The status of lymph node is considered a critical prognostic factor for staging and guiding the future adjuvant treatment in many cancer types. The estimation of undetected micrometastases (0.2-2mm diameter) by conventional pathology was around 30-60% cases which has created a demand for the development of more fast and accurate approaches. In response, a paired-agent imaging approach is presented by employing a control imaging agent to allow rapid, quantitative mapping of microscopic cancer cells in lymph nodes to guide pathology sectioning. To identify the most feasible and effective protocol using this approach to detect micrometastases intraoperatively, swine cervical lymph nodes were used to evaluate the potential of different protocols for the agents to diffuse into and out of intact nodes. Aby-029, an anti-EGFR affibody molecule labeled with IRDye-800CW was used as targeted imaging agent, and the IRDye-700DX carboxylate was used as control agent. The time-course paired-agent fluorescence of whole lymph node were recorded to monitor the uptake and washout kinetics. Subsequently, lymph nodes were frozen-sectioned and imaged under an 85-um resolution fluorescence imaging system (Pearl, LICOR) to confirm equivalence of spatial distribution of both agents in the entire node. After much trial-and error, the intranodal infusion staining and rinsing protocol demonstrated promising results that both imaging agents shown strong correlation with each other in the absence of cancer cells (r=0.99, p<0.001). This methodology indicated the potential of using paired-agent imaging approach to allow rapid and sufficient detection of micrometastases in excised lymph nodes intraoperatively.
Sentinel lymph node involvement is recognized as a prognostic factor in breast cancer staging and is essential to guide optimal treatment. The possibility of missed micrometastases by using conventional methods was estimated around 20-60% cases has created a demand for the development of more accurate approaches. A paired-agent imaging approach is presented by employing a control imaging agent to allow rapid, quantitative mapping of microscopic populations of tumor cells in lymph nodes to guide pathology sectioning. To test the feasibility of this approach to identify micrometastases, lymph node micrometastases biological tissue model was developed and were stained with targeted and control imaging agent solution to evaluate the binding potential of the agents of intact nodes. ABY-029, an EGFR specific affibody was labeled with IRDye-800CW(LICOR) as targeted agent and IRDye-700DX was hydrolyzed as control agent. Lymph nodes phantoms were stained for 60 min, followed by 60 min rinsing, and the fluorescence of whole lymph node phantoms were recorded to evaluate the spatial distribution of both agents in the entire phantom. Measured binding potential of targeted agent between micrometastases and control regions were 0.652 ± 0.130 and -0.008 ± 0.042 respectively (p < 0.0001). The results demonstrate the potential to enhance the sensitivity of lymph node pathology using paired-agent imaging in a whole human lymph node.
Lymph node biopsy is a primary means of staging breast cancer, yet standard pathological techniques are time-consuming and typically sample less than 1% of the total node volume. A low-cost fluorescence optical projection tomography (OPT) protocol is demonstrated for rapid imaging of whole lymph nodes in three dimensions. The relatively low scattering properties of lymph node tissue can be leveraged to significantly improve spatial resolution of lymph node OPT by employing angular restriction of photon detection. It is demonstrated through porcine lymph node metastases models that simple filtered-backprojection reconstruction is sufficient to detect and localize 200-μm-diameter metastases (the smallest clinically significant) in 1-cm-diameter lymph nodes.
Sentinel lymph node status is a critical prognostic factor in breast cancer treatment and is essential to guide future adjuvant treatment. The estimation that 20-60% of micrometastases are missed by conventional pathology has created a demand for the development of more accurate approaches. Here, a paired-agent imaging approach is presented that employs a control imaging agent to allow rapid, quantitative mapping of microscopic populations of tumor cells in lymph nodes to guide pathology sectioning. To test the feasibility of this approach to identify micrometastases, healthy pig lymph nodes were stained with targeted and control imaging agent solution to evaluate the potential for the agents to diffuse into and out of intact nodes. Aby-029, an anti-EGFR affibody was labeled with IRDye 800CW (LICOR) as targeted agent and IRDye 700DX was hydrolyzed as a control agent. Lymph nodes were stained and rinsed by directly injecting the agents into the lymph nodes after immobilization in agarose gel. Subsequently, lymph nodes were frozen-sectioned and imaged under an 80-um resolution fluorescence imaging system (Pearl, LICOR) to confirm equivalence of spatial distribution of both agents in the entire node. The binding potentials were acquired by a pixel-by-pixel calculation and was found to be 0.02 ± 0.06 along the lymph node in the absence of binding. The results demonstrate this approach’s potential to enhance the sensitivity of lymph node pathology by detecting fewer than 1000 cell in a whole human lymph node.
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