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

• Published in: Annals of surgical oncology Vol. 24; no. 7; pp. 1897 - 1903
• Main Authors: Mondal, Suman B., Gao, Shengkui, Zhu, Nan, Habimana-Griffin, LeMoyne, Akers, Walter J., Liang, Rongguang, Gruev, Viktor, Margenthaler, Julie, Achilefu, Samuel
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-07-2017; Springer Nature B.V
• Subjects: Biopsy; Breast cancer; Breast Oncology; Fluorescence; I.R. radiation; Leg; Lymph nodes; Lymphatic system; Medicine; Medicine & Public Health; Oncology; Paraffin; Patients; Sulfur; Surgery; Surgical Oncology; Tumors; Sentinel Lymph Node; Sentinel Lymph Node Biopsy; Partial Mastectomy; Undergo Sentinel Lymph Node Biopsy; Popliteal Lymph Node
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-017-5804-8

Background
The inability to visualize the patient and surgical site directly, 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
99m
Tc-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 four 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.