 85 clinical trials. Four FGS contrast agents are currently being studied in phase III clinical trials and are poised to reach FDA approval within the next two to three years. Among all novel FGS contrast agents, a wide variety of probe types, targeting mechanisms, and fluorescence properties exists. Clinically available FGS imaging systems have been developed for FDA approved FGS contrast agents, and thus further clinical development is required to yield FGS imaging systems tuned for the variety of contrast agents in the clinical pipeline. Additionally, study of current FGS contrast agents for additional disease types and development of anatomy specific contrast agents is required to provide surgeons FGS tools for all surgical specialties and associated comorbidities. The work reviewed here represents a significant effort from many groups and further development of this promising technology will have an enormous impact on surgical outcomes across all specialties.
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Affiliation(s)
- Connor W Barth
- Biomedical Engineering Department, Oregon Health & Science University, Portland, OR 97201
| | - Summer L Gibbs
- Biomedical Engineering Department, Oregon Health & Science University, Portland, OR 97201
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97201
- OHSU Center for Spatial Systems Biomedicine, Oregon Health & Science University, Portland, OR 97201
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Vargas SH, Lin C, AghaAmiri S, Voss J, Ikoma N, Tran Cao HS, Ghosh SC, Uselmann AJ, Azhdarinia A. A proof-of-concept methodology to validate the in situ visualization of residual disease using cancer-targeted molecular agents in fluorescence-guided surgery. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2020; 11222. [PMID: 34054189 DOI: 10.1117/12.2546190] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Introduction The clinical need for improved intraoperative tumor visualization has led to the development of targeted contrast agents for fluorescence-guided surgery (FGS). A key characteristic of these agents is their high tumor specificity, which could enable detection of residual lesions that would likely be missed by visual inspection. Here, we examine the utility of a promising somatostatin receptor subtype-2 (SSTR2)-targeted fluorescent agent for detecting residual disease in mouse xenografts using FGS and post-operative histopathological validation. Methods Mice (n=2) implanted with SSTR2 overexpressing tumors were injected with 2 nmol of the dual-labeled somatostatin analog, 67Ga-MMC(IR800)-TOC, and tumors were resected 48 h post-injection using traditional white light reflectance and palpation. Tumors underwent gamma counting and histopathology analysis. The wide-field FGS imaging platform (OnLume) was used to evaluate residual disease in situ under ambient light representative of an operating room. Results The tumor was resected with grossly negative margins using conventional inspection and palpation; however, additional in situ residual disease was found in the tumor cavity using FGS imaging. In situ fluorescent tumor contrast-to-noise ratios (CNRs) were 3.0 and 5.2. Agent accumulation was 7.72 and 8.20 %ID/g in tumors and 0.27 and 0.20 %ID/g in muscle. Fluorescence pixel values and gamma counts were highly correlated (r = 0.95, P < 0.048). H&E and IHC staining confirmed cancer positivity and SSTR2-overexpression, respectively. Conclusion Our findings demonstrate that the use of clinically relevant fluorescence imaging instrumentation enhances the evaluation of promising FGS agents for in situ visualization of residual disease.
