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Kedrzycki MS, Leiloglou M, Ashrafian H, Jiwa N, Thiruchelvam PTR, Elson DS, Leff DR. Meta-analysis Comparing Fluorescence Imaging with Radioisotope and Blue Dye-Guided Sentinel Node Identification for Breast Cancer Surgery. Ann Surg Oncol 2021; 28:3738-3748. [PMID: 33156466 PMCID: PMC8184731 DOI: 10.1245/s10434-020-09288-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 09/27/2020] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Conventional methods for axillary sentinel lymph node biopsy (SLNB) are fraught with complications such as allergic reactions, skin tattooing, radiation, and limitations on infrastructure. A novel technique has been developed for lymphatic mapping utilizing fluorescence imaging. This meta-analysis aims to compare the gold standard blue dye and radioisotope (BD-RI) technique with fluorescence-guided SLNB using indocyanine green (ICG). METHODS This study was registered with PROSPERO (CRD42019129224). The MEDLINE, EMBASE, Scopus, and Web of Science databases were searched using the Medical Subject Heading (MESH) terms 'Surgery' AND 'Lymph node' AND 'Near infrared fluorescence' AND 'Indocyanine green'. Studies containing raw data on the sentinel node identification rate in breast cancer surgery were included. A heterogeneity test (using Cochran's Q) determined the use of fixed- or random-effects models for pooled odds ratios (OR). RESULTS Overall, 1748 studies were screened, of which 10 met the inclusion criteria for meta-analysis. ICG was equivalent to radioisotope (RI) at sentinel node identification (OR 2.58, 95% confidence interval [CI] 0.35-19.08, p < 0.05) but superior to blue dye (BD) (OR 9.07, 95% CI 6.73-12.23, p < 0.05). Furthermore, ICG was superior to the gold standard BD-RI technique (OR 4.22, 95% CI 2.17-8.20, p < 0.001). CONCLUSION Fluorescence imaging for axillary sentinel node identification with ICG is equivalent to the single technique using RI, and superior to the dual technique (RI-BD) and single technique with BD. Hospitals using RI and/or BD could consider changing their practice to ICG given the comparable efficacy and improved safety profile, as well as the lesser burden on hospital infrastructure.
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Affiliation(s)
- Martha S Kedrzycki
- Hamlyn Centre, Institute of Global Health Innovation, Imperial College London, London, UK. .,Department of Surgery and Cancer, Imperial College London, London, UK. .,Department of Breast Surgery, Imperial Healthcare Trust, London, UK.
| | - Maria Leiloglou
- Hamlyn Centre, Institute of Global Health Innovation, Imperial College London, London, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - Hutan Ashrafian
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Natasha Jiwa
- Department of Surgery and Cancer, Imperial College London, London, UK.,Department of Breast Surgery, Imperial Healthcare Trust, London, UK
| | - Paul T R Thiruchelvam
- Department of Surgery and Cancer, Imperial College London, London, UK.,Department of Breast Surgery, Imperial Healthcare Trust, London, UK
| | - Daniel S Elson
- Hamlyn Centre, Institute of Global Health Innovation, Imperial College London, London, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - Daniel R Leff
- Department of Surgery and Cancer, Imperial College London, London, UK.,Department of Breast Surgery, Imperial Healthcare Trust, London, UK
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Kanniyappan U, Wang B, Yang C, Ghassemi P, Litorja M, Suresh N, Wang Q, Chen Y, Pfefer TJ. Performance test methods for near-infrared fluorescence imaging. Med Phys 2020; 47:3389-3401. [PMID: 32304583 PMCID: PMC7496362 DOI: 10.1002/mp.14189] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 03/03/2020] [Accepted: 04/10/2020] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Near-infrared fluorescence (NIRF) imaging using exogenous contrast has gained much attention as a technique for enhancing visualization of vasculature using untargeted agents, as well as for the detection and localization of cancer with targeted agents. In order to address the emerging need for standardization of NIRF imaging technologies, it is necessary to identify the best practices suitable for objective, quantitative testing of key image quality characteristics. Toward the development of a battery of test methods that are rigorous yet applicable to a wide variety of devices, we have evaluated techniques for phantom design, measurement, and calculation of specific performance metrics. METHODS Using a NIRF imaging system for indocyanine green imaging, providing excitation at 780 nm and detection above 830 nm, we explored methods to evaluate uniformity, field of view, spectral crosstalk, spatial resolution, depth of field, sensitivity, linearity, and penetration depth. These measurements were performed using fluorophore-doped multiwell plate and high turbidity planar phantoms, as well as a 3D-printed multichannel phantom and a USAF 1951 resolution target. RESULTS AND CONCLUSIONS Based on a wide range of approaches described in medical and fluorescence imaging literature, we have developed and demonstrated a cohesive battery of test methods for evaluation of fluorescence image quality in wide-field imagers. We also propose a number of key metrics that can facilitate direct, quantitative comparison of device performance. These methods have the potential to facilitate more uniform evaluation and inter-comparison of clinical and preclinical imaging systems than is typically achieved, with the long-term goal of establishing international standards for fluorescence image quality assessment.
