title: Optical See-Through Cancer Vision Goggles Enable Direct Patient Visualization and Real-Time Fluorescence-Guided Oncologic Surgery.
abstract: BACKGROUND
  The inability to visualize the patient and surgical site directly, limits the use of current near infrared fluorescence-guided surgery systems for real-time sentinel lymph node biopsy and tumor margin assessment.
  
  
  METHODS
  We evaluated an optical see-through goggle augmented imaging and navigation system (GAINS) for near-infrared, fluorescence-guided surgery. Tumor-bearing mice injected with a near infrared cancer-targeting agent underwent fluorescence-guided, tumor resection. Female Yorkshire pigs received hind leg intradermal indocyanine green injection and underwent fluorescence-guided, popliteal lymph node resection. Four breast cancer patients received99mTc-sulfur colloid and indocyanine green retroareolarly before undergoing sentinel lymph node biopsy using radioactive tracking and fluorescence imaging. Three other breast cancer patients received indocyanine green retroareolarly before undergoing standard-of-care partial mastectomy, followed by fluorescence imaging of resected tumor and tumor cavity for margin assessment.
  
  
  RESULTS
  Using near-infrared fluorescence from the dyes, the optical see-through GAINS accurately identified all mouse tumors, pig lymphatics, and four pig popliteal lymph nodes with high signal-to-background ratio. In 4 human breast cancer patients, 11 sentinel lymph nodes were identified with a detection sensitivity of 86.67 ± 0.27% for radioactive tracking and 100% for GAINS. Tumor margin status was accurately predicted by GAINS in all three patients, including clear margins in patients 1 and 2 and positive margins in patient 3 as confirmed by paraffin-embedded section histopathology.
  
  
  CONCLUSIONS
  The optical see-through GAINS prototype enhances near infrared fluorescence-guided surgery for sentinel lymph node biopsy and tumor margin assessment in breast cancer patients without disrupting the surgical workflow in the operating room.
authors.affiliation: Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA.|Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, USA.
authors.forename: Suman B
authors.initials: SB
authors.lastname: Mondal
authors.affiliation: Department of Computer Science and Engineering, Washington University in St. Louis, St. Louis, MO, USA.
authors.forename: Shengkui
authors.initials: S
authors.lastname: Gao
authors.affiliation: College of Optical Science, The University of Arizona, Tucson, 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.|Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, USA.
authors.forename: LeMoyne
authors.initials: L
authors.lastname: Habimana-Griffin
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: College of Optical Science, The University of Arizona, Tucson, AZ, USA.
authors.forename: Rongguang
authors.initials: R
authors.lastname: Liang
authors.affiliation: Department of Computer Science and Engineering, Washington University in St. Louis, St. Louis, MO, USA.
authors.forename: Viktor
authors.initials: V
authors.lastname: Gruev
authors.affiliation: Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: Julie
authors.initials: J
authors.lastname: Margenthaler
authors.affiliation: Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA. achilefu@wustl.edu.|Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, USA. achilefu@wustl.edu.|Department of Biochemistry and Molecular Biophysics, Washington University School of Medicine, St. Louis, MO, USA. achilefu@wustl.edu.|Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA. achilefu@wustl.edu.
authors.forename: Samuel
authors.initials: S
authors.lastname: Achilefu
mesh_terms: D000328:Adult; D000368:Aged; D000818:Animals; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D005135:Eye Protective Devices; D005260:Female; D005453:Fluorescence; D006801:Humans; D007208:Indocyanine Green; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery*; D051379:Mice; D008807:Mice, Inbred BALB C; D008819:Mice, Nude; D008875:Middle Aged; D011379:Prognosis; D021701:Sentinel Lymph Node Biopsy; D025321:Surgery, Computer-Assisted / Q000379:methods*; D000071077:Surgical Oncology; D013552:Swine
chemical_list: D007208:Indocyanine Green