Cerenkov luminescence imaging (CLI) for image-guided cancer surgery

Grootendorst, Maarten; Cariati, Maurizio; Kothari, Ashutosh; Tuch, David S.; Purushotham, A.D.

doi:10.1007/s40336-016-0183-x

Cited by 78 publications

(60 citation statements)

References 80 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The technique is attractive for guiding surgical margins, especially if PET imaging is planned and the imaging agents are already present in the patient. 69 This approach has been used in a study with 18F-fluorodeoxyglucose (FDG) in human patients for intraoperative breast tumor margin assessment. Promising results were found in that elevated tumor radiance was observed at 2.4 times the background tissue, at a dose of only 10's of microSv to surgical staff.…”

Section: Cherenkov Petmentioning

confidence: 99%

Review of methods for intraoperative margin detection for breast conserving surgery

et al. 2018

View full text Add to dashboard Cite

Breast conserving surgery (BCS) is an effective treatment for early-stage cancers as long as the margins of the resected tissue are free of disease according to consensus guidelines for patient management. However, 15% to 35% of patients undergo a second surgery since malignant cells are found close to or at the margins of the original resection specimen. This review highlights imaging approaches being investigated to reduce the rate of positive margins, and they are reviewed with the assumption that a new system would need high sensitivity near 95% and specificity near 85%. The problem appears to be twofold. The first is for complete, fast surface scanning for cellular, structural, and/or molecular features of cancer, in a lumpectomy volume, which is variable in size, but can be large, irregular, and amorphous. A second is for full, volumetric imaging of the specimen at high spatial resolution, to better guide internal radiologic decision-making about the spiculations and duct tracks, which may inform that surfaces are involved. These two demands are not easily solved by a single tool. Optical methods that scan large surfaces quickly are needed with cellular/molecular sensitivity to solve the first problem, but volumetric imaging with high spatial resolution for soft tissues is largely outside of the optical realm and requires x-ray, micro-CT, or magnetic resonance imaging if they can be achieved efficiently. In summary, it appears that a combination of systems into hybrid platforms may be the optimal solution for these two very different problems. This concept must be cost-effective, image specimens within minutes and be coupled to decision-making tools that help a surgeon without adding to the procedure. The potential for optical systems to be involved in this problem is emerging and clinical trials are underway in several of these technologies to see if they could reduce positive margin rates in BCS.

show abstract

Section: Cherenkov Petmentioning

confidence: 99%

Review of methods for intraoperative margin detection for breast conserving surgery

et al. 2018

View full text Add to dashboard Cite

show abstract

“…As an example, in [67] the use of fused silica rather than Schott-75 glass was suggested to improve sensitivity. In addition, long-pass filters have been employed for deeply located sources to suppress the contribution of short wavelength Cerenkov photons produced superficially (farther away from the source).…”

Section: Reviewmentioning

confidence: 99%

Cerenkov luminescence imaging: physics principles and potential applications in biomedical sciences

Ciarrocchi

Belcari

2017

EJNMMI Phys

View full text Add to dashboard Cite

Cerenkov luminescence imaging (CLI) is a novel imaging modality to study charged particles with optical methods by detecting the Cerenkov luminescence produced in tissue. This paper first describes the physical processes that govern the production and transport in tissue of Cerenkov luminescence. The detectors used for CLI and their most relevant specifications to optimize the acquisition of the Cerenkov signal are then presented, and CLI is compared with the other optical imaging modalities sharing the same data acquisition and processing methods. Finally, the scientific work related to CLI and the applications for which CLI has been proposed are reviewed. The paper ends with some considerations about further perspectives for this novel imaging modality.