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Affiliation(s)
- Udayakumar Kanniyappan
- Fischell Department of Bioengineering, University of Maryland, College Park, MD, USA.,Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD, USA
| | - Bohan Wang
- Fischell Department of Bioengineering, University of Maryland, College Park, MD, USA
| | - Charles Yang
- Fischell Department of Bioengineering, University of Maryland, College Park, MD, USA
| | - Pejhman Ghassemi
- Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD, USA
| | - Maritoni Litorja
- National Institute of Standards and Technology, Gaithersburg, MD, USA
| | - Nitin Suresh
- Fischell Department of Bioengineering, University of Maryland, College Park, MD, USA
| | - Quanzeng Wang
- Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD, USA
| | - Yu Chen
- Fischell Department of Bioengineering, University of Maryland, College Park, MD, USA.,Department of Biomedical Engineering, University of Massachusetts Amherst, MA, USA
| | - T Joshua Pfefer
- Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD, USA
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Kim DW, Jeong B, Shin IH, Kang U, Lee Y, Park YS, Ahn SH, Park DJ, Kim HH. Sentinel node navigation surgery using near-infrared indocyanine green fluorescence in early gastric cancer. Surg Endosc 2018; 33:1235-1243. [PMID: 30167947 DOI: 10.1007/s00464-018-6401-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 08/20/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the feasibility of indocyanine green (ICG) fluorescent method for sentinel lymph node detection in early gastric cancer. METHODS Between December 2012 and December 2014, 28 cases of pilot examination were performed at Seoul National University Bundang Hospital. Advanced version of multispectral fluorescence organoscope was used to identify sentinel node by quantitative estimation of ICG fluorescent signal intensity. Sensitivity, specificity, false positive value were analyzed and compared with dual tracer method. RESULTS A total of 443 lymph nodes in 28 cases were examined and 184 sentinel nodes (41.5%) were identified by dual tracer method. The sensitivity using near-infrared ICG method was 98.9%. The specificity was 76.0% and false positive rate was 25.4% compared with dual tracer method. The adequate threshold for sentinel node detection was considered as 10% of maximum signal intensity. CONCLUSION New near-infrared ICG fluorescent method could be a promising protocol for sentinel node navigation surgery in early gastric cancer.
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Affiliation(s)
- Dong-Wook Kim
- Department of Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong Bundang-gu, Seongnam, Gyeonggi-do, 463-707, Republic of Korea
| | - Bosu Jeong
- Advanced Medical Device Research Division, Korea Electrotechnology Research Institute, Seoul, Republic of Korea
| | - Il-Hyung Shin
- Advanced Medical Device Research Division, Korea Electrotechnology Research Institute, Seoul, Republic of Korea
| | - Uk Kang
- Advanced Medical Device Research Division, Korea Electrotechnology Research Institute, Seoul, Republic of Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yoontaek Lee
- Department of Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong Bundang-gu, Seongnam, Gyeonggi-do, 463-707, Republic of Korea
| | - Young Suk Park
- Department of Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong Bundang-gu, Seongnam, Gyeonggi-do, 463-707, Republic of Korea
| | - Sang-Hoon Ahn
- Department of Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong Bundang-gu, Seongnam, Gyeonggi-do, 463-707, Republic of Korea.
