State of the Art: Precision Surgery Guided by Intraoperative Molecular Imaging

Azari, Feredun; Zhang, Kevin; Kennedy, Gregory T.; Chang, Ashley; Nadeem, Bilal; Delikatny, Edward J.; Singhal, Sunil

doi:10.2967/jnumed.121.263409

Cited by 16 publications

(14 citation statements)

References 61 publications

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“…Medical imaging technology has significantly increased the precision of identifying tumor tissue during tumor resection surgery. − Surgeons can observe the distribution of near-infrared fluorescent (NIRF) probes in vivo and accurately remove tumors according to the tumor edges indicated by the probes. − NIRF probes are divided into active targeting probes and passive targeting probes. − Indocyanine green (ICG) is an approved passive targeting probe. Although ICG can be used in the diagnosis of liver cancer, it is difficult to diagnose small infiltrating lesions, especially liver metastasis. − An active targeting probe is developed on the premise of finding and identifying suitable tumor targets.…”

Section: Introductionmentioning

confidence: 99%

FGF19-Based Mini Probe Targeting FGFR4 for Diagnosis and Surgical Navigation of Hepatocellular Carcinoma

Cai,

Lian,

et al. 2024

J. Med. Chem.

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Hepatocellular carcinoma (HCC) is a frequent malignancy that has a high death rate and a high rate of recurrence following surgery, owing to insufficient surgical resection. Furthermore, HCC is prone to peritoneal metastasis (HCC-PM), resulting in a significant number of tiny cancer lesions, making surgical removal more challenging. As a potential imaging target, FGFR4 is highly expressed in tumors, especially in HCC, but is less expressed in the normal liver. In this study, we used computational simulation approaches to develop peptide I0 derived from FGF19, a particular ligand of FGFR4, and labeled it with the NIRF dye, MPA, for HCC detection. In surgical navigation, the TBR was 9.31 ± 1.36 and 8.57 ± 1.15 in HepG2 in situ tumor and HCC-PM models, respectively, indicating considerable tumor uptake. As a result, peptide I0 is an excellent clinical diagnostic reagent for HCC, as well as a tool for surgically resecting HCC peritoneal metastases.

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Section: Introductionmentioning

confidence: 99%

FGF19-Based Mini Probe Targeting FGFR4 for Diagnosis and Surgical Navigation of Hepatocellular Carcinoma

Cai,

Lian,

et al. 2024

J. Med. Chem.

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“…Hepatectomy is currently one of the most effective curative treatments [ 4 ], while the long-term oncological outcome is still poor due to high recurrence rates and metastasis after surgery [ 5 ]. With the development of precision surgery [ 6 ], modern hepatectomy has shown relatively satisfactory clinical responses for the treatment of HCC [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Data-Driven Assisted Decision Making for Surgical Procedure of Hepatocellular Carcinoma Resection and Prognostic Prediction: Development and Validation of Machine Learning Models

Wang

Song

Wang

et al. 2023

Cancers

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Background: Currently, surgical decisions for hepatocellular carcinoma (HCC) resection are difficult and not sufficiently personalized. We aimed to develop and validate data driven prediction models to assist surgeons in selecting the optimal surgical procedure for patients. Methods: Retrospective data from 361 HCC patients who underwent radical resection in two institutions were included. End-to-end deep learning models were built to automatically segment lesions from the arterial phase (AP) of preoperative dynamic contrast enhanced magnetic resonance imaging (DCE-MRI). Clinical baseline characteristics and radiomic features were rigorously screened. The effectiveness of radiomic features and radiomic-clinical features was also compared. Three ensemble learning models were proposed to perform the surgical procedure decision and the overall survival (OS) and recurrence-free survival (RFS) predictions after taking different solutions, respectively. Results: SegFormer performed best in terms of automatic segmentation, achieving a Mean Intersection over Union (mIoU) of 0.8860. The five-fold cross-validation results showed that inputting radiomic-clinical features outperformed using only radiomic features. The proposed models all outperformed the other mainstream ensemble models. On the external test set, the area under the receiver operating characteristic curve (AUC) of the proposed decision model was 0.7731, and the performance of the prognostic prediction models was also relatively excellent. The application web server based on automatic lesion segmentation was deployed and is available online. Conclusions: In this study, we developed and externally validated the surgical decision-making procedures and prognostic prediction models for HCC for the first time, and the results demonstrated relatively accurate predictions and strong generalizations, which are expected to help clinicians optimize surgical procedures.

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“…for cancer imaging are 5-aminolevulinic acid (5-ALA), methylene blue, and indocyanine green (for intraoperative tumor identification). (Azari et al 2022;Chen et al 2020;Weissleder and Pittet 2008;Wu et al 2023;Zhang et al 2017) 5-ALA is approved for fluorescence-guided surgery, but their excitation and emission wavelengths (405/645 nm) are heavily absorbed by tissue, thus, hindering the imaging depth. (Van Keulen et al 2022;Weissleder and Pittet 2008;Zhang et al 2017) Methylene blue is approved for sentinel lymph nodes (SLNs) mapping, but it possess potential toxicity for metabolic encephalopathy and exihibits a small stokes shift with largely overlapping spectra (668/688 nm).…”

mentioning

confidence: 99%

In vivo imaging of prostate tumor-targeted folic acid conjugated quantum dots

et al. 2023

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Cancer is a major threat to human health; thus, early detection is imperative for successful management. Rapid diagnosis can be achieved by imaging primary (subcutaneous) tumors using fluorophores conjugated with tumor markers. Here, the application of biocompatible, quantum efficient, monodisperse, and photostable polymer-coated quantum dots (PQDs) is demonstrated for targeted prostate tumor imaging in living SCID mice. Briefly, PQDs (blue) are conjugated to folic acid (FA-PQDs) using DCC-NHS chemistry. Initially, in vitro targeted imaging via FA-PQDs is evaluated in LNCaP cells. The confocal microscopic evaluation demonstrates the uptake of FA-PQDs. To understand the dispersion of PQDs in vivo, the biodistribution of PQDs is assessed at different time intervals (1- 180 min) using whole-body fluorescence imaging and computed tomography (CT) scan. PQDs are seen to accumulate in organs like the liver, kidneys, spleen, lungs, and urinary bladder within 60 min, however, PQDs are not observed at 180 min indicating renal clearance. Further, to target the prostate tumor (~ 200 mm3) in mice, FA-PQDs are injected intravenously, and whole-body fluorescence imaging along with a CT scan is recorded. FA-PQDs are seen at the tumor site as compared to PQDs. The results confirm that the FA-PQDs function as excellent nanoprobes for targeted tumor imaging in vivo.

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State of the Art: Precision Surgery Guided by Intraoperative Molecular Imaging

Cited by 16 publications

References 61 publications

FGF19-Based Mini Probe Targeting FGFR4 for Diagnosis and Surgical Navigation of Hepatocellular Carcinoma

FGF19-Based Mini Probe Targeting FGFR4 for Diagnosis and Surgical Navigation of Hepatocellular Carcinoma

Data-Driven Assisted Decision Making for Surgical Procedure of Hepatocellular Carcinoma Resection and Prognostic Prediction: Development and Validation of Machine Learning Models

In vivo imaging of prostate tumor-targeted folic acid conjugated quantum dots

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