title: Binocular Goggle Augmented Imaging and Navigation System provides real-time fluorescence image guidance for tumor resection and sentinel lymph node mapping.
abstract: The inability to identify microscopic tumors and assess surgical margins in real-time during oncologic surgery leads to incomplete tumor removal, increases the chances of tumor recurrence, and necessitates costly repeat surgery. To overcome these challenges, we have developed a wearable goggle augmented imaging and navigation system (GAINS) that can provide accurate intraoperative visualization of tumors and sentinel lymph nodes in real-time without disrupting normal surgical workflow. GAINS projects both near-infrared fluorescence from tumors and the natural color images of tissue onto a head-mounted display without latency. Aided by tumor-targeted contrast agents, the system detected tumors in subcutaneous and metastatic mouse models with high accuracy (sensitivity = 100%, specificity = 98% ± 5% standard deviation). Human pilot studies in breast cancer and melanoma patients using a near-infrared dye show that the GAINS detected sentinel lymph nodes with 100% sensitivity. Clinical use of the GAINS to guide tumor resection and sentinel lymph node mapping promises to improve surgical outcomes, reduce rates of repeat surgery, and improve the accuracy of cancer staging.
authors.affiliation: 1] Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA [2] Department of Biomedical Engineering, Washington University, St. Louis, MO, USA.
authors.forename: Suman B
authors.initials: SB
authors.lastname: Mondal
authors.affiliation: Department of Computer Science and Engineering, Washington University, St. Louis, MO, USA.
authors.forename: Shengkui
authors.initials: S
authors.lastname: Gao
authors.affiliation: College of Optical Sciences, The University of Arizona, Tuscon, AZ, USA.
authors.forename: Nan
authors.initials: N
authors.lastname: Zhu
authors.affiliation: Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: Gail P
authors.initials: GP
authors.lastname: Sudlow
authors.affiliation: Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: Kexian
authors.initials: K
authors.lastname: Liang
authors.affiliation: 1] Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA [2] Department of Biomedical Engineering, Washington University, St. Louis, MO, USA.
authors.forename: Avik
authors.initials: A
authors.lastname: Som
authors.affiliation: Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: Walter J
authors.initials: WJ
authors.lastname: Akers
authors.affiliation: Department of Surgery, Barnes-Jewish Hospital, and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: Ryan C
authors.initials: RC
authors.lastname: Fields
authors.affiliation: Department of Surgery, Barnes-Jewish Hospital, and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: Julie
authors.initials: J
authors.lastname: Margenthaler
authors.affiliation: College of Optical Sciences, The University of Arizona, Tuscon, AZ, USA.
authors.forename: Rongguang
authors.initials: R
authors.lastname: Liang
authors.affiliation: Department of Computer Science and Engineering, Washington University, St. Louis, MO, USA.
authors.forename: Viktor
authors.initials: V
authors.lastname: Gruev
authors.affiliation: 1] Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA [2] Department of Biomedical Engineering, Washington University, St. Louis, MO, USA [3] Department of Biochemistry &Molecular Biophysics, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: Samuel
authors.initials: S
authors.lastname: Achilefu
mesh_terms: D000818:Animals; D005453:Fluorescence; D007208:Indocyanine Green; D051379:Mice; D008819:Mice, Nude; D009374:Neoplasms, Experimental / Q000473:pathology* / Q000601:surgery*; D021701:Sentinel Lymph Node Biopsy; D015348:Vision, Binocular
chemical_list: D007208:Indocyanine Green