| | - Do Joong Park
- Department of Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong Bundang-gu, Seongnam, Gyeonggi-do, 463-707, Republic of Korea
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyung-Ho Kim
- Department of Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong Bundang-gu, Seongnam, Gyeonggi-do, 463-707, Republic of Korea
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
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Aldrich MB, Gross D, Morrow JR, Fife CE, Rasmussen JC. Effect of pneumatic compression therapy on lymph movement in lymphedema-affected extremities, as assessed by near-infrared fluorescence lymphatic imaging. JOURNAL OF INNOVATIVE OPTICAL HEALTH SCIENCES 2017; 10:1650049. [PMID: 29104671 PMCID: PMC5665410 DOI: 10.1142/s1793545816500498] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Previous studies have shown cost effectiveness and quality-of-life benefit of pneumatic compression therapy (PCT) for lymphedema. Insurers, such as the Centers for Medicare/Medicaid (CMS), however, desire visual proof that PCT moves lymph. Near-infrared fluorescence lymphatic imaging (NIRFLI) was used to visualize lymphatic anatomy and function in four subjects with primary and cancer treatment-related lymphedema (LE) of the lower extremities before, during, and after pneumatic compression therapy (PCT). Optically transparent and windowed PCT garments allowed visualization of lymph movement during single, one-hour PCT treatment sessions. Visualization revealed significant extravascular and lymphatic vascular movement of intradermally injected dye in all subjects. In one subject with sufficient patent lymphatic vessels to allow quantification of lymph pumping velocities and frequencies, these values were significantly increased during and after PCT as compared to pre-treatment values. Lymphatic contractile activity in patent lymphatic vessels occurred in concert with the sequential cycling of PCT. Direct visualization revealed increased lymphatic function, during and after PCT therapy, in all lymphedema-affected extremities. Further studies are warranted to assess the effects of PCT pressure and sequences on lymph uptake and movement.
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Affiliation(s)
- Melissa B. Aldrich
- Center for Molecular Imaging, The Brown Institute for Molecular Medicine, UTHealth, Houston, Texas
| | | | - John Rodney Morrow
- Center for Molecular Imaging, The Brown Institute for Molecular Medicine, UTHealth, Houston, Texas
| | - Caroline E. Fife
- CHI St. Luke’s Health, The Woodlands Hospital, The Woodlands, Texas
| | - John C. Rasmussen
- Center for Molecular Imaging, The Brown Institute for Molecular Medicine, UTHealth, Houston, Texas
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Rini CJ, McVey E, Sutter D, Keith S, Kurth HJ, Nosek L, Kapitza C, Rebrin K, Hirsch L, Pettis RJ. Intradermal insulin infusion achieves faster insulin action than subcutaneous infusion for 3-day wear. Drug Deliv Transl Res 2016; 5:332-45. [PMID: 26037035 PMCID: PMC4529466 DOI: 10.1007/s13346-015-0239-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Rapid uptake previously demonstrated by intradermal (ID) drug administration indicates compound delivery within the dermis may have clinical and pharmacological advantages for certain drug therapies. This study is the first clinical trial to evaluate continuous microneedle-based drug infusion, device wearability, and intradermal microneedle insulin kinetics over a multi-day (72 h) wear period. This was a single center, open-label, two-period crossover study in T1DM patients on continuous subcutaneous insulin infusion (CSII). Patients received treatment during interventional visits: one SC and one ID basal/bolus infusion of insulin aspart (NovoRapid® U-100) administered over 3 days in a randomized order. Twenty-eight patients were randomized and exposed to trial product, and 23 completed the study. Bolus insulin infusions were given prior to standardized breakfast and lunch test meals on each of the three treatment days. Blood samples were drawn at predefined time points for measurements of insulin aspart and blood glucose in serum. The primary endpoint insulin Tmax demonstrated that ID bolus infusion was associated with a significantly shorter Tmax with statistically significantly smaller intra-subject variability, compared to SC infusion, and this difference was maintained over three treatment days. Analyses of secondary PK endpoints corresponded with the primary endpoint findings. Postprandial glycemic response was significantly less pronounced after ID bolus: For most endpoints ID vs. SC, differences were statistically significant within the 0–1.5 or 0–2 h time period. Intradermal delivery of insulin is a viable delivery route alternative providing reduced time for insulin absorption with less intra-subject variability and lower glycemic response.
