Clinical Study Shows Fluorescent Dye Can Localize Tumors During Surgery in Real-time
An experimental cancer imaging tool that makes tumors glow brightly during surgery has shown promise again in a new Penn Medicine clinical study, this time in patients with brain cancer. The fluorescent dye technique, originally developed by surgeons at the Penn Center for Precision Surgery to treat lung cancer, illuminated brain tumors in real-time during surgery, helping physicians distinguish between healthy and cancerous tissue. Each year, over 15,000 people in the United States undergo surgeries to remove brain tumors.
Findings from the pilot study, led by first author John Y.K. Lee, MD, MSCE, an associate professor of Neurosurgery in the Perelman School of Medicine at the University of Pennsylvania, and co-director of the Center for Precision Surgery, were reported in this week in Neurosurgery.
A big challenge with brain surgery is ensuring the entire tumor is removed. It is difficult to identify the margins of the tumor with current approaches. Cancer tissue not visible to the naked eye or felt by fingers is often missed during tumor removal, leading to recurrence in some patients – about 20 to 50 percent.
Penn’s approach, which relies on an injectable dye that accumulates in cancerous tissues more so than normal tissues, may help change that.
“Fluorescent contrast agents take visualization to a whole new level,” Lee said. “It has the potential for real-time imaging, identification of disease, and most importantly, precise detection of the tumor’s margins. With this, we know better where to cut.”
The study also includes co-author, Sunil Singhal, MD, an associate professor of Surgery, and co-director the Center for Precision Surgery at Penn’s Abramson Cancer Center, who first started work on this approach in his lab nearly 10 years ago.
The technique uses near-infrared, or NIR, imaging and the contrasting agent indocyanine green (ICG), which fluoresces a bright green under NIR light. ICG was developed during World War II as a dye in photography and, in 1958, it was approved by the U.S. Food and Drug Administration (FDA) for use in medicine, primarily in liver diagnostics and later in cardiology.
However, for this study, researchers used a modified version of ICG at a higher concentration delivered intravenously about 24 hours before surgery to ensure margins were included. This is the first time, to the authors knowledge, that this delayed imaging of ICG has been used to visualize brain tumors.
Patients enrolled in the clinical study were between the ages of 20 and 81 with a diagnosis of a solitary brain tumor and a presumed glioma based on imaging or prior surgery or biopsy.
Twelve of the 15 tumors demonstrated strong intraoperative fluorescence. The lack of glow in the three remaining tumors could potentially be due to their disease grade and timing of the injection, the authors suggested.
Eight of the 15 patients demonstrated a visible glow through the dura, a thick membrane on the meninges of the brain, was opened, demonstrating the technology’s ability to see deeply within the brain before the tumor is exposed. Once opened, all tumors were picked up by NIR imaging.
The researchers also studied the surgical margins using neuropathology and magnetic resonance imaging, (MRI) to assess the accuracy and precision of NIR fluorescence in identifying tumor tissue.
Of the 71 specimens collected from MRI-enhanced tumors and their surgical margins, 61 (85.9 percent) fluoresced and 51 of these (71.8 percent) were classified as glioma tissue.
Of the 12 MRI-enhancing gliomas, four patients had biopsy specimens that were both non-fluorescent and negative for tumor, which matched the gross total resection seen on their MRI. In contrast, 8 patients had residual fluorescent signal in the resection cavity. Only 3 of these patients showed gross total resection on MRI. This suggests a benefit of true-negative NIR signal after resection, the authors said.
Over the past three plus years, Singhal, Lee, and their colleagues have performed more than 300 surgeries with the imaging tool in patients with various types of cancer, including lung, brain, bladder and breast.
“This technique, if approved by the FDA, may offer great promise to physicians and patients,” Singhal said. “It’s a strategy that could allow greater precision across many different cancer types, help with early detection, and hopefully better treatment success.”
The Latest on: Glowing Tumor Technology
via Google News
The Latest on: Glowing Tumor Technology
- KRONOS ADVANCED TECHNOLOGIES AIR PURIFIERS HELPING SCHOOLS REOPEN IN 2020-21.on January 21, 2021 at 11:32 am
This order resulted from Kronos launching a community program to help provide safer indoor air to schools after donating air purifiers to several local schools. We will now donate our newest sensor ...
- Using CRISPR technology, team tracks lineage of individual cancer cells as they proliferate and metastasize in real timeon January 21, 2021 at 11:11 am
When cancer is confined to one spot in the body, doctors can often treat it with surgery or other therapies. Much of the mortality associated with cancer, however, is due to its tendency to ...
- Catching cancer in the acton January 21, 2021 at 11:04 am
Researchers have turned a CRISPR tool into a way to track the lineage of cancer cells in real time. Using this method, the researchers were able to identify the individual cells involved in metastasis ...
- 10 Inauguration quotes from the last 10 Presidentson January 20, 2021 at 9:24 am
All eyes and ears will be focused on Joseph Biden as he addresses the nation at his inauguration Wednesday, January 20. He will be sworn in as the 46th President of the ...
- 25 Best Senators’ Memories From 25 Years at Canadian Tire Centreon January 16, 2021 at 3:17 pm
There is a special birthday in the Ottawa suburb of Kanata this weekend. Canadian Tire Centre turns 25. Its doors first opened on Jan. 15, 1996, for a Bryan Adams concert. The Senators played their ...
- Plumbing the marvels of 'mRNA' in creating vaccines, therapeuticson January 14, 2021 at 8:19 am
RNA is the molecule that actually does the work of creating those proteins. For years, Rossi and other scientists tried designing strands of mRNA that would force cells to make specific proteins. But ...
- CES 2021 Highlights: 79 Gadgets and Glimpses Into the Futureon January 13, 2021 at 9:42 am
The consumer tech show is virtual this year, and the WIRED Gear crew is watching all the Zooms to bring you up-to-the-minute highlights of news from CES.
- Pictures from space! Our image of the dayon January 12, 2021 at 8:35 am
Astronauts practice for spaceflight here on Earth in a number of unique ways, including underwater.
- This Company Raised $40 Million To Make Tumors Reveal Themselveson January 12, 2021 at 6:00 am
Earli, a South San Francisco-based biotech company, has a plan to fix this problem: instead of searching through the body for a tumor or cancer cells, it plans to make cancer cells reveal themselves.
via Bing News