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Affiliation(s)
- Servando Hernandez Vargas
- Institute of Molecular Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (Houston, TX, USA)
| | | | - Solmaz AghaAmiri
- Institute of Molecular Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (Houston, TX, USA)
| | - Julie Voss
- Institute of Molecular Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (Houston, TX, USA)
| | - Naruhiko Ikoma
- University of Texas MD Anderson Cancer Center (Houston, TX, USA)
| | - Hop S Tran Cao
- University of Texas MD Anderson Cancer Center (Houston, TX, USA)
| | - Sukhen C Ghosh
- Institute of Molecular Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (Houston, TX, USA)
| | | | - Ali Azhdarinia
- Institute of Molecular Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (Houston, TX, USA)
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6
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Samkoe KS, Sardar HS, Gunn J, Feldwisch J, Linos K, Henderson E, Pogue B, Paulsen K. Measuring microdose ABY-029 fluorescence signal in a primary human soft-tissue sarcoma resection. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2019; 10862. [PMID: 31595101 DOI: 10.1117/12.2510935] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Microdose administration of ABY-029, an anti-epidermal growth factor receptor Affibody molecule conjugated to IRDye 800CW, is being studied in a Phase 0 trial for resection of soft-tissue sarcomas. The excised tissue of a single patient in the microdose administration group was imaged with both a wide-field fluorescence surgical system and a flat-bed scanning fluorescence imaging system. Here the resultant fluorescence from a breadloaf section of the primary tumor specimen and six region-specific tissue samples collected from that breadloaf are compared using these two imaging systems - a flatbed, black-box, fluorescence scanning system, the Odyssey CLx, and a open-air, wide-field, pre-clinical surgical imaging system, the Solaris. Florescence signal is compared using a variety of methods including: mean, standard deviation, variance, tumor-to-background ratio, biological-variance ratio, and contrast-to-noise ratio. The images produced from the Odyssey scanner have higher signal variance but more accurately represent the EGFR expression in small tissue sections. The Solaris system has higher depth sensitivity and volume averaging, and as such has lower signal variation and higher contrast-to-noise ratio.
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Affiliation(s)
- Kimberley S Samkoe
- Geisel School of Medicine, Dartmouth College, Hanover, NH 03755.,Department of Surgery, Dartmouth-Hitchcock, Lebanon, NH, 03756.,Thayer School of Engineering, Dartmouth College, Hanover, NH, 03755
| | | | - Jason Gunn
- Department of Surgery, Dartmouth-Hitchcock, Lebanon, NH, 03756
| | | | - Konstantinos Linos
- Geisel School of Medicine, Dartmouth College, Hanover, NH 03755.,Department of Pathology, Dartmouth-Hitchcock, Lebanon, NH, 03756
| | - Eric Henderson
- Geisel School of Medicine, Dartmouth College, Hanover, NH 03755.,Department of Orthopaedics, Dartmouth-Hitchcock, Lebanon, NH, 03756
| | - Brian Pogue
- Thayer School of Engineering, Dartmouth College, Hanover, NH, 03755
| | - Keith Paulsen
- Thayer School of Engineering, Dartmouth College, Hanover, NH, 03755
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7
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Samkoe KS, Sardar HS, Bates BD, Tselepidakis NN, Gunn JR, Hoffer-Hawlik KA, Feldwisch J, Pogue BW, Paulsen KD, Henderson ER. Preclinical imaging of epidermal growth factor receptor with ABY-029 in soft-tissue sarcoma for fluorescence-guided surgery and tumor detection. J Surg Oncol 2019; 119:1077-1086. [PMID: 30950072 DOI: 10.1002/jso.25468] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 02/26/2019] [Accepted: 03/14/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND OBJECTIVES Fluorescence-guided surgery using epidermal growth factor receptor (EGFR) targeting has been performed successfully in clinical trials using a variety of fluorescent agents. We investigate ABY-029 (anti-EGFR Affibody® molecule labeled with IRDye 800CW) compared with a small-molecule perfusion agent, IRDye 700DX carboxylate, in a panel of soft-tissue sarcomas with varying levels of EGFR expression and vascularization. METHODS Five xenograft soft-tissue sarcoma cell lines were implanted into immunosuppressed mice. ABY-029 and IRDye 700DX were each administered at 4.98 μM. Fluorescence from in vivo and ex vivo (fresh and formalin-fixed) fixed tissues were compared. The performance of three fluorescence imaging systems was assessed for ex vivo tissues. RESULTS ABY-029 is retained longer within tumor tissue and achieves higher tumor-to-background ratios both in vivo and ex vivo than IRDye 700DX. ABY-029 fluorescence is less susceptible to formalin fixation than IRDye 700DX, but both agents have disproportional signal loss in a variety of tissues. The Pearl Impulse provides the highest contrast-to-noise ratio, but all systems have individual advantages. CONCLUSIONS ABY-029 demonstrates promise to assist in wide local excision of soft-tissue sarcomas. Further clinical evaluation of in situ or freshly excised ex vivo tissues using fluorescence imaging systems is warranted.