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Nolan RM, Adie SG, Marjanovic M, Chaney EJ, South FA, Monroy GL, Shemonski ND, Erickson-Bhatt SJ, Shelton RL, Bower AJ, Simpson DG, Cradock KA, Liu ZG, Ray PS, Boppart SA. Intraoperative optical coherence tomography for assessing human lymph nodes for metastatic cancer. BMC Cancer 2016; 16:144. [PMID: 26907742 PMCID: PMC4763478 DOI: 10.1186/s12885-016-2194-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 02/17/2016] [Indexed: 12/21/2022] Open
Abstract
Background Evaluation of lymph node (LN) status is an important factor for detecting metastasis and thereby staging breast cancer. Currently utilized clinical techniques involve the surgical disruption and resection of lymphatic structure, whether nodes or axillary contents, for histological examination. While reasonably effective at detection of macrometastasis, the majority of the resected lymph nodes are histologically negative. Improvements need to be made to better detect micrometastasis, minimize or eliminate lymphatic disruption complications, and provide immediate and accurate intraoperative feedback for in vivo cancer staging to better guide surgery. Methods We evaluated the use of optical coherence tomography (OCT), a high-resolution, real-time, label-free imaging modality for the intraoperative assessment of human LNs for metastatic disease in patients with breast cancer. We assessed the sensitivity and specificity of double-blinded trained readers who analyzed intraoperative OCT LN images for presence of metastatic disease, using co-registered post-operative histopathology as the gold standard. Results Our results suggest that intraoperative OCT examination of LNs is an appropriate real-time, label-free, non-destructive alternative to frozen-section analysis, potentially offering faster interpretation and results to empower superior intraoperative decision-making. Conclusions Intraoperative OCT has strong potential to supplement current post-operative histopathology with real-time in situ assessment of LNs to preserve both non-cancerous nodes and their lymphatic vessels, and thus reduce the associated risks and complications from surgical disruption of lymphoid structures following biopsy.
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Affiliation(s)
- Ryan M Nolan
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign (UIUC), 405 N. Mathews Ave., Urbana, IL, 61801, USA. .,PhotoniCare, Inc., Champaign, IL, USA.
| | - Steven G Adie
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign (UIUC), 405 N. Mathews Ave., Urbana, IL, 61801, USA. .,Department of Biomedical Engineering, Cornell University, Ithaca, NY, USA.
| | - Marina Marjanovic
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign (UIUC), 405 N. Mathews Ave., Urbana, IL, 61801, USA.
| | - Eric J Chaney
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign (UIUC), 405 N. Mathews Ave., Urbana, IL, 61801, USA.
| | - Fredrick A South
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign (UIUC), 405 N. Mathews Ave., Urbana, IL, 61801, USA. .,Department of Electrical and Computer Engineering, UIUC, Illinois, USA.
| | - Guillermo L Monroy
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign (UIUC), 405 N. Mathews Ave., Urbana, IL, 61801, USA. .,Department of Bioengineering, UIUC, Illinois, USA.
| | - Nathan D Shemonski
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign (UIUC), 405 N. Mathews Ave., Urbana, IL, 61801, USA. .,Department of Electrical and Computer Engineering, UIUC, Illinois, USA. .,Carl Zeiss Meditec, Inc., Dublin, CA, USA.
| | - Sarah J Erickson-Bhatt
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign (UIUC), 405 N. Mathews Ave., Urbana, IL, 61801, USA.
| | - Ryan L Shelton
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign (UIUC), 405 N. Mathews Ave., Urbana, IL, 61801, USA. .,PhotoniCare, Inc., Champaign, IL, USA.
| | - Andrew J Bower
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign (UIUC), 405 N. Mathews Ave., Urbana, IL, 61801, USA. .,Department of Electrical and Computer Engineering, UIUC, Illinois, USA.
| | - Douglas G Simpson
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign (UIUC), 405 N. Mathews Ave., Urbana, IL, 61801, USA. .,Department of Statistics, UIUC, Illinois, USA.
| | | | | | - Partha S Ray
- Carle Foundation Hospital, Urbana, IL, USA. .,Department of Surgery, University of Illinois College of Medicine at Urbana-Champaign and Carle Cancer Center, Urbana, IL, USA.
| | - Stephen A Boppart
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign (UIUC), 405 N. Mathews Ave., Urbana, IL, 61801, USA. .,Department of Electrical and Computer Engineering, UIUC, Illinois, USA. .,Department of Bioengineering, UIUC, Illinois, USA. .,Department of Internal Medicine, UIUC, Illinois, USA.
