Optical See-Through Cancer Vision Goggles Enable Direct Patient Visualization and Real-Time Fluorescence-Guided Oncologic Surgery

Abstract

Background The inability to directly visualize the patient and surgical site limits the use of current near infrared fluorescence-guided surgery systems for real-time sentinel lymph node biopsy and tumor margin assessment. Methods We evaluated an optical see-through goggle augmented imaging and navigation system (GAINS) for near-infrared fluorescence-guided surgery. Tumor-bearing mice injected with a near infrared cancer-targeting agent underwent fluorescence-guided tumor resection. Female Yorkshire pigs received hind leg intradermal indocyanine green injection and underwent fluorescence-guided popliteal lymph node resection. Four breast cancer patients received 99mTc-sulfur colloid and indocyanine green retroareolarly, before undergoing sentinel lymph node biopsy using radioactive tracking and fluorescence imaging. Three other breast cancer patients received indocyanine green retroareolarly before undergoing standard-of-care partial mastectomy, followed by fluorescence imaging of resected tumor and tumor cavity for margin assessment. Results Using near-infrared fluorescence from the dyes, the optical see-through GAINS accurately identified all mouse tumors, pig lymphatics, and 4 pig popliteal lymph nodes with high signal-to-background ratio. In 4 human breast cancer patients, 11 sentinel lymph nodes were identified with a detection sensitivity of 86.67± 0.27% for radioactive tracking and 100% for GAINS. Tumor margin status was accurately predicted by GAINS in all three patients, including clear margins in patients 1 and 2 and positive margins in patient 3 as confirmed by paraffin embedded section histopathology. Conclusions The optical see-through GAINS prototype enhances near infrared fluorescence-guided surgery for sentinel lymph node biopsy and tumor margin assessment in breast cancer patients without disrupting the surgical workflow in the operating room.

Navigating surgical fluorescence cameras using near-infrared optical tracking

“…24,25 Next to the fluorescence cameras that are currently available in the clinic, this research also supports the navigation of future surgical fluorescence imaging devices; e.g., fluorescence goggles and head-mounted displays. 26…”

Current possibilities of peri-operative evaluation of the radicality of primary tumour resection in breast cancer patients treated with BCT (breast conserving treatment)

“…The largest advantage of the new solution is its increased mobility and the fact that the operator is independent from the assistant, whilst the former clinical value of the method is still preserved. In accordance with the suggestion of the authors of the studies carried out with the use of the OST GAINS technique, it is necessary to continue these studies on a larger group of subjects [39].…”

Repurposing Molecular Imaging and Sensing for Cancer Image–Guided Surgery

“…Wearable devices use miniaturized imaging detectors, powerful processors, and fast image-processing to display real-time molecular information to surgeons via head-mounted displays. Direct projection of the molecular information to the surgeon's field of view enables seamless integration to the intraoperative surgical workflow (28,29). Head-mounted displays are increasingly used for medical image visualization in mixed-reality applications, and their small size, low cost, and intuitive user experience make them very amenable for wide clinical adoption (Supplemental Table 3).…”

“…Indocyanine green is a Food and Drug Administration-approved NIR fluorescent contrast agent that has been widely used for MIGS (55), especially for highly sensitive detection of SLNs comparable to or better than standard-of-care radioactive and blue dye tracking (Fig. 4) (22,28,29). A NIR folate receptor-targeted fluorophore, OTL38, was recently tested in ovarian cancer patients and enabled an additional 29% of malignant lesions to be removed that were not identified by standard surgical practice (68).…”