Tissue texture extraction in indocyanine green fluorescence imaging for breast-conserving surgery

Leiloglou, Maria; Chalau, Vadzim; Kedrzycki, Martha; Thiruchelvam, Paul; Darzi, Ara; Leff, Daniel; Elson, Daniel S.

doi:10.1088/1361-6463/abe571

Cited by 8 publications

(39 citation statements)

References 22 publications

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“…Upcoming work will be focused on extracting advanced image texture analysis 16 in the angiography cohort to exploit the different vasculature characteristics between tumor and normal tissue. 21 Subsequently, both pixel intensity and texture algorithms will be tested on the remaining images (in vivo, tumor bed, and superior/inferior/medial/lateral ex vivo).…”

Section: Discussionmentioning

confidence: 99%

“… 21 Subsequently, both pixel intensity and texture algorithms will be tested on the remaining images (in vivo, tumor bed, and superior/inferior/medial/lateral ex vivo). Finally, our dual camera FGS system 16 will be adapted for in vivo imaging using targeting contrast agents more specific to breast cancer.…”

Section: Discussionmentioning

confidence: 99%

“…15 In the case of breast tissue, with a systemic injection of 12.5 mg ICG, the emission peak has been reported to be 814 nm. 16 Clinically approved uses include angiography and lymphography, as ICG is retained within the vessels into which it has been injected (blood or lymph vessels) due to its considerable size upon binding with plasma proteins. Moreover, systemic administration of ICG has recently been investigated for macroscopic tumor fluorescence evaluation in BCS, yet has thus far lacked in sensitivity and specificity.…”

mentioning

confidence: 99%

“… 15 In the case of breast tissue, with a systemic injection of 12.5 mg ICG, the emission peak has been reported to be 814 nm. 16 …”

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confidence: 99%

“… 21 Our previous 10-patient BCS feasibility study (REC 18/LO/2018), has shown that our in-house dual camera system detects ICG fluorescence in vivo at a sub-millimeter scale, while fluorescence image texture pattern analysis could improve the tumor detection accuracy. 16 The primary aims of this follow-on clinical study were to (a) investigate the diagnostic accuracy of ICG fluorescence images for tumor detection during BCS via our developed imaging system, and (b) determine whether the timing of ICG administration affects diagnostic accuracy.…”

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confidence: 99%

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The Impact of Temporal Variation in Indocyanine Green Administration on Tumor Identification During Fluorescence Guided Breast Surgery

et al. 2021

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Background On average, 21% of women in the USA treated with Breast Conserving Surgery (BCS) undergo a second operation because of close positive margins. Tumor identification with fluorescence imaging could improve positive margin rates through demarcating location, size, and invasiveness of tumors. We investigated the technique’s diagnostic accuracy in detecting tumors during BCS using intravenous indocyanine green (ICG) and a custom-built fluorescence camera system. Methods In this single-center prospective clinical study, 40 recruited BCS patients were sub-categorized into two cohorts. In the first ‘enhanced permeability and retention’ (EPR) cohort, 0.25 mg/kg ICG was injected ~ 25 min prior to tumor excision, and in the second ‘angiography’ cohort, ~ 5 min prior to tumor excision. Subsequently, an in-house imaging system was used to image the tumor in situ prior to resection, ex vivo following resection, the resection bed, and during grossing in the histopathology laboratory to compare the technique’s diagnostic accuracy between the cohorts. Results The two cohorts were matched in patient and tumor characteristics. The majority of patients had invasive ductal carcinoma with concomitant ductal carcinoma in situ. Tumor-to-background ratio (TBR) in the angiography cohort was superior to the EPR cohort (TBR = 3.18 ± 1.74 vs 2.10 ± 0.92 respectively, p = 0.023). Tumor detection reached sensitivity and specificity scores of 0.82 and 0.93 for the angiography cohort and 0.66 and 0.90 for the EPR cohort, respectively (p = 0.1051 and p = 0.9099). Discussion ICG administration timing during the angiography phase compared with the EPR phase improved TBR and diagnostic accuracy. Future work will focus on image pattern analysis and adaptation of the camera system to targeting fluorophores specific to breast cancer.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