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Affiliation(s)
- Kimberley S Samkoe
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.,Department of Surgery, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire.,Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire
| | - Hira S Sardar
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire
| | - Brent D Bates
- Department of Orthaepedics, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | | | - Jason R Gunn
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire
| | | | | | - Brian W Pogue
- Department of Surgery, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire.,Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire
| | - Keith D Paulsen
- Department of Surgery, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire.,Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire
| | - Eric R Henderson
- Department of Orthaepedics, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire.,Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
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8
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Samkoe KS, Bates BD, Elliott JT, LaRochelle E, Gunn JR, Marra K, Feldwisch J, Ramkumar DB, Bauer DF, Paulsen KD, Pogue BW, Henderson ER. Application of Fluorescence-Guided Surgery to Subsurface Cancers Requiring Wide Local Excision: Literature Review and Novel Developments Toward Indirect Visualization. Cancer Control 2018; 25:1073274817752332. [PMID: 29334791 PMCID: PMC5933571 DOI: 10.1177/1073274817752332] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Accepted: 12/05/2017] [Indexed: 01/08/2023] Open
Abstract
The excision of tumors by wide local excision is challenging because the mass must be removed entirely without ever viewing it directly. Positive margin rates in sarcoma resection remain in the range of 20% to 35% and are associated with increased recurrence and decreased survival. Fluorescence-guided surgery (FGS) may improve surgical accuracy and has been utilized in other surgical specialties. ABY-029, an anti-epidermal growth factor receptor Affibody molecule covalently bound to the near-infrared fluorophore IRDye 800CW, is an excellent candidate for future FGS applications in sarcoma resection; however, conventional methods with direct surface tumor visualization are not immediately applicable. A novel technique involving imaging through a margin of normal tissue is needed. We review the past and present applications of FGS and present a novel concept of indirect FGS for visualizing tumor through a margin of normal tissue and aiding in excising the entire lesion as a single, complete mass with tumor-free margins.
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Affiliation(s)
- Kimberley S. Samkoe
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
- Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA
| | - Brent D. Bates
- Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | | | - Ethan LaRochelle
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA
| | - Jason R. Gunn
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA
| | - Kayla Marra
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA
| | | | - Dipak B. Ramkumar
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - David F. Bauer
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Keith D. Paulsen
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA
| | - Brian W. Pogue
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA
| | - Eric R. Henderson
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
- White River Junction VA Medical Center, White River Junction, VT, USA
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Dsouza A, Lin H, Gunn JR, Gladstone DJ, Jarvis LA, Pogue BW. Cherenkov-excited Multi-Fluorophore Sensing in Tissue-Simulating Phantoms and In Vivo from External Beam Radiotherapy. Radiat Res 2017; 189:197-204. [PMID: 29251551 DOI: 10.1667/rr14943.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
In this work, Cherenkov-excited molecular sensing was used to assess the potential for simultaneous quantitative sensing of two NIR fluorophores within tissue-simulating phantoms through spectral separation of signals. Cherenkov emissions induced by external beam gamma photon radiation treatment to tissues/tissue-simulating phantoms were detectable over the 500-900-nm wavelength range. The presence of blood was demonstrated to reduce the integrated intensity of detected Cherenkov emissions by nearly 50%, predominantly at wavelengths below 620 nm. The molecular dyes, IRDye 680RD and IRDye 800CW, have excitation and emission spectra at longer wavelengths than the strongest blood absorption peaks, and also where the intensity of Cherenkov light is at its lowest, so that the emission signal relative to background signal is maximized. Tissue phantoms composed of 1% intralipid and 1% blood were used to simulate human breast tissue, and vials containing fluorophore were embedded in the media, and irradiated with gamma photons for Cherenkov excitation. We observed that fluorescence emissions excited by the Cherenkov signal produced within the phantom could be detected at 5-mm depth into the media within a 0.1-25 μ M fluorophore concentration range. The detected fluorescence signals from these dyes showed linear relationships with radiation doses down to the cGy level. In vivo tests were successful only within the range near a μ M, suggesting that these could be used for metabolic probes in vivo where the local concentrations are near this range.
