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Thapa P, Singh V, Gupta K, Shrivastava A, Kumar V, Kataria K, Mishra PR, Mehta DS. Point-of-care devices based on fluorescence imaging and spectroscopy for tumor margin detection during breast cancer surgery: Towards breast conservation treatment. Lasers Surg Med 2023; 55:423-436. [PMID: 36884000 DOI: 10.1002/lsm.23651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 02/22/2023] [Accepted: 02/23/2023] [Indexed: 03/09/2023]
Abstract
OBJECTIVE Fluorescence-based methods are highly specific and sensitive and have potential in breast cancer detection. Simultaneous fluorescence imaging and spectroscopy during intraoperative procedures of breast cancer have great advantages in detection of tumor margin as well as in classification of tumor to healthy tissues. Intra-operative real-time confirmation of breast cancer tumor margin is the aim of surgeons, and therefore, there is an urgent need for such techniques and devices which fulfill the surgeon's priorities. METHODS In this article, we propose the development of fluorescence-based smartphone imaging and spectroscopic point-of-care multi-modal devices for detection of invasive ductal carcinoma in tumor margin during removal of tumor. These multimodal devices are portable, cost-effective, noninvasive, and user-friendly. Molecular level sensitivity of fluorescence process shows different behavior in normal, cancerous and marginal tissues. We observed significant spectral changes, such as, red-shift, full-width half maximum (FWHM), and increased intensity as we go towards tumor center from normal tissue. High contrast in fluorescence images and spectra are also recorded for cancer tissues compared to healthy tissues. Preliminary results for the initial trial of the devices are reported in this article. RESULTS A total 44 spectra from 11 patients of invasive ductal carcinoma (11 spectra for invasive ductal carcinoma and rest are normal and negative margins) are used. Principle component analysis is used for the classification of invasive ductal carcinoma with an accuracy of 93%, specificity of 75% and sensitivity of 92.8%. We obtained an average 6.17 ± 1.66 nm red shift for IDC with respect to normal tissue. The red shift and maximum fluorescence intensity indicates p < 0.01. These results described here are supported by histopathological examination of the same sample. CONCLUSION In the present manuscript, simultaneous fluorescence-based imaging and spectroscopy is accomplished for the classification of IDC tissues and breast cancer margin detection.
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Affiliation(s)
- Pramila Thapa
- Department of Physics, Bio-photonics and Green-photonics Laboratory, Indian Institute of Technology Delhi, New Delhi, India
| | - Veena Singh
- Department of Physics, Bio-photonics and Green-photonics Laboratory, Indian Institute of Technology Delhi, New Delhi, India
| | - Komal Gupta
- Department of Surgical Disciplines, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Anurag Shrivastava
- Department of Surgical Disciplines, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Virendra Kumar
- Department of Physics, Bio-photonics and Green-photonics Laboratory, Indian Institute of Technology Delhi, New Delhi, India
| | - Kamal Kataria
- Department of Surgical Disciplines, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Piyush R Mishra
- Department of Surgical Disciplines, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Dalip S Mehta
- Department of Physics, Bio-photonics and Green-photonics Laboratory, Indian Institute of Technology Delhi, New Delhi, India
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Albaharna H, Alshareef M, Alromaih S, Aloulah M, Alsaleh S, Alroqi A. Topical Intranasal Fluorescein to Diagnose and Localize Cerebrospinal Fluid Leak: A Systematic Review. Turk Arch Otorhinolaryngol 2021; 59:223-229. [PMID: 34713008 PMCID: PMC8527542 DOI: 10.4274/tao.2021.2021-3-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/14/2021] [Indexed: 12/01/2022] Open
Abstract
Objective: This study evaluates the available evidence regarding using topical intranasal fluorescein (TINF) to diagnose and localize nasal cerebrospinal fluid (CSF) leak. Methods: A literature search was conducted through PubMed, the Cochrane Database, Scopus, and Ovid to identify the articles providing insight into using TINF to diagnose CSF leak preoperatively or to localize the leak intraoperatively. The articles from the database were screened and filtered by two authors according to the selection criteria. A spreadsheet was created to collect the data including demographic characteristics, the sensitivity and specificity of TINF for diagnosing and localizing a CSF leak, the protocol of applying TINF, and the complications. Results: After excluding duplicates and articles that did not meet our selection criteria, we included five reports in the final analysis. The average age of the 94 participants was 39.5, and there was an equal distribution of males and females. The sensitivity of TINF to make a preoperative diagnosis of CSF leak was 100%, and it was 97% to localize the site intraoperatively. Complications associated with TINF were not reported in any of the reports. This review showed a grade C recommendation based on five case series. Conclusion: Based on the current evidence, TINF cannot be recommended for standard clinical practice. It can, however, be considered in situations where other gold standard tools are unavailable since it is feasible and easy to use. A standardized control trial should be conducted to yield additional unbiased evidence.