“… 15 In the case of breast tissue, with a systemic injection of 12.5 mg ICG, the emission peak has been reported to be 814 nm. 16 …”

mentioning

confidence: 99%

mentioning

confidence: 99%

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The Impact of Temporal Variation in Indocyanine Green Administration on Tumor Identification During Fluorescence Guided Breast Surgery

et al. 2021

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Fluorescence imaging for real-time detection of breast cancer tumors using IV injection of indocyanine green with non-conventional imaging: a systematic review of preclinical and clinical studies of perioperative imaging technologies

Pop,

Veys,

Bormans

et al. 2024

Breast Cancer Res Treat

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Background This review summarizes the available data on the effectiveness of indocyanine green fluorescence imaging (ICG-FI) for real-time detection of breast cancer (BC) tumors with perioperative imaging technologies. Methods PubMed and Scopus databases were exhaustively searched for publications on the use of the real-time ICG-FI evaluation of BC tumors with non-conventional breast imaging technologies. Results Twenty-three studies were included in this review. ICG-FI has been used for BC tumor identification in 12 orthotopic animal tumor experiences, 4 studies on animal assessment, and for 7 human clinical applications. The BC tumor-to-background ratio (TBR) was 1.1–8.5 in orthotopic tumor models and 1.4–3.9 in animal experiences. The detection of primary human BC tumors varied from 40% to 100%. The mean TBR reported for human BC varied from 2.1 to 3.7. In two studies evaluating BC surgical margins, good sensitivity (93.3% and 100%) and specificity (60% and 96%) have been reported, with a negative predictive value of ICG-FI to predict margin involvement intraoperatively of 100% in one study. Conclusions The use of ICG-FI as a guiding tool for the real-time identification of BC tumors and for the assessment of tumor boundaries is promising. There is great variability between the studies with regard to timing and dose. Further evidence is needed to assess whether ICG-guided BC surgery may be implemented as a standard of care.

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Indocyanine green fluorescence image processing techniques for breast cancer macroscopic demarcation

Leiloglou

Kedrzycki

Chalau

et al. 2022

Sci Rep

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Re-operation due to disease being inadvertently close to the resection margin is a major challenge in breast conserving surgery (BCS). Indocyanine green (ICG) fluorescence imaging could be used to visualize the tumor boundaries and help surgeons resect disease more efficiently. In this work, ICG fluorescence and color images were acquired with a custom-built camera system from 40 patients treated with BCS. Images were acquired from the tumor in-situ, surgical cavity post-excision, freshly excised tumor and histopathology tumour grossing. Fluorescence image intensity and texture were used as individual or combined predictors in both logistic regression (LR) and support vector machine models to predict the tumor extent. ICG fluorescence spectra in formalin-fixed histopathology grossing tumor were acquired and analyzed. Our results showed that ICG remains in the tissue after formalin fixation. Therefore, tissue imaging could be validated in freshly excised and in formalin-fixed grossing tumor. The trained LR model with combined fluorescence intensity (pixel values) and texture (slope of power spectral density curve) identified the tumor’s extent in the grossing images with pixel-level resolution and sensitivity, specificity of 0.75 ± 0.3, 0.89 ± 0.2.This model was applied on tumor in-situ and surgical cavity (post-excision) images to predict tumor presence.

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Tissue texture extraction in indocyanine green fluorescence imaging for breast-conserving surgery

Cited by 8 publications

References 22 publications

The Impact of Temporal Variation in Indocyanine Green Administration on Tumor Identification During Fluorescence Guided Breast Surgery

The Impact of Temporal Variation in Indocyanine Green Administration on Tumor Identification During Fluorescence Guided Breast Surgery

Fluorescence imaging for real-time detection of breast cancer tumors using IV injection of indocyanine green with non-conventional imaging: a systematic review of preclinical and clinical studies of perioperative imaging technologies

Indocyanine green fluorescence image processing techniques for breast cancer macroscopic demarcation

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