Researchers develop innovative technique for distinguishing tumour from normal tissue

Patients from Newcastle Hospitals have played a part in a study which aims to distinguish healthy tissue from tumour tissues.

Removing a patient’s tumour while sparing healthy tissue requires precision, but often surgeons must rely on their eyes and hands to determine where to cut.

A team of researchers from Mass General Brigham, a leading hospital, research and education institute in the US, has developed a visualisation tool that combines high-speed cameras and fluorescent injection to distinguish tumour tissue from normal tissue across cancer types.

The team evaluated the new imaging technology, known as fluorescence lifetime (FLT) imaging, using specimens from more than 60 patients, including those from Newcastle Hospitals, who underwent surgery of various cancers.

In a paper published in Nature Biomedical Engineering, the team reported that the technique was over 97 percent accurate across tumour types, with the potential to improve the accuracy of cancer surgeries.

To develop and test this technology, Kumar and his team worked closely with colleagues at Mass Eye and Ear, a member of the Mass General Brigham healthcare system, where patients are treated for head and neck cancer.

Many technologies have been pursued to improve visualization of tumours during surgery, including fluorescence imaging and advanced microscopy, but such technologies have not yet been widely adopted and most are restricted to specific types or subtypes of cancer.

Fluorescence imaging can use dyes to target cancer-specific molecules, but standard imaging techniques can have limited accuracy for detecting tumour margins—or the edges of normal tissue that surround a tumour—since the expression of these molecules can vary widely within and across tumour types.

The technique used by the Mass General Brigham team, known as FLT imaging, takes a different tact. Instead of relying on dyes only for targeting cancer, the technique uses high-speed cameras to detect changes in the property of the light emitted by tissue.

In their current study, the team applied the same principle to samples from patients. The team began by analysing samples from patients undergoing liver surgery at MGH and head and neck surgery at Mass Eye and Ear. Patients had received an ICG injection at least a day before the surgery.

Building on this initial work, the team collaborated across multiple institutions and evaluated specimens from more than 60 patients representing multiple cancer types, including liver, brain, tongue, skin, bone and soft tissue, who were treated at MGH, Mass Eye and Ear, The University of Pennsylvania, Newcastle Hospitals/Newcastle University, and Leiden University in the Netherlands.

The team was able to detect an FLT shift at the cellular level that was consistent across tumour types and in multiple patients. The technique was also able to distinguish benign from metastatic lymph nodes. Overall, it was more than 97 percent accurate at distinguishing tumour tissue from healthy tissue.

Mr Kenny Rankin, consultant orthopaedic surgeon at Newcastle Hospitals and honorary senior lecturer at Newcastle University, said:

“On behalf of the North of England Bone and Soft Tissue Tumour Service it has been exciting to work on this project. Our contribution has included input from patients undergoing surgery for musculoskeletal cancers who kindly donated their tumours for research and also the NovoPath laboratories who were able to support the processing of the tissue.

“We look forward to the next developments which will put Newcastle at the forefront of the introduction of this technology into clinical practice.”

The study has been supported by the orthopaedics research team at Newcastle Hospitals.

Anand Kumar, PhD, associate professor of Radiology at the Athinoula A. Martinos Center for Biomedical Imaging at Massachusetts General Hospital (MGH) who led the study, said: “This has been a thrilling collaboration with leading surgeons and pathologists from five hospitals in the US and Europe,”

“Our lab has been studying fluorescence lifetime imaging since 2002, but this is the first time that anyone has combined it with tumour imaging and injectable dyes in humans. By doing so, we’ve developed a technique for accurately distinguishing tumour tissue from healthy tissue across cancer types.”

Newcastle University and Newcastle Hospitals are both part of Newcastle Health Innovation Partners (NHIP). NHIP is one of eight prestigious Academic Health Science Centres (AHSCs) across the UK, bringing together partners to deliver excellence in research, health education and patient care.

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