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Affiliation(s)
- Hussain Albaharna
- Department of Otolaryngology-Head and Neck surgery, Qatif Central Hospital, Qatif, Eastern province, Saudi Arabia.,Department of Otolaryngology-Head & Neck Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Mohammad Alshareef
- Department of Otolaryngology-Head and Neck Surgery, Khamis Mushait General Hospital, Khamis Mushait City, Saudi Arabia.,Department of Otolaryngology-Head & Neck Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Saud Alromaih
- Department of Otolaryngology-Head & Neck Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Mohammad Aloulah
- Department of Otolaryngology-Head & Neck Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Saad Alsaleh
- Department of Otolaryngology-Head & Neck Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Ahmad Alroqi
- Department of Otolaryngology-Head & Neck Surgery, King Saud University, Riyadh, Saudi Arabia
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Osterkamp J, Strandby RB, Nerup N, Svendsen MBS, Svendsen LB, Achiam MP. Time to maximum indocyanine green fluorescence of gastric sentinel lymph nodes and feasibility of combined indocyanine green/sodium fluorescein gastric lymphography. Langenbecks Arch Surg 2021; 406:2717-2724. [PMID: 34245352 DOI: 10.1007/s00423-021-02265-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 07/01/2021] [Indexed: 12/23/2022]
Abstract
PURPOSE Indocyanine green (ICG) and sodium fluorescein (SF) are fluorescent dyes used for sentinel lymph node mapping. In oncological gastric surgery, ICG lymphography has increased the number of resected lymph nodes. However, the optimal time to administer ICG is unclear, and both preoperative and intraoperative injections have been practised. As dye spillage will diminish lymphogram visibility, a second dye with different excitation and emission spectra may present a clinical alternative. We measured the time until maximum ICG fluorescence of gastric sentinel lymph nodes and investigated the feasibility of combined lymphography with two fluorescent dyes: ICG and SF. METHODS Ten Danish Landrace/Yorkshire pigs were used in this study. After completion of the laparoscopic setup, ICG and then SF were endoscopically injected into the gastric submucosa. Lymphograms for both dyes were recorded, and the time until maximum ICG sentinel lymph node fluorescence was determined. RESULTS The mean time until maximum ICG fluorescence of gastric sentinel lymph nodes was 50 s (± 12.5), and the fluorescent signal then remained stable until the end of the recorded period (45 min). A lymphogram showing both ICG and SF was acquired for eight of the ten pigs. CONCLUSIONS Because of the short time until maximum ICG fluorescence of sentinel lymph nodes, intraoperative injections could be a sufficient alternative to preoperative injections for oncological gastric surgery. Combined ICG and SF lymphography was feasible and resulted in clear lymphograms with no interference between the two dyes. The ability to use multiple dyes during a surgical procedure offers the exciting prospect of simultaneously assessing perfusion and performing fluorescence lymphography.
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Affiliation(s)
- Jens Osterkamp
- Oesophago Gastric Cancer Surgery Group (OGCS), Department of Surgical Gastroenterology, Rigshospitalet, University Hospital of Copenhagen, Inge Lehmanns Vej 7, 2100, Copenhagen Ø, Denmark.
| | - Rune B Strandby
- Oesophago Gastric Cancer Surgery Group (OGCS), Department of Surgical Gastroenterology, Rigshospitalet, University Hospital of Copenhagen, Inge Lehmanns Vej 7, 2100, Copenhagen Ø, Denmark
| | - Nikolaj Nerup
- Oesophago Gastric Cancer Surgery Group (OGCS), Department of Surgical Gastroenterology, Rigshospitalet, University Hospital of Copenhagen, Inge Lehmanns Vej 7, 2100, Copenhagen Ø, Denmark
| | - Morten Bo Søndergaard Svendsen
- Copenhagen Academy for Medical Education and Simulation (CAMES) - CAMES Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Lars Bo Svendsen
- Oesophago Gastric Cancer Surgery Group (OGCS), Department of Surgical Gastroenterology, Rigshospitalet, University Hospital of Copenhagen, Inge Lehmanns Vej 7, 2100, Copenhagen Ø, Denmark
| | - Michael Patrick Achiam
- Oesophago Gastric Cancer Surgery Group (OGCS), Department of Surgical Gastroenterology, Rigshospitalet, University Hospital of Copenhagen, Inge Lehmanns Vej 7, 2100, Copenhagen Ø, Denmark
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Li L, Gao N, Yang AQ, Xu WH, Ding Y, Chu J, Lin XN, Liu JQ. Application of fluorescein combined with methylene blue in sentinel lymph node biopsy of breast cancer. Sci Rep 2021; 11:12119. [PMID: 34108563 PMCID: PMC8190180 DOI: 10.1038/s41598-021-91641-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 05/28/2021] [Indexed: 02/06/2023] Open
Abstract
Sentinel lymph node biopsy (SLNB) for axillary lymph node staging in early breast cancer has been widely recognized. The combination of radio-colloids and dye method is the best method recognized. The reagents and equipment required in the process of the combined method are complex and expensive, so there are certain restrictions in the use of primary medical institutions. As a new tracer, fluorescent tracer technology has attracted much attention. We aimed to evaluate the feasibility and safety of fluorescein for SLNB in breast cancer. In this study, a total of 123 patients with breast cancer were divided into group A (n = 67) and group B (n = 56). The efficacy of Indocyanine green (ICG) combined with methylene blue (group A) and fluorescein combined with methylene blue (group B) in SLNB of breast cancer was compared, complications were observed at the same time. No local or systemic reactions were observed in the two groups. In group A, Sentinel lymph nodes of breast cancer were detected in 63 patients, with a detection rate of 94.0% (63/67), a false-negative rate of 7.5% (4/53). In group B, Sentinel lymph nodes of breast cancer were detected in 52 patients, with a detection rate of 92.9% (52/56), a false-negative rate of 7.5% (3/40). There was no significant difference in biopsy results between the two groups. This prospective clinical study suggests that SLNB using fluorescein and ultraviolet LED light is feasible in breast cancer patients. No adverse reactions were observed in this study, but larger studies are needed to properly assess the adverse reaction rate.
