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Prostate specific membrane antigen-radio guided surgery using Cerenkov luminescence imaging—utilization of a short-pass filter to reduce technical pitfalls

BACKGROUND: Intraoperative Cerenkov luminescence imaging (CLI) is a novel technique to assess surgical margins in patients undergoing nerve sparing radical prostatectomy (RP). Here, we analyze the efficacy of a 550-nm optical short-pass filter (OF) to improve its performance. METHODS: In this prospe...

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Autores principales: Darr, Christopher, Fragoso Costa, Pedro, Kesch, Claudia, Krafft, Ulrich, Püllen, Lukas, Harke, Nina Natascha, Hess, Jochen, Szarvas, Tibor, Haubold, Johannes, Reis, Henning, Fendler, Wolfgang Peter, Herrmann, Ken, Radtke, Jan Philipp, Hadaschik, Boris Alexander, Tschirdewahn, Stephan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: AME Publishing Company 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8575587/
https://www.ncbi.nlm.nih.gov/pubmed/34804840
http://dx.doi.org/10.21037/tau-20-1141
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author Darr, Christopher
Fragoso Costa, Pedro
Kesch, Claudia
Krafft, Ulrich
Püllen, Lukas
Harke, Nina Natascha
Hess, Jochen
Szarvas, Tibor
Haubold, Johannes
Reis, Henning
Fendler, Wolfgang Peter
Herrmann, Ken
Radtke, Jan Philipp
Hadaschik, Boris Alexander
Tschirdewahn, Stephan
author_facet Darr, Christopher
Fragoso Costa, Pedro
Kesch, Claudia
Krafft, Ulrich
Püllen, Lukas
Harke, Nina Natascha
Hess, Jochen
Szarvas, Tibor
Haubold, Johannes
Reis, Henning
Fendler, Wolfgang Peter
Herrmann, Ken
Radtke, Jan Philipp
Hadaschik, Boris Alexander
Tschirdewahn, Stephan
author_sort Darr, Christopher
collection PubMed
description BACKGROUND: Intraoperative Cerenkov luminescence imaging (CLI) is a novel technique to assess surgical margins in patients undergoing nerve sparing radical prostatectomy (RP). Here, we analyze the efficacy of a 550-nm optical short-pass filter (OF) to improve its performance. METHODS: In this prospective single-center feasibility study ten patients with prostate cancer (PC) were included between December 2019 and April 2020, including three patients without tracer injection as a control group. After preoperative injection of 68-Ga-prostate-specific membrane antigen (PSMA)-11 followed by RP, CLI of the excised prostate and the incised index lesion was performed to visualize the primary tumor lesion. We compared the findings on intraoperative CLI to postoperative histopathology. Furthermore, CLI-intensities determined as tumor to background ratio (TBR) and contrast to noise ratio (CNR) were measured. RESULTS: Histopathology proved positive surgical margins (PSM) in 3 patients with corresponding findings in CLI. After magnetic resonance imaging (MRI)-informed incision above the index lesion 2 out of 3 prostates demonstrated elevated CLI signals with histopathological confirmation of PC cells. The use of the OF enabled a significant reduction of the area of the regions of interest from a median of 1.80 to 0.15 cm(2) (reduction by 85%, P=0.005) leading to increased specificity. Signals due to PSMs were not suppressed by the 550-nm OF. The median TBR was reduced from 3.33 to 2.10. In all three patients of the control group elevated CLI intensities were detected at locations with diathermal energy deposition during surgery. After application of the 550-nm OF these were almost totally suppressed with a TBR of 1.10. Measurements of Cerenkov luminescence intensity with the 550-nm OF showed a significant Pearson’s correlation of 0.82 between PSM and the elevated TBR (P=0.003) and a significant Pearson’s correlation of 0.66 between PSM and elevated CNR (P=0.04). Measurements without the OF did not correlate significantly. CONCLUSIONS: Intraoperative 68-Ga-PSMA CLI in PC is a tool that warrants further investigation to visualize PSM especially in intermediate and high-risk PC. Intraoperative CLI benefits from usage of a 550-nm OF to reduce false-positive signals.
