Lighting up tumors could help surgeons remove them more precisely

A new technique that combines highly detailed, real-time images of inside the body with a type of infrared light has, for the first time, been used during surgery to differentiate between cancerous tumours and healthy tissue.

The pioneering technique, demonstrated in mice, has been developed by engineers at the Surgical WEISS center at University College London and surgeons at Great Ormond Street Hospital (GOSH), the university announced in a press release.

Researchers say the development could have implications for treating neuroblastoma, which is the most common form of solid cancer tumour, other than brain tumours, found in children. Standard treatment typically involves surgery to completely remove cancerous cells, which can be difficult to see as they look similar to the surrounding healthy tissue.

Seeing tumor growth in a 3D tumor microenvironment model

In the 3D bio-printing laboratory at the Medical University of Innsbruck, researchers are working on the production of human tissue that can be built using 3D bio-printers. The replication of human tissue makes it possible to simulate and study diseases.

How the method works

For the study, scientists at UCL and GOSH used a technique called ‘molecular imaging’ during surgery, where chemicals are injected into the bloodstream to act as imaging probes. These chemicals are attracted to cancerous cells in the body, and once attached, the probes light up through a process called ‘fluorescence’, which in turn lights up the tumour. The technique, used during preclinical testing in mice, successfully revealed part of a tumour that had not been removed during surgery.

Next the team wanted to test whether they could improve the visual quality of the images, by using a ‘new’ type of light, short wave infrared light (SWIR), that has only recently become accessible to scientists through new technology.

For this they used a special high definition camera to capture SWIR fluorescence. SWIR is invisible to the naked eye and has a longer wavelength than visible light, allowing it to penetrate deeper into the tissue to provide sharper, more detailed images. Using this technique, surgeons were able to distinguish between cancerous tumours and healthy tissue during the preclinical tests.

Precisely scanning neuroblastoma, for better treatment

Neuroblastoma is a devasting childhood cancer and accounts for 8-10 percent of all childhood cancers and around 15 percent of childhood deaths from cancer. In around a third of patients the cancer has already spread to other parts of the body at the time of diagnosis, making it harder to treat.

Team leader Dr. Stefano Giuliani, Paediatric Surgeon at Great Ormond Street Hospital, said: “Surgery to remove neuroblastoma requires a delicate balance. Remove too little and the tumour might grow back, but remove too much and the surgeon risks damaging the surrounding blood vessels, nerves and other healthy organs. This technique effectively lights up the tumour, allowing surgeons to remove it with unprecedented precision. We hope to be able to translate this innovative technology into clinical practice at GOSH as soon as possible to benefit the largest number of children with cancerous tumours.”

Unlike X-ray or magnetic resonance imaging (MRI), which focus on organs and bones, molecular imaging produces detailed pictures of biological processes, and can be done live during surgery, meaning clinical teams don’t have to wait for biopsy or culture results when screening for diseases. The SWIR enhances the images in real time.

“Next generation” cancer treatment: less side effects and precise targeting

Scientists at the University of East Anglia are a step closer to creating a new generation of light-activated cancer treatments. The innovative treatment would work by switching on LED lights embedded close to a tumour, which would then activate biotherapeutic drugs.

A need for new technologies

UCL’s Dr. Laura Privitera said: “Paediatric surgical oncology faces an ever-increasing need for novel technologies and devices that can help visualise tumours intraoperatively. By using targeted fluorescence-guided surgery, we demonstrate the possibility of safely and specifically delineating tumour margins, allowing its differentiation from surrounding healthy tissue. Fluorescence-guided surgery is a game-changing innovation that will help surgeons to obtain safer and more complete resection”. Scientists at GOSH and UCL WEISS are now working to fast-track the technology into the operating theatre at GOSH within the next 12 months to benefit children with cancerous tumours.