Cerenkov luminescence imaging identifies surgical margin status in
radical prostatectomy

Date:
October 7, 2020
Source:
Society of Nuclear Medicine and Molecular Imaging
Summary:
A new intraoperative imaging technique, Cerenkov luminescence
imaging (CLI), can accurately assess surgical margins during
radical prostatectomy, according to a first-in-human research. The
feasibility study showed that 68Ga-PSMA CLI can image the entire
excised prostate specimen's surface to detect prostate cancer
tissue at the resection margin.



FULL STORY ==========================================================================
A new intraoperative imaging technique, Cerenkov luminescence
imaging (CLI), can accurately assess surgical margins during radical prostatectomy, according to a first-in-human research published in the
October issue of the Journal of Nuclear Medicine. The feasibility study
showed that 68Ga-PSMA CLI can image the entire excised prostate specimen's surface to detect prostate cancer tissue at the resection margin.


========================================================================== Radical prostatectomy is one of the primary treatment options for men
with localized prostate cancer. The goal of a radical prostatectomy
is to completely resect the prostate without positive surgical
margins. Incomplete removal of the cancer tissue during radical
prostatectomy is often associated with poorer patient outcomes, including increased likelihood of recurrence and prostate cancer-related mortality.

Prostate-specific membrane antigen (PSMA) ligand positron emission
tomography (PET) has emerged as an accurate tool to detect prostate
cancer both in primary staging and at time of biochemical recurrence. As
PET imaging agents also emit optical photons via a phenomenon called
Cerenkov luminescence, researchers sought to evaluate the feasibility
and diagnostic accuracy of CLI in detecting prostate cancer.

"Intraoperative radioguidance with CLI may help surgeons in the detection
of extracapsular extension, positive surgical margins and lymph node
metastases with the aim of increasing surgical precision," stated
Christopher Darr, PhD, resident at the Department of Urology of the
University Medical Center Essen in Essen, Germany. "The intraoperative
use of CLI would allow the examination of the entire prostate surface and provide the surgeon with real-time feedback on the resection margins."
The single-center study included 10 patients with high-risk primary
prostate cancer. 68Ga-PSMA PET scans were performed followed by radical prostatectomy and intraoperative CLI of the excised prostate. CLI images
were analyzed postoperatively to determine regions of interest based on
signal intensity, and tumor-to-background ratios were calculated. CLI
tumor margin assessment was performed by analyzing elevated signals at the surface of the intact prostate images. To determine accuracy, tumor margin status as detected by CLI was compared to postoperative histopathology.

Tumor cells were successfully detected on the incised prostate CLI
images and confirmed by histopathology. Three patients had positive
surgical margins, and in two of the patients, elevated signal levels
enabled correct identification on CLI. Overall, 25 out of 35 