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Dual probe difference specimen imaging for prostate cancer margin assessment.

Marcus J Kwon1, Broderick J House1, Connor W Barth1

  • 1Oregon Health & Science University, Biomedical Engineering Department, Portland, Oregon, United States.

Journal of Biomedical Optics
|April 21, 2023
PubMed
Summary

Dual probe difference specimen imaging (DDSI) offers rapid, accurate intraoperative assessment of prostate cancer margins. This molecularly specific imaging technique improves patient outcomes by ensuring complete tumor removal during radical prostatectomy.

Keywords:
dual probe difference specimen imagingfluorescence guided surgeryprostate cancerprostatectomytumor margin assessment

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Area of Science:

  • Oncology
  • Medical Imaging
  • Biotechnology

Background:

  • Positive margin status in prostate cancer surgery leads to reoperation or adjuvant therapy, increasing patient morbidity and mortality.
  • Current intraoperative margin assessment methods like frozen section analysis are time-consuming and disruptive to surgical workflow.
  • Successful initial tumor removal during radical prostatectomy is crucial to avoid adverse treatment effects such as erectile dysfunction and incontinence.

Purpose of the Study:

  • To evaluate the utility of Dual Probe Difference Specimen Imaging (DDSI) for rapid, intraoperative assessment of prostate cancer tumor margins.
  • To determine if DDSI can accurately detect prostate-specific membrane antigen (PSMA) positive prostate cancer in resected tissue specimens.
  • To establish DDSI as a viable molecularly specific imaging modality for intraoperative margin detection in prostate cancer.

Main Methods:

  • DDSI utilizes paired antibody-based probes (one targeting PSMA, one untargeted) labeled with distinct fluorophores.
  • Probes were administered as a cocktail to stain resected murine prostate tissue specimens.
  • Ratiometric images were generated by calculating the difference in probe uptake, and accuracy was assessed using receiver operator characteristic curve analysis.

Main Results:

  • The DDSI approach demonstrated substantial contrast between PSMA-positive tumors and normal tissues (prostate, adipose, muscle).
  • Ratiometric correction effectively addressed nonspecific probe uptake, enabling clear differentiation between high and low PSMA-expressing tumors.
  • DDSI accurately assessed PSMA status, serving as a surrogate for prostate cancer margin status in resected tissues.

Conclusions:

  • DDSI is a robust, ratiometric imaging technique suitable for intraoperative margin detection in prostate cancer.
  • The method provides molecularly specific imaging, enabling rapid and accurate assessment of PSMA status.
  • Further studies will explore DDSI's potential for quantitatively characterizing prostate cancer margin status using PSMA as a biomarker.