Repurposing Molecular Imaging and Sensing for Cancer Image–Guided Surgery

Abstract

Gone are the days when medical imaging was used primarily to visualize anatomic structures. The emergence of molecular imaging (MI), championed by radiolabeled 18 F-FDG PET, has expanded the information content derived from imaging to include pathophysiologic and molecular processes. Cancer imaging, in particular, has leveraged advances in MI agents and technology to improve the accuracy of tumor detection, interrogate tumor heterogeneity, monitor treatment response, focus surgical resection, and enable image-guided biopsy. Surgeons are actively latching on to the incredible opportunities provided by medical imaging for preoperative planning, intraoperative guidance, and postoperative monitoring. From label-free techniques to enabling cancer-selective imaging agents, imageguided surgery provides surgical oncologists and interventional radiologists both macroscopic and microscopic views of cancer in the operating room. This review highlights the current state of MI and sensing approaches available for surgical guidance. Salient features of nuclear, optical, and multimodal approaches will be discussed, including their strengths, limitations, and clinical applications. To address the increasing complexity and diversity of methods available today, this review provides a framework to identify a contrast mechanism, suitable modality, and device. Emerging low-cost, portable, and user-friendly imaging systems make the case for adopting some of these technologies as the global standard of care in surgical practice.

Novel Multimodal, Multiscale Imaging System with Augmented Reality

“…The ability to have multiscale fluorescence imaging and functional microscopy has the potential to provide better intraoperative image guidance [ 66 , 67 ]. Surgical setting often needs different scale to accommodate various imaging application, such as tissue perfusion test and tumor margin assessment [ 12 , 13 , 68 ]. Fluorescence imaging at different scales hold great promise for solving many clinical problems [ 69 ].…”

“…The ability to actively or passively target, label, and enhance the visibility of blood vessels, lymph nodes, and cancerous or pre-cancerous lesions beneath the tissue surface has found use in many operative procedures and surgical planning [ 3 , 4 , 5 ]. Fluorescence imaging has received significant interest from researchers in the last decade [ 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 ]. A limitation of fluorescence imaging is the inability to provide significant contrast support at tissue depths beyond a few millimeters from the surface.…”

RGD-Functionalized Melanin Nanoparticles for Intraoperative Photoacoustic Imaging-Guided Breast Cancer Surgery

“…Imaging-guided surgery is gaining increasing importance in the operating room. It can help detect microscopic tumours or residual lesions that are readily missed during surgery and guide intraoperative surgical margin assessment [24]. Thus, this approach could potentially improve patient outcome following oncologic surgery.…”

Endoscopic Molecular Imaging plus Photoimmunotherapy: A New Strategy for Monitoring and Treatment of Bladder Cancer

“…Recently, molecular fluorescent tracer-mediated molecular imaging and photoimmunotherapy (PIT) have shown some potential advantages in the management of cancers. 1 , 2 , 3 , 4 Molecular imaging refers to a subject of qualitative and quantitative study of pathological processes at the cellular and molecular levels using imaging technologies, such as optical molecular imaging, magnetic resonance molecular imaging, ultrasound, and nuclear medicine molecular imaging, which may indicate diseases prior to macrostructure changes. 5 Unlike magnetic and nuclear medicine molecular imaging, endoscopic molecular imaging provides a real-time and dynamic image during operation.…”