show abstract

“…Optical imaging of Cerenkov photons emitted by PET agents is an emerging imaging modality called Cerenkov luminescence imaging (CLI). CLI combines high diagnostic performance and clinical translatability of PET imaging with high spatial resolution and compactness of optical cameras, thus making it a promising technology for intraoperative margin assessment in breast cancer surgery (8).…”

mentioning

confidence: 99%

Intraoperative Assessment of Tumor Resection Margins in Breast-Conserving Surgery Using ¹⁸F-FDG Cerenkov Luminescence Imaging: A First-in-Human Feasibility Study

et al. 2016

View full text Add to dashboard Cite

In early-stage breast cancer, the primary treatment option for most women is breast-conserving surgery (BCS). There is a clear need for more accurate techniques to assess resection margins intraoperatively, because on average 20% of patients require further surgery to achieve clear margins. Cerenkov luminescence imaging (CLI) combines optical and molecular imaging by detecting light emitted by 18 F-FDG. Its high-resolution and small size imaging equipment make CLI a promising technology for intraoperative margin assessment. A first-in-human study was conducted to evaluate the feasibility of 18 F-FDG CLI for intraoperative assessment of tumor margins in BCS. Methods: Twenty-two patients with invasive breast cancer received 18 F-FDG (5 MBq/kg) 45-60 min before surgery. Sentinel lymph node biopsy was performed using an increased 99m Tc-nanocolloid activity of 150 MBq to facilitate nodal detection against the g-probe background signal (cross-talk) from 18 F-FDG. The cross-talk and 99m Tc dose required was evaluated in 2 lead-in studies. Immediately after excision, specimens were imaged intraoperatively in an investigational CLI system. The first 10 patients were used to optimize the imaging protocol; the remaining 12 patients were included in the analysis dataset. Cerenkov luminescence images from incised BCS specimens were analyzed postoperatively by 2 surgeons blinded to the histopathology results, and mean radiance and margin distance were measured. The agreement between margin distance on CLI and histopathology was assessed. Radiation doses to staff were measured. Results: Ten of the 12 patients had an elevated tumor radiance on CLI. Mean radiance and tumor-to-background ratio were 560 6 160 photons/s/cm 2 /sr and 2.41 6 0.54, respectively. All 15 assessable margins were clear on CLI and histopathology. The agreement in margin distance and interrater agreement was good (k 5 0.81 and 0.912, respectively). Sentinel lymph nodes were successfully detected in all patients. The radiation dose to staff was low; surgeons received a mean dose of 34 6 15 mSv per procedure. Conclusion: Intraoperative 18 F-FDG CLI is a promising, low-risk technique for intraoperative assessment of tumor margins in BCS. A randomized controlled trial will evaluate the impact of this technique on reexcision rates. In early-stage breast cancer, the primary treatment option for most women is breast-conserving surgery (BCS) by wide local excision (WLE) of the tumor. WLE often fails to achieve clear surgical margins, and on average 20% of patients who undergo BCS will require repeated surgery to achieve clear margins (1) (although this may vary because there is no global agreement of the definition of clear margins). Reoperations potentially have several negative consequences including delayed commencement of adjuvant therapy, worse cosmesis, increased patient anxiety, and costs (2,3).There have been several attempts to assess surgical margins intraoperatively to reduce breast cancer reoperation rates after WLE (1). Techniques evaluated to date in...

show abstract

Cerenkov luminescence imaging (CLI) for image-guided cancer surgery

Cited by 78 publications

References 80 publications

Review of methods for intraoperative margin detection for breast conserving surgery

Review of methods for intraoperative margin detection for breast conserving surgery

Cerenkov luminescence imaging: physics principles and potential applications in biomedical sciences

Intraoperative Assessment of Tumor Resection Margins in Breast-Conserving Surgery Using ¹⁸F-FDG Cerenkov Luminescence Imaging: A First-in-Human Feasibility Study

Contact Info

Product

Resources

About

Cerenkov luminescence imaging (CLI) for image-guided cancer surgery

Cited by 78 publications

References 80 publications

Review of methods for intraoperative margin detection for breast conserving surgery

Review of methods for intraoperative margin detection for breast conserving surgery

Cerenkov luminescence imaging: physics principles and potential applications in biomedical sciences

Intraoperative Assessment of Tumor Resection Margins in Breast-Conserving Surgery Using 18F-FDG Cerenkov Luminescence Imaging: A First-in-Human Feasibility Study

Contact Info

Product

Resources

About

Intraoperative Assessment of Tumor Resection Margins in Breast-Conserving Surgery Using ¹⁸F-FDG Cerenkov Luminescence Imaging: A First-in-Human Feasibility Study