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spelling pubmed-85755872021-11-18 Prostate specific membrane antigen-radio guided surgery using Cerenkov luminescence imaging—utilization of a short-pass filter to reduce technical pitfalls Darr, Christopher Fragoso Costa, Pedro Kesch, Claudia Krafft, Ulrich Püllen, Lukas Harke, Nina Natascha Hess, Jochen Szarvas, Tibor Haubold, Johannes Reis, Henning Fendler, Wolfgang Peter Herrmann, Ken Radtke, Jan Philipp Hadaschik, Boris Alexander Tschirdewahn, Stephan Transl Androl Urol Original Article on Management of Advanced Genitourinary Malignancies BACKGROUND: Intraoperative Cerenkov luminescence imaging (CLI) is a novel technique to assess surgical margins in patients undergoing nerve sparing radical prostatectomy (RP). Here, we analyze the efficacy of a 550-nm optical short-pass filter (OF) to improve its performance. METHODS: In this prospective single-center feasibility study ten patients with prostate cancer (PC) were included between December 2019 and April 2020, including three patients without tracer injection as a control group. After preoperative injection of 68-Ga-prostate-specific membrane antigen (PSMA)-11 followed by RP, CLI of the excised prostate and the incised index lesion was performed to visualize the primary tumor lesion. We compared the findings on intraoperative CLI to postoperative histopathology. Furthermore, CLI-intensities determined as tumor to background ratio (TBR) and contrast to noise ratio (CNR) were measured. RESULTS: Histopathology proved positive surgical margins (PSM) in 3 patients with corresponding findings in CLI. After magnetic resonance imaging (MRI)-informed incision above the index lesion 2 out of 3 prostates demonstrated elevated CLI signals with histopathological confirmation of PC cells. The use of the OF enabled a significant reduction of the area of the regions of interest from a median of 1.80 to 0.15 cm(2) (reduction by 85%, P=0.005) leading to increased specificity. Signals due to PSMs were not suppressed by the 550-nm OF. The median TBR was reduced from 3.33 to 2.10. In all three patients of the control group elevated CLI intensities were detected at locations with diathermal energy deposition during surgery. After application of the 550-nm OF these were almost totally suppressed with a TBR of 1.10. Measurements of Cerenkov luminescence intensity with the 550-nm OF showed a significant Pearson’s correlation of 0.82 between PSM and the elevated TBR (P=0.003) and a significant Pearson’s correlation of 0.66 between PSM and elevated CNR (P=0.04). Measurements without the OF did not correlate significantly. CONCLUSIONS: Intraoperative 68-Ga-PSMA CLI in PC is a tool that warrants further investigation to visualize PSM especially in intermediate and high-risk PC. Intraoperative CLI benefits from usage of a 550-nm OF to reduce false-positive signals. AME Publishing Company 2021-10 /pmc/articles/PMC8575587/ /pubmed/34804840 http://dx.doi.org/10.21037/tau-20-1141 Text en 2021 Translational Andrology and Urology. All rights reserved. https://creativecommons.org/licenses/by-nc-nd/4.0/Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) .
spellingShingle Original Article on Management of Advanced Genitourinary Malignancies
Darr, Christopher
Fragoso Costa, Pedro
Kesch, Claudia
Krafft, Ulrich
Püllen, Lukas
Harke, Nina Natascha
Hess, Jochen
Szarvas, Tibor
Haubold, Johannes
Reis, Henning
Fendler, Wolfgang Peter
Herrmann, Ken
Radtke, Jan Philipp
Hadaschik, Boris Alexander
Tschirdewahn, Stephan
Prostate specific membrane antigen-radio guided surgery using Cerenkov luminescence imaging—utilization of a short-pass filter to reduce technical pitfalls
title Prostate specific membrane antigen-radio guided surgery using Cerenkov luminescence imaging—utilization of a short-pass filter to reduce technical pitfalls
title_full Prostate specific membrane antigen-radio guided surgery using Cerenkov luminescence imaging—utilization of a short-pass filter to reduce technical pitfalls
title_fullStr Prostate specific membrane antigen-radio guided surgery using Cerenkov luminescence imaging—utilization of a short-pass filter to reduce technical pitfalls
title_full_unstemmed Prostate specific membrane antigen-radio guided surgery using Cerenkov luminescence imaging—utilization of a short-pass filter to reduce technical pitfalls
title_short Prostate specific membrane antigen-radio guided surgery using Cerenkov luminescence imaging—utilization of a short-pass filter to reduce technical pitfalls
title_sort prostate specific membrane antigen-radio guided surgery using cerenkov luminescence imaging—utilization of a short-pass filter to reduce technical pitfalls
topic Original Article on Management of Advanced Genitourinary Malignancies
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8575587/
https://www.ncbi.nlm.nih.gov/pubmed/34804840
http://dx.doi.org/10.21037/tau-20-1141
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