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Whitley MJ, Weissleder R, Kirsch DG. Tailoring Adjuvant Radiation Therapy by Intraoperative Imaging to Detect Residual Cancer. Semin Radiat Oncol 2015; 25:313-21. [PMID: 26384279 PMCID: PMC4575408 DOI: 10.1016/j.semradonc.2015.05.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
For many solid cancers, radiation therapy is offered as an adjuvant to surgical resection to lower rates of local recurrence and improve survival. However, a subset of patients treated with surgery alone will not have a local recurrence. Currently, there is no way to accurately determine which patients have microscopic residual disease in the tumor bed after surgery and therefore are most likely to benefit from adjuvant radiation therapy. To address this problem, a number of technologies have been developed to try to improve margin assessment of resected tissue and to detect residual cancer in the tumor bed. Moreover, some of these approaches have been translated from the preclinical arena into clinical trials. Here, we review different types of intraoperative molecular imaging systems for cancer. Optical imaging techniques like epi-illumination, fluorescence molecular tomography and optoacoustic imaging can be coupled with exogenous fluorescent imaging probes that accumulate in tumors passively via the enhanced permeability and retention effect or are targeted to tumor tissues based on affinity or enzyme activity. In these approaches, detection of fluorescence in the tumor bed may indicate residual disease. Protease activated probes have generated great interest because of their potential for leading to high tumor to normal contrast. Recently, the first Phase I clinical trial to assess the safety and activation of a protease activated probe was conducted. Spectroscopic methods like radiofrequency spectroscopy and Raman spectroscopy, which are based on energy absorption and scattering, respectively, have also been tested in humans and are able to distinguish between normal and tumors tissues intraoperatively. Most recently, multimodal contrast agents have been developed that target tumors and contain both fluorescent dyes and magnetic resonance imaging contrast agents, allowing for preoperative planning and intraoperative margin assessment with a single contrast agent. Further clinical testing of these various intraoperative imaging approaches may lead to more accurate methods for margin assessment and the intraoperative detection of microscopic residual disease, which could guide further resection and the use of adjuvant radiation therapy.
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Affiliation(s)
- Melodi J Whitley
- Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, NC
| | - Ralph Weissleder
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA; Department of Systems Biology, Harvard Medical School, Boston, MA
| | - David G Kirsch
- Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, NC; Department of Radiation Oncology, Duke University Medical Center, Durham, NC.
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Zhu B, Sevick-Muraca EM. A review of performance of near-infrared fluorescence imaging devices used in clinical studies. Br J Radiol 2015; 88:20140547. [PMID: 25410320 DOI: 10.1259/bjr.20140547] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Near-infrared fluorescence (NIRF) molecular imaging holds great promise as a new "point-of-care" medical imaging modality that can potentially provide the sensitivity of nuclear medicine techniques, but without the radioactivity that can otherwise place limitations of usage. Recently, NIRF imaging devices of a variety of designs have emerged in the market and in investigational clinical studies using indocyanine green (ICG) as a non-targeting NIRF contrast agent to demark the blood and lymphatic vasculatures both non-invasively and intraoperatively. Approved in the USA since 1956 for intravenous administration, ICG has been more recently used off label in intradermal or subcutaneous administrations for fluorescence imaging of the lymphatic vasculature and lymph nodes. Herein, we summarize the devices of a variety of designs, summarize their performance in lymphatic imaging in a tabular format and comment on necessary efforts to develop standards for device performance to compare and use these emerging devices in future, NIRF molecular imaging studies.
