Feasibility study of novel endoscopic Cerenkov luminescence imaging system in detecting and quantifying gastrointestinal disease: first human results

Hu, Hao; Cao, Xin; Kang, Fei; Wang, Min; Lin, Yenan; Liu, Muhan; Li, Shujun; Yao, Liping; Liang, Jie; Liang, Jinling; Nie, Yongzhan; Chen, Xueli; Wang, Jing; Wu, Kaichun

doi:10.1007/s00330-014-3574-2

Cited by 58 publications

(43 citation statements)

References 23 publications

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“…Three clinical pilot studies of CLI have been published to date. These have focused on the use of CLI to image radiopharmaceutical uptake in the thyroid, CLI for noninvasive detection of nodal disease, and Cerenkov luminescence endoscopy to aid detection of cancerous lesions in the gastrointestinal tract (17)(18)(19). To our knowledge, this is the first report of intraoperative CLI.…”

Section: Discussionmentioning

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

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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...

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Section: Discussionmentioning

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

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“…It has been shown that, it is possible to detect the organs within the body by using optical fibers and a CCD camera [54], as well as enable endoscopic testing [55,56]. These studies led to introduction of CLE systems which have apparently high sensitivity and resolution and consist of an optical fiber connect to a CCD sensitive camera which can be used as a helpful tool during the cancer surgery [16] (Fig.…”

Section: čErenkov Luminescence Endoscopy (Cle)mentioning

confidence: 99%

Review of biomedical Čerenkov luminescence imaging applications

Tanha

Pashazadeh

Pogue

2015

Biomed. Opt. Express

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Čerenkov radiation is a fascinating optical signal, which has been exploited for unique diagnostic biological sensing and imaging, with significantly expanded use just in the last half decade. Čerenkov Luminescence Imaging (CLI) has desirable capabilities for niche applications, using specially designed measurement systems that report on radiation distributions, radiotracer and nanoparticle concentrations, and are directly applied to procedures such as medicine assessment, endoscopy, surgery, quality assurance and dosimetry. When compared to the other imaging tools such as PET and SPECT, CLI can have the key advantage of lower cost, higher throughput and lower imaging time. CLI can also provide imaging and dosimetry information from both radioisotopes and linear accelerator irradiation. The relatively short range of optical photon transport in tissue means that direct Čerenkov luminescence imaging is restricted to small animals or near surface human use. Use of Čerenkov-excitation for additional molecular probes, is now emerging as a key tool for biosensing or radiosensitization. This review evaluates these new improvements in CLI for both medical value and biological insight. References and links 1. P. Čerenkov, "Visible radiation produced by electrons moving in a medium with velocities exceeding the of light," Phys. Rev. 52(4), 378-379 (1937). 2. P. Čerenkov, "Visible Emission of Člean Liquids by Action of $\gamma$ Radiation," Dokl. Akad. Nauk SSSR 2, 451-454 (1934). 3. R. H. Elrick and R. P. Parker, "The use of Cerenkov radiation in the measurement of beta-emitting radionuclides," Int. J. Appl. Radiat. Isot. 19(3), 263-271 (1968). 4. M. K. Johnson, "Counting of Čerenkov radiation from 32P in nonaqueous media," Anal. Biochem. 29(2), 348-350 (1969). 5. F. L. Hoch, R. A. Kuras, and J. D. Jones, "Iodine analysis of biological samples by neutron activation of 127-I, with scintillation counting of Čerenkov radiation," Anal. Biochem. 40(1), 86-94 (1971). 6. G. Bosia, C. Castagnoli, M. Dardo, and G. Marangoni, "Observation of structure in Čerenkov pulses from extensive air showers using fast techniques," Nature 225(5232), 532-533 (1970). 7. W. C. Haxton, "Salty water Čerenkov detectors for solar neutrinos," Phys. Rev. Lett. 76(10), 1562-1565 (1996). Chen, "PET and NIR optical imaging using self-illuminating (64)Cu-doped chelator-free gold nanoclusters," Biomaterials 35(37), 9868-9876 (2014). 72.

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“…The first CLI clinical studies utilized the PET tracer [ 18 F]-FDG in endoscopic studies and detection of nodal disease (13,14), while another study imaged 131 I thyroid uptake in one patient (15). These proof-of-concept studies employed widely used radiotracers to correlate images obtained through traditional nuclear medicine instrumentation with CLI as a means to quantify the efficacy.…”

Section: Optical Imaging Of Charged Particlesmentioning

confidence: 99%

Optical Imaging of Ionizing Radiation from Clinical Sources

2016

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Nuclear medicine utilizes ionizing radiation for both in vivo diagnosis and therapy. Ionizing radiation comes from a variety of sources, including X-rays, beam therapy, brachytherapy, and various injected radionuclides. While positron emission tomography and single-photon emission computed tomography remain clinical mainstays, optical readouts of ionizing radiation offer numerous benefits and complement these standard techniques. Furthermore, for ionizing radiation sources that cannot be imaged using these standard techniques, optical imaging offers a unique imaging alternative. This article reviews optical imaging of both radionuclide- and beam-based ionizing radiation from high-energy photons and charged particles through mechanisms including radioluminescence, Cerenkov luminescence, and scintillation. Therapeutically, these visible photons have been combined with photodynamic therapeutic agents pre-clinically for increasing therapeutic response at depths difficult to reach with external light sources. Lastly, new microscopy methods that allow single cell optical imaging of radionuclides are reviewed.

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Feasibility study of novel endoscopic Cerenkov luminescence imaging system in detecting and quantifying gastrointestinal disease: first human results

Cited by 58 publications

References 23 publications

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

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

Review of biomedical Čerenkov luminescence imaging applications

Optical Imaging of Ionizing Radiation from Clinical Sources

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Feasibility study of novel endoscopic Cerenkov luminescence imaging system in detecting and quantifying gastrointestinal disease: first human results

Cited by 58 publications

References 23 publications

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

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

Review of biomedical Čerenkov luminescence imaging applications

Optical Imaging of Ionizing Radiation from Clinical Sources

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

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