SignificanceShortwave-infrared (SWIR) imaging is reported to yield better contrast in fluorescence-guided surgery than near-infrared (NIR) imaging, due to a reduction in scattering. This benefit of SWIR was shown in animal studies, however not yet in clinical studies with patient samples.AimWe investigate the potential benefit of SWIR to NIR imaging in clinical samples containing cetuximab-IRDye800CW in fluorescence-guided surgery.ApproachThe potential of the epidermal growth factor-targeted NIR dye cetuximab-IRDye800CW in the shortwave range was examined by recording the absorption and emission spectrum. An ex vivo comparison of NIR and SWIR images using clinical tumor samples of patients with penile squamous cell carcinoma (PSCC) and head and neck squamous cell carcinoma (HNSCC) containing cetuximab-IRDye800CW was performed. The comparison was based on the tumor-to-background ratio and an adapted contrast-to-noise ratio (aCNR) using the standard of care pathology tissue assessment as the golden standard.ResultsBased on the emission spectrum, cetuximab-IRDye800CW can be detected in the SWIR range. In clinical PSCC samples, overall SWIR imaging was found to perform similarly to NIR imaging (NIR imaging is better than SWIR in the 2/7 criteria examined, and SWIR is better than NIR in the 3/7 criteria). However, when inspecting HNSCC data, NIR is better than SWIR in nearly all (5/7) examined criteria. This difference seems to originate from background autofluorescence overwhelming the off-peak SWIR fluorescence signal in HNSCC tissue.ConclusionSWIR imaging using the targeted tracer cetuximab-IRDye800CW currently does not provide additional benefit over NIR imaging in ex vivo clinical samples. Background fluorescence in the SWIR region, resulting in a higher background signal, limits SWIR imaging in HNSCC samples. However, SWIR shows potential in increasing the contrast of tumor borders in PSCC samples, as shown by a higher aCNR over a line.
Oral squamous cell carcinomas represent a significant number of cancers diagnosed globally. Of these cancers, surgical resection of the primary tumor is the standard treatment. Conventional methods of assessing completeness of resection are time-consuming, laborious, and cannot be used to evaluate the entire margin of a resected tumor. As such, widefield fluorescence molecular imaging is being explored as an intraoperative technique to guide resections. The widely used single-view, wide aperture techniques have had high success in identifying positive margins (those with thickness < 1mm), but limited success in identifying close margins (1-5 mm). Here a dual aperture fluorescence ratio is presented as a means of improved detection of close margins, with evidence that this technique may be highly useful for future intraoperative fluorescence molecular imaging applications. Monte Carlo simulations are conducted to assess the technique’s ability to minimize optical property heterogeneities across regions with varying absorption and scattering characteristics.
Cancer continues to be a significant global health issue in the 21st century, presenting substantial risks to the health and well-being of individuals worldwide. Although there have been improvements in comprehending the molecular processes of the disease and creating treatments that specifically target it, a considerable portion of patients continue to encounter difficulties in attaining favorable results. Conventional two-dimensional (2D) cell cultures have been extensively used in cancer research. However, their inability to accurately mimic the intricate characteristics of tumors limits their effectiveness in predicting how anticancer treatments would perform in clinical settings. In order to overcome these restrictions, three-dimensional (3D) cell culture models, specifically multicellular spheroids, have arisen as promising tool for investigating cancer biology and therapeutic response. This work analyzes the development and growth dynamics of spheroids obtained from four distinct cancer cell lines: 9L-GFP, U251-RFP, A431, and FaDu. The stability and growth features of these spheroids were evaluated by culturing them using different cell counts and dilution ratios. Confocal microscopy was used to observe the formation of spheroids and measure their sizes for a duration of seven days. The results of our study reveal clear variations in growth patterns and stability profiles across the investigated cell lines. Notably, the 9L-GFP cell line demonstrates exceptional stability and continuous growth. The statistical analysis demonstrated that spheroids exhibited the most stability when the cell count was 25,000 cells and the dilution ratio was 1:3, as indicated by the high R-squared values. These findings highlight the significance of adjusting the number of cells and dilution ratios to ensure consistent and replicable spheroid formation. In summary, our study emphasizes the capacity of 3D spheroid models as effective instruments in cancer research and medication development, providing vital information about tumor biology and therapeutic responses in a context that closely resembles the physiological conditions.