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Affiliation(s)
| | - Huiyun Lin
- a Thayer School of Engineering and.,d Key Laboratory of OptoElectronic Science and Technology for Medicine of Ministry of Education, Fujian Provincial Key Laboratory of Photonics Technology, Fujian Normal University, Fuzhou, 350007, P.R. China
| | | | - David J Gladstone
- a Thayer School of Engineering and.,b Department of Medicine, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire 03755.,c Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03756; and
| | - Lesley A Jarvis
- b Department of Medicine, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire 03755.,c Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03756; and
| | - Brian W Pogue
- a Thayer School of Engineering and.,c Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03756; and
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10
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Samkoe KS, Bates BD, Tselepidakis NN, DSouza AV, Gunn JR, Ramkumar DB, Paulsen KD, Pogue BW, Henderson ER. Development and evaluation of a connective tissue phantom model for subsurface visualization of cancers requiring wide local excision. JOURNAL OF BIOMEDICAL OPTICS 2017; 22:1-12. [PMID: 29274143 PMCID: PMC5741805 DOI: 10.1117/1.jbo.22.12.121613] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 12/01/2017] [Indexed: 05/14/2023]
Abstract
Wide local excision (WLE) of tumors with negative margins remains a challenge because surgeons cannot directly visualize the mass. Fluorescence-guided surgery (FGS) may improve surgical accuracy; however, conventional methods with direct surface tumor visualization are not immediately applicable, and properties of tissues surrounding the cancer must be considered. We developed a phantom model for sarcoma resection with the near-infrared fluorophore IRDye 800CW and used it to iteratively define the properties of connective tissues that typically surround sarcoma tumors. We then tested the ability of a blinded surgeon to resect fluorescent tumor-simulating inclusions with ∼1-cm margins using predetermined target fluorescence intensities and a Solaris open-air fluorescence imaging system. In connective tissue-simulating phantoms, fluorescence intensity decreased with increasing blood concentration and increased with increasing intralipid concentrations. Fluorescent inclusions could be resolved at ≥1-cm depth in all inclusion concentrations and sizes tested. When inclusion depth was held constant, fluorescence intensity decreased with decreasing volume. Using targeted fluorescence intensities, a blinded surgeon was able to successfully excise inclusions with ∼1-cm margins from fat- and muscle-simulating phantoms with inclusion-to-background contrast ratios as low as 2∶1. Indirect, subsurface FGS is a promising tool for surgical resection of cancers requiring WLE.
