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Published on: September 19, 2014
Near-infrared operating lamp for intraoperative molecular imaging of a mediastinal tumor
Jane Keating1, Ryan Judy2, Andrew Newton3
1Department of Surgery, University of Pennsylvania and Philadelphia VA Medical Center, 6 White Building, 3400 Spruce Street, Philadelphia, PA, 19104, USA. janejkeating@gmail.com.
Background:
Near-Infrared (NIR) intraoperative molecular imaging is a new diagnostic modality utilized during cancer surgery for the identification of tumors, metastases and lymph nodes. Surgeons typically use headlamps during an operation to increase visible light; however, these light sources are not adapted to function simultaneously with NIR molecular imaging technology. Here, we design a NIR cancelling headlamp and utilize it during surgery to assess whether intraoperative molecular imaging of mediastinal tumors is possible.
Methods:
A NIR cancelling headlamp was designed and tested using NIR spectroscopy preoperatively. Next, a 46 year-old-female was referred to the thoracic surgery clinic for a 5.8 cm mediastinal mass noted on chest x-ray. Prior to surgery, she was given intravenous indocyanine green (ICG). Then, the prototype headlamp was used in conjunction with our intraoperative molecular imaging device. The tumor was imaged both in vivo and following resection prior to pathological examination.
Results:
NIR spectroscopy confirmed NIR light excitation of the unfiltered headlamp and the absence of NIR emitted light after addition of the filter. Next, in vivo imaging confirmed fluorescence of the tumor, but also demonstrated a significant amount of NIR background fluorescence emanating from the unfiltered headlamp. During imaging with the filtered headlamp, we again demonstrated a markedly fluorescent tumor but with a reduced false positive NIR signal. Final pathology was well-differentiated thymoma with negative surgical margins.
Conclusions:
NIR intraoperative molecular imaging using a systemic injection of intravenous ICG was successful in localizing a thymoma. Additionally, a simple design and implementation of a NIR cancelling headlamp reduces false positive NIR fluorescence.
Insights
A novel near-infrared (NIR) cancelling headlamp improved intraoperative molecular imaging during surgery for mediastinal tumors. This technology reduces false positives, enhancing tumor localization for better surgical outcomes.
Area of Science:
- Oncology
- Surgical Technology
- Medical Imaging
Background:
- Near-infrared (NIR) intraoperative molecular imaging aids in identifying cancerous tissues during surgery.
- Standard surgical headlamps interfere with NIR imaging due to light emission.
- A new NIR-cancelling headlamp was developed to overcome this limitation.
Observation:
- A prototype NIR-cancelling headlamp was tested using NIR spectroscopy.
- A patient with a mediastinal mass received intravenous indocyanine green (ICG) before surgery.
- The headlamp was used with an intraoperative imaging device to visualize the tumor.
Findings:
- NIR spectroscopy confirmed the headlamp filter effectively blocked NIR light.
- In vivo imaging showed a fluorescent tumor, with reduced background noise using the filtered headlamp.
- Pathology confirmed a well-differentiated thymoma with clear surgical margins.
Implications:
- NIR intraoperative molecular imaging with ICG successfully localized a thymoma.
- The NIR-cancelling headlamp design effectively reduces false-positive signals in surgical imaging.
- This technology has the potential to improve the precision of cancer surgery.