Surgical excision is the primary treatment for solid tumors in oral squamous cell carcinomas, where achieving a healthy tissue margin of >5 mm is the goal. However, current clinical methods of assessing surgical margins cannot provide assessment of the whole margins intraoperatively (while the patient is still on the operating table) and while recent intraoperative fluorescence-guided surgery approaches have shown promise for detected “positive” inadequate margins (<1 mm), they have had limited success in the detection of “close” inadequate margins (1-5 mm), in patients injected with cetuximab-IRDye 800CW prior to surgery. Here, a dual aperture fluorescence ratio (dAFR) approach presented previously by our group is expanded upon, where herein we present a version of the analysis where the measurements are normalized by a background signal. We compare this additional approach directly against a single aperture view fluorescence (sAF) and pathology measurements of margin thickness in specimens from five patients and a total 14 margin locations (1 positive, 7 close, and 6 clear margins). The area under the curve of the receiver operating characteristic, representing the ability to detect close compared to clear margins was found to be 1.0 and 0.6 using dAFR and sAF, respectively, with the improvements in dAFR being statistically significant (p < 0.01). We demonstrate that the addition of a background normalization can account for noise and low signal in narrow aperture images.
In the United States, the annual incidence of oral squamous cell carcinoma (OSCC) exceeds 50,000 cases. Primary tumor resection remains the first line of treatment in these patients yet follow up neck dissection and chemoradiation treatment may be indicated if cancer has spread to tumor draining lymph nodes. There is a push to minimize morbidity from neck dissection by sentinel lymph node biopsy, where only the first lymph node(s) draining the primary tumor are excised and evaluated for cancer spread. However, with current pathology methods, results are not available to surgeons until patients have been sent home. In response, we are developing a method to rapidly stain and image whole excised lymph nodes in less than 30 min, so surgeons can react to positive cases while patients are still on the operating table. Here we present a human head and neck cancer spheroid model implanted in porcine lymph nodes as a means evaluating the potential for our staining and imaging protocols to rapidly identify cancer burden in lymph nodes.
SignificanceSurgical excision is the main treatment for solid tumors in oral squamous cell carcinomas, where wide local excision (achieving a healthy tissue margin of >5 mm around the excised tumor) is the goal as it results in reduced local recurrence rates and improved overall survival.AimNo clinical methods are available to assess the complete surgical margin intraoperatively while the patient is still on the operating table; and while recent intraoperative back-bench fluorescence-guided surgery approaches have shown promise for detecting “positive” inadequate margins (<1 mm), they have had limited success in the detection of “close” inadequate margins (1 to 5 mm). Here, a dual aperture fluorescence ratio (dAFR) approach was evaluated as a means of improving detection of close margins.ApproachThe approach was evaluated on surgical specimens from patients who were administered a tumor-specific fluorescent imaging agent (cetuximab-800CW) prior to surgery. The dAFR approach was compared directly against standard wide-field fluorescence imaging and pathology measurements of margin thickness in specimens from three patients and a total of 12 margin locations (1 positive, 5 close, and 6 clear margins).ResultsThe area under the receiver operating characteristic curve, representing the ability to detect close compared to clear margins (>5 mm) was found to be 1.0 and 0.57 for dAFR and sAF, respectively. Improvements in dAFR were found to be statistically significant (p<0.02).ConclusionsThese results provide evidence that the dAFR approach potentially improves detection of close surgical margins.
An increasing number of cancer surgery protocols are including sentinel lymph node biopsies on the day of resection to stage for non-palpable spread of cancer through tumor draining lymph nodes. The challenge is that often a tumor-positive node will make it necessary to perform an enhanced resection of the lymphatic network, and if lymph node processing is not completed within the timeframe of surgery, then patients may have to be called back for additional surgery or have to undergo amplified chemo or radiation therapy. Our group is working on a rapid lymph node staining and fluorescence tomography system that we call ADEPT to provide surgeons with lymph node biopsy results within 15 min. The aim is to minimize the number of callback surgery or amplified therapy procedures to minimize stress to patients and reduce health care costs. This work predicts, using Monte Carlo photon propagation modeling simulations, that ADEPT has the potential to yield greater than 95% accuracy in detecting the smallest amount of cancer considered clinically relevant withing 15 min of tissue processing and imaging.
