Indocyanine green fluorescence image processing techniques for breast cancer macroscopic demarcation

Abstract

Re-operation due to disease being inadvertently close to the resection margin is a major challenge in breast conserving surgery (BCS). Indocyanine green (ICG) fluorescence imaging could be used to visualize the tumor boundaries and help surgeons resect disease more efficiently. In this work, ICG fluorescence and color images were acquired with a custom-built camera system from 40 patients treated with BCS. Images were acquired from the tumor in-situ, surgical cavity post-excision, freshly excised tumor and histopathology tumour grossing. Fluorescence image intensity and texture were used as individual or combined predictors in both logistic regression (LR) and support vector machine models to predict the tumor extent. ICG fluorescence spectra in formalin-fixed histopathology grossing tumor were acquired and analyzed. Our results showed that ICG remains in the tissue after formalin fixation. Therefore, tissue imaging could be validated in freshly excised and in formalin-fixed grossing tumor. The trained LR model with combined fluorescence intensity (pixel values) and texture (slope of power spectral density curve) identified the tumor’s extent in the grossing images with pixel-level resolution and sensitivity, specificity of 0.75 ± 0.3, 0.89 ± 0.2.This model was applied on tumor in-situ and surgical cavity (post-excision) images to predict tumor presence.

Recent advances in optical imaging through deep tissue: imaging probes and techniques

“…It is obvious that the optical probes and techniques could not remove this limitation completely, but relatively increase the penetration depth compared to traditional materials and methods. It was reported that the penetration depth of the representative conventional optical probe, indocyanine green is about 4 mm [ 84 ]. Some of the introduced optical probes showed better data, but they were still below 20 mm.…”

Fluorescence guided surgery imaging systems for breast cancer identification: a systematic review

“…23 Five studies included patients who underwent neoadjuvant chemotherapy (NACT) prior to BCS or mastectomy. Unkart et al 25 included five pretreated patients out of 27, Veys et al 37 encompassed eight pretreated patients, and Kedrzycki et al 14 and Leiloglou et al 28 reported 2 out of 40 patients that had received NACT. However, only Zhang et al 32 investigated the impact of patients with NACT compared to those with primary surgery using a custom-built camera system.…”

Deciphering the Role of H-Ferritin Nanocages in Improving Tumor-Targeted Delivery of Indocyanine Green: Combined Analysis of Murine Tissue Homogenates with UHPLC–MS/MS and Fluorescence

“…Following intravenous administration, ICG interacts with plasma proteins and acts as a vascular agent allowing tissue perfusion and lymphatic drainage assessments . This fluorophore has been widely exploited in clinics for angiography and in various surgical fields, including vascular, gastrointestinal, and reconstructive surgery . More recently, ICG has been employed as an optical contrast agent in surgical oncology, and also reported as a photothermal and photosensitizer agent suitable for photothermal and photodynamic therapy in cancer treatment .…”