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Affiliation(s)
- Kimberley S. Samkoe
- Dartmouth-Hitchcock Medical Center, Department of Surgery, Lebanon, New Hampshire, United States
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, United States
- Thayer School of Engineering at Dartmouth, Hanover, New Hampshire, United States
- Address all correspondence to: Kimberley S. Samkoe, E-mail:
| | - Brent D. Bates
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, United States
| | - Niki N. Tselepidakis
- Thayer School of Engineering at Dartmouth, Hanover, New Hampshire, United States
| | - Alisha V. DSouza
- Thayer School of Engineering at Dartmouth, Hanover, New Hampshire, United States
| | - Jason R. Gunn
- Thayer School of Engineering at Dartmouth, Hanover, New Hampshire, United States
| | - Dipak B. Ramkumar
- Dartmouth-Hitchcock Medical Center, Department of Orthopaedics, Lebanon, New Hampshire, United States
| | - Keith D. Paulsen
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, United States
- Thayer School of Engineering at Dartmouth, Hanover, New Hampshire, United States
| | - Brian W. Pogue
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, United States
- Thayer School of Engineering at Dartmouth, Hanover, New Hampshire, United States
| | - Eric R. Henderson
- Dartmouth-Hitchcock Medical Center, Department of Orthopaedics, Lebanon, New Hampshire, United States
- White River Junction VAMC, White River Junction, Vermont, United States
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Pogue BW, Paulsen KD, Samkoe KS, Elliott JT, Hasan T, Strong TV, Draney DR, Feldwisch J. Vision 20/20: Molecular-guided surgical oncology based upon tumor metabolism or immunologic phenotype: Technological pathways for point of care imaging and intervention. Med Phys 2017; 43:3143-3156. [PMID: 27277060 DOI: 10.1118/1.4951732] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Surgical guidance with fluorescence has been demonstrated in individual clinical trials for decades, but the scientific and commercial conditions exist today for a dramatic increase in clinical value. In the past decade, increased use of indocyanine green based visualization of vascular flow, biliary function, and tissue perfusion has spawned a robust growth in commercial systems that have near-infrared emission imaging and video display capabilities. This recent history combined with major preclinical innovations in fluorescent-labeled molecular probes, has the potential for a shift in surgical practice toward resection guidance based upon molecular information in addition to conventional visual and palpable cues. Most surgical subspecialties already have treatment management decisions partially based upon the immunohistochemical phenotype of the cancer, as assessed from molecular pathology of the biopsy tissue. This phenotyping can inform the surgical resection process by spatial mapping of these features. Further integration of the diagnostic and therapeutic value of tumor metabolism sensing molecules or immune binding agents directly into the surgical process can help this field mature. Maximal value to the patient would come from identifying the spatial patterns of molecular expression in vivo that are well known to exist. However, as each molecular agent is advanced into trials, the performance of the imaging system can have a critical impact on the success. For example, use of pre-existing commercial imaging systems are not well suited to image receptor targeted fluorophores because of the lower concentrations expected, requiring orders of magnitude more sensitivity. Additionally the imaging system needs the appropriate dynamic range and image processing features to view molecular probes or therapeutics that may have nonspecific uptake or pharmacokinetic issues which lead to limitations in contrast. Imaging systems need to be chosen based upon objective performance criteria, and issues around calibration, validation, and interpretation need to be established before a clinical trial starts. Finally, as early phase trials become more established, the costs associated with failures can be crippling to the field, and so judicious use of phase 0 trials with microdose levels of agents is one viable paradigm to help the field advance, but this places high sensitivity requirements on the imaging systems used. Molecular-guided surgery has truly transformative potential, and several key challenges are outlined here with the goal of seeing efficient advancement with ideal choices. The focus of this vision 20/20 paper is on the technological aspects that are needed to be paired with these agents.
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Affiliation(s)
- Brian W Pogue
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire 03755 and Department of Surgery, Dartmouth College, Hanover, New Hampshire 03755
| | - Keith D Paulsen
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire 03755; Department of Surgery, Dartmouth College, Hanover, New Hampshire 03755; and Department of Diagnostic Radiology, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire 03755
| | - Kimberley S Samkoe
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire 03755 and Department of Surgery, Dartmouth College, Hanover, New Hampshire 03755
| | - Jonathan T Elliott
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire 03755
| | - Tayyaba Hasan
- Wellman Center for Photomedicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114 and Division of Health Sciences and Technology, Harvard University and Massachusetts Institute of Technology, Cambridge, Massachusetts 02139
| | - Theresa V Strong
- Vector Production Facility, Division of Hematology Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama 35294
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