Post-operative assessment of resected tumor margins is critical to ensure the entirety of malignant tissue has been removed from a patient. Microscopic assessment of tissue post-excision is the current gold standard, however the long wait times for proper specimen evaluation limit a surgeon’s ability to be certain they obtained clear margins. To address this need, fluorescence-guided surgery approaches are under development that can yield molecular contrast between healthy and malignant tissues intraoperatively. In head and neck cancer specifically, heterogenous optical properties lead to poor identification in margins greater than 1 mm thick when viewed with single projections. Thus, we demonstrate the use of variable aperture approach to decrease the effects of local optical property variations in the imaged specimen. Here we use Monte Carlo simulations to verify the utility of the idea in a homogenous medium as well in a medium with heterogenous properties. We demonstrate that a ratio metric approach can provide near identical depth discrimination as a single projection in a homogenous medium and is further capable of reducing pixel variability due to local optical properties in a heterogenous medium than a single projection alone.
Photodynamic therapy (PDT) has been used clinically for the treatment of head and neck cancer. The effectiveness of PDT is often strongly dependent on fluence rate. Targeted photo-immunotherapy (PIT) may reduce the adverse effects of non-targeted PDT. The in-vivo distribution of the anti-EGFR targeted conjugate Cetuximab-IRDye700DX was investigated. Vascular and tumor responses were determined with respect to fluence rate.
Intra-vital confocal microscopy of skin-fold chambers with the EGFR-overexpressing OSC-19 tumor showed peak tumor fluorescence 24 hrs after administration. Tumor to normal ratio was 3.1±1.6 (n=8). Tumor vascular responses were determined by imaging rhodamine-dextran extravasation. Two hrs after illumination (24 hr DLI, 100 J.cm-2 at 50 mW.cm-2) showed no leakage in 3 of 4 animals and stasis in 1. Normal vasculature showed mild to severe constriction of larger vessels up to 48 hrs after illumination. Subcutaneous OSC-19 tumors were transdermally illuminated with 100 J.cm-2 at 20, 50 and 150 mW.cm-2. Control tumors took 5.3±1.1 days to grow to 200%. All animals treated with 20 mW.cm-2 showed no tumor up to 90 days post treatment (n=4) compared to 1 of 4 in the 50 and 150 mW.cm-2 groups. The remaining tumors reached 200% after 17.9±5.2 and 19.5±7.4 days. Crust formation of the overlying skin was observed at low fluence rate.
Cetuximab-IRDye700DX showed significant tumor to normal ratio. Normal tissue responses like vascular effects and crust formation of the skin was observed and may be caused by conjugate still present in the circulation. The effect of targeted-PIT is strongly dependent on fluence rate.
In vivo measurement of photosensitizer concentrations may optimize clinical photodynamic therapy (PDT). Fluorescence differential path-length spectroscopy (FDPS) is a non-invasive optical technique that has been shown to accurately quantify the concentration of Foscan® in rat liver. As a next step towards clinical translation, the effect of two liposomal formulations of mTHPC, Fospeg® and Foslip®, on FDPS response was investigated. Furthermore, FDPS was evaluated in target organs for head-and-neck PDT. Fifty-four healthy rats were intravenously injected with one of the three formulations of mTHPC at 0.15 mg kg − 1. FDPS was performed on liver, tongue, and lip. The mTHPC concentrations estimated using FDPS were correlated with the results of the subsequent harvested and chemically extracted organs. An excellent goodness of fit (R2) between FDPS and extraction was found for all formulations in the liver (R2 = 0.79). A much lower R2 between FDPS and extraction was found in lip (R2 = 0.46) and tongue (R2 = 0.10). The lower performance in lip and in particular tongue was mainly attributed to the more layered anatomical structure, which influences scattering properties and photosensitizer distribution.
