Technique lights up tumours for more accurate surgery

The technique has been developed by engineers at the Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS) at University College London (UCL) and surgeons at Great Ormond Street Hospital (GOSH). The team’s development is detailed in Cancer Research.

The development could have implications for treating neuroblastoma, which is the most common form of solid cancer tumour found in children. According to UCL, standard treatment typically involves surgery to completely remove cancerous cells, which can be difficult to see as they look like the surrounding healthy tissue.

For the study, scientists at UCL and GOSH used molecular imaging during surgery, a process where chemicals are injected into the bloodstream to act as imaging probes. These chemicals are attracted to cancerous cells in the body and fluoresce once attached, lighting up the tumour.

Used during preclinical testing in mice, the technique revealed part of a tumour that had not been removed during surgery.

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In a statement, Dr Laura Priviter, UCL Great Ormond Street Institute of Child Health, said: “Fluorescence-guided surgery is a game-changing innovation that will help surgeons to obtain safer and more complete resection.”

The team then tested whether they could improve the visual quality of the images with short wave infrared light (SWIR), which has 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.

Team leader Dr Stefano Giuliani, Consultant Paediatric Surgeon at Great Ormond Street Hospital and Associate Professor at UCL Great Ormond Street Institute of Child Health, 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.”

Neuroblastoma accounts for 8-10 per cent of all childhood cancers and around 15 per cent 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.

Molecular imaging produces detailed pictures of biological processes and can be carried out during surgery, so clinical teams don’t have to wait for biopsy or culture results when screening for diseases. The SWIR enhances the images in real time.

Dr Dale Waterhouse, Wellcome/EPSRC Centre for Interventional & Surgical Sciences (WEISS) at UCL, said: “This work shows that SWIR imaging, a technology first used for material inspection, can enhance the surgeon’s vision beyond the capabilities of the human eye, allowing more precise tumour surgery. It is very exciting to be part of an interdisciplinary team where surgeons and engineers work together, pioneering cutting-edge technologies that promise to improve the treatment of patients at GOSH.”

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.

The study was supported by the Medical Research Council, WEISS, EPSRC, the Royal Academy of Engineering and GOSH.