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Affiliation(s)
- B Zhu
- Center for Molecular Imaging, The Brown Foundation Institute of Molecular Medicine, The University of Texas Health Science Center, Houston, TX, USA
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Agollah GD, Wu G, Sevick-Muraca EM, Kwon S. In vivo lymphatic imaging of a human inflammatory breast cancer model. J Cancer 2014; 5:774-83. [PMID: 25368678 PMCID: PMC4216802 DOI: 10.7150/jca.9835] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 09/25/2014] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Inflammatory breast cancer (IBC) remains the most aggressive type of breast cancer with the greatest potential for metastasis and as a result, the highest mortality rate. IBC cells invade and metastasize through dermal lymphatic vessels; however, it is unknown how lymphatic drainage patterns change during IBC growth and metastasis. Herein, we non-invasively and longitudinally imaged lymphatics in an animal model of IBC using near-infrared fluorescence (NIRF) imaging. MATERIALS AND METHODS Mice were imaged in vivo prior to, and up to 11 weeks after subcutaneous or orthotopic inoculation of human IBC SUM149 cells, which were stably transfected with infrared fluorescence protein (iRFP) gene reporter (SUM149-iRFP), following intradermal (i.d.) injection of indocyanine green (ICG). RESULTS Fluorescence images showed well-defined lymphatic vessels prior to SUM149-iRFP inoculation. However, altered lymphatic drainage patterns including rerouting of lymphatic drainage were detected in mice with SUM149-iRFP, due to lymphatic obstruction of normal lymphatic drainages caused by tumor growth. In addition, we observed tortuous lymphatic vessels and extravasation of ICG-laden lymph in mice with SUM149-iRFP. We also observed increased and dilated fluorescent lymphatic vessels in the tumor periphery, which was confirmed by ex vivo immunohistochemical staining of lymphatic vessels. CONCLUSIONS Our pre-clinical studies demonstrate that non-invasive NIRF imaging can provide a method to assess changes in lymphatic drainage patterns during IBC growth and metastasis.
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Affiliation(s)
- Germaine D Agollah
- 1. Center for Molecular Imaging, The Brown Foundation Institute of Molecular Medicine, The University of Texas Health Science Center, Houston, TX 77030; ; 2. The University of Texas Graduate School of Biomedical Sciences at Houston. The University of Texas MD Anderson Cancer Center, Houston, Texas 77030
| | - Grace Wu
- 1. Center for Molecular Imaging, The Brown Foundation Institute of Molecular Medicine, The University of Texas Health Science Center, Houston, TX 77030
| | - Eva M Sevick-Muraca
- 1. Center for Molecular Imaging, The Brown Foundation Institute of Molecular Medicine, The University of Texas Health Science Center, Houston, TX 77030
| | - Sunkuk Kwon
- 1. Center for Molecular Imaging, The Brown Foundation Institute of Molecular Medicine, The University of Texas Health Science Center, Houston, TX 77030
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Sevick-Muraca EM, Kwon S, Rasmussen JC. Emerging lymphatic imaging technologies for mouse and man. J Clin Invest 2014; 124:905-14. [PMID: 24590275 DOI: 10.1172/jci71612] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The lymphatic circulatory system has diverse functions in lipid absorption, fluid homeostasis, and immune surveillance and responds dynamically when presented with infection, inflammation, altered hemodynamics, and cancer. Visualization of these dynamic processes in human disease and animal models of disease is key to understanding the contributory role of the lymphatic circulatory system in disease and to devising effective therapeutic strategies. Longitudinal, non-destructive, and repeated imaging is necessary to expand our understanding of disease progression and regression in basic science and clinical investigations. Herein we summarize recent advances in in vivo lymphatic imaging employing magnetic resonance, computed tomography, lymphoscintigraphy, and emerging optical techniques with respect to their contributory roles in both basic science and clinical research investigations.
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Zhu B, Rasmussen JC, Sevick-Muraca EM. Non-invasive fluorescence imaging under ambient light conditions using a modulated ICCD and laser diode. BIOMEDICAL OPTICS EXPRESS 2014; 5:562-72. [PMID: 24575349 PMCID: PMC3920885 DOI: 10.1364/boe.5.000562] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 01/22/2014] [Accepted: 01/22/2014] [Indexed: 05/06/2023]
Abstract
One limitation of fluorescence molecular imaging that can limit clinical implementation and hamper small animal imaging is the inability to eliminate ambient light. Herein, we demonstrate the ability to conduct rapid non-invasive, far-red and near-infrared fluorescence imaging in living animals and a phantom under ambient light conditions using a modulated image intensified CCD (ICCD) and a laser diode operated in homodyne detection. By mapping AC amplitude from three planar images at varying phase delays, we show improvement in target-to-background ratios (TBR) and reasonable signal-to-noise ratios (SNR) over continuous wave measurements. The rapid approach can be used to accurately collect fluorescence in situations where ambient light cannot be spectrally conditioned or controlled, such as in the case of fluorescent molecular image-guided surgery.
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