The complementary value of intraoperative fluorescence imaging and Raman spectroscopy for cancer surgery: combining the incompatibles

A clear margin is an important prognostic factor for most solid tumours treated by surgery. Intraoperative fluorescence imaging using exogenous tumour-specific fluorescent agents has shown particular benefit in improving complete resection of tumour tissue. However, signal processing for fluorescenc...

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Bibliographic Details
Published in:European journal of nuclear medicine and molecular imaging 2022-06, Vol.49 (7), p.2364-2376
Main Authors: Lauwerends, L. J., Abbasi, H., Bakker Schut, T. C., Van Driel, P. B. A. A., Hardillo, J. A. U., Santos, I. P., Barroso, E. M., Koljenović, S., Vahrmeijer, A. L., Baatenburg de Jong, R. J., Puppels, G. J., Keereweer, S.
Format: Article
Language:English
Subjects:
Cardiology
Chemical composition
Fluorescence
Imaging
Medicine
Medicine & Public Health
Nuclear Medicine
Oncology
Oncology – General
Optics
Orthopedics
Radiology
Raman spectroscopy
Review
Review Article
Signal processing
Solid tumors
Spectrum analysis
State-of-the-art reviews
Surgery
Tumors
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Summary:A clear margin is an important prognostic factor for most solid tumours treated by surgery. Intraoperative fluorescence imaging using exogenous tumour-specific fluorescent agents has shown particular benefit in improving complete resection of tumour tissue. However, signal processing for fluorescence imaging is complex, and fluorescence signal intensity does not always perfectly correlate with tumour location. Raman spectroscopy has the capacity to accurately differentiate between malignant and healthy tissue based on their molecular composition. In Raman spectroscopy, specificity is uniquely high, but signal intensity is weak and Raman measurements are mainly performed in a point-wise manner on microscopic tissue volumes, making whole-field assessment temporally unfeasible. In this review, we describe the state-of-the-art of both optical techniques, paying special attention to the combined intraoperative application of fluorescence imaging and Raman spectroscopy in current clinical research. We demonstrate how these techniques are complementary and address the technical challenges that have traditionally led them to be considered mutually exclusive for clinical implementation. Finally, we present a novel strategy that exploits the optimal characteristics of both modalities to facilitate resection with clear surgical margins.
ISSN:1619-7070
1619-7089
DOI:10.1007/s00259-022-05705-z