The development of optical techniques for non-invasive diagnosis of cancer is an ongoing challenge to biomedical optics. For head and neck cancer we see two main fields of potential application
1) Screening for second primaries in patients with a history of oral cancer. This requires imaging techniques or an approach where a larger area can be scanned quickly.
2) Distinguishing potentially malignant visible primary lesions from benign ones. Here fiberoptic point measurements can be used as the location of the lesion is known.
This presentation will focus on point measurement techniques.
Various techniques for point measurements have been developed and investigated clinically for different applications. Differential Pathlength Spectroscopy is a recently developed fiberoptic point measurement technique that measures scattered light in a broad spectrum. Due to the specific fiberoptic geometry we measure only scattered photons that have travelled a predetermined pathlength. This allows us to analyse the spectrum mathematically and translate the measured curve into a set of parameters that are related to the microvasculature and to the intracellular morphology. DPS has been extensively evaluated on optical phantoms and tested clinically in various clinical applications.
The first measurements in biopsy proven squamous cell carcinoma showed significant changes in both vascular and morphological parameters. Measurements on thick keratinized lesions however failed to generate any vascular signatures. This is related to the sampling depth of the standard optical fibers used. Recently we developed a fiberoptic probe with a ~1 mm sampling depth. Measurements on several leukoplakias showed that with this new probe we sample just below the keratin layer and can obtain vascular signatures. The results of a first set of clinical measurements will be presented and the significance for clinical diagnostics will be discussed.
In this study, a ratiometric quantification method is developed and applied to monitor mesotetra(hydroxyphenyl) chlorin (mTHPC) pharmacokinetics in the rat skin-fold observation chamber. The method
employs a combination of dual-wavelength excitation and dual-wavelength detection. The excitation and
detection wavelengths were selected in close to NIR. The first excitation wavelength was used to excite the
mTHPC and autofluorescence and the second to excite only autofluorescence, so that this could be substracted.
Subsequently the difference was divided by the autofluorescence. Since the method applies division of signal
with no mTHPC fluorescence, theory suggests on linear dependency of the method on photosensitizer
concentration.
Autofluorescence spectroscopy shows promising results for detection and staging of oral (pre-)malignancies. To improve staging reliability, we develop and compare algorithms for lesion classification. Furthermore, we examine the potential for detecting invisible tissue alterations. Autofluorescence spectra are recorded at six excitation wavelengths from 172 benign, dysplastic, and cancerous lesions and from 97 healthy volunteers. We apply principal components analysis (PCA), artificial neural networks, and red/green intensity ratio's to separate benign from (pre-)malignant lesions, using four normalization techniques. To assess the potential for detecting invisible tissue alterations, we compare PC scores of healthy mucosa and surroundings/contralateral positions of lesions. The spectra show large variations in shape and intensity within each lesion group. Intensities and PC score distributions demonstrate large overlap between benign and (pre-)malignant lesions. The receiver-operator characteristic areas under the curve (ROC-AUCs) for distinguishing cancerous from healthy tissue are excellent (0.90 to 0.97). However, the ROC-AUCs are too low for classification of benign versus (pre-)malignant mucosa for all methods (0.50 to 0.70). Some statistically significant differences between surrounding/contralateral tissues of benign and healthy tissue and of (pre-)malignant lesions are observed. We can successfully separate healthy mucosa from cancers (ROC-AUC>0.9). However, autofluorescence spectroscopy is not able to distinguish benign from visible (pre-)malignant lesions using our methods (ROC-AUC<0.65). The observed significant differences between healthy tissue and surroundings/contralateral positions of lesions might be useful for invisible tissue alteration detection.
Previous clinical results demonstrate the potential of in vivo autofluorescence spectroscopy for early detection of (pre-)malignant lesions of the oral mucosa. For reliable diagnosis, it is necessary to study autofluorescence spectra of healthy mucosa first. We measured excitation-emission maps in healthy subjects and subjects with a history of cancer in the head -neck region. Our results show that different anatomical locations produce distinct autofluorescence spectra. Influences of, among others, smoking and drinking habits require further investigation.
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