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Affiliation(s)
- Liang Li
- Department of Breast Surgery, Zibo Central Hospital, Shandong First Medical University, Zibo, Shandong Province, China
| | - Ning Gao
- Department of Breast Surgery, Zibo Central Hospital, Shandong First Medical University, Zibo, Shandong Province, China.
| | - Ai Qing Yang
- Zibo Center for Disease Control and Prevention, Zibo, Shandong Province, China
| | - Wen Hao Xu
- Department of Breast Surgery, Zibo Central Hospital, Shandong First Medical University, Zibo, Shandong Province, China
| | - Yu Ding
- Department of Breast Surgery, Zibo Central Hospital, Shandong First Medical University, Zibo, Shandong Province, China
| | - Jun Chu
- Department of Breast Surgery, Zibo Central Hospital, Shandong First Medical University, Zibo, Shandong Province, China
| | - Xiao Na Lin
- Department of Breast Surgery, Zibo Central Hospital, Shandong First Medical University, Zibo, Shandong Province, China
| | - Jia Qi Liu
- Department of Breast Surgery, Zibo Central Hospital, Shandong First Medical University, Zibo, Shandong Province, China
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Chang YW, Lee HY, Lee CM, Jung SP, Kim WY, Woo SU, Lee JB, Son GS. Sentinel lymph node detection using fluorescein and blue light-emitting diodes in patients with breast carcinoma: A single-center prospective study. Asian J Surg 2020; 43:220-226. [DOI: 10.1016/j.asjsur.2019.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 02/02/2019] [Accepted: 03/04/2019] [Indexed: 10/27/2022] Open
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Wang LY, Li JH, Zhou X, Zheng QC, Cheng X. Clinical application of carbon nanoparticles in curative resection for colorectal carcinoma. Onco Targets Ther 2017; 10:5585-5589. [PMID: 29200873 PMCID: PMC5702162 DOI: 10.2147/ott.s146627] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Purpose To explore the potential of carbon nanoparticles (CNs) for the intraoperative detection of positive and negative lymph nodes in the treatment of colorectal cancer. Patients and methods The clinical data of 470 patients undergoing surgical procedures for colorectal cancer from June 2010 to February 2013 were analyzed retrospectively. The patients were divided into the CN group (183 males and 161 females; mean age, 58.6±12.4 years), who were given a CN suspension, and the control group (78 males and 48 females; mean age, 59.1±12.2 years), who were not given a CN suspension. The operative time, blood loss, number of lymph nodes detected/positive lymph nodes, and prevalence of postoperative complications were compared between the two groups. Three years after surgery, 444 cases (327 cases in the CN group and 117 cases in the control group) were interviewed, with the remaining 26 cases lost to follow-up. With regard to tumor, node, metastasis staging, the survival and prevalence of recurrence in each group at 3 years were analyzed. Results The number of positive lymph nodes was higher and the prevalence of blood loss was lower in the CN group than in the control group (p<0.05). There were no significant differences in the operative time, number of lymph nodes detected, or the prevalence of postoperative complications, survival, metastasis, or recurrence between the two groups at 3 years (p>0.05). Conclusion The application of CNs is convenient for the detection of lymph nodes to reduce blood loss and increase the probability of detecting positive lymph nodes accurately and rapidly.
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Affiliation(s)
- Li-Yu Wang
- Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jia-Huan Li
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xing Zhou
- Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qi-Chang Zheng
- Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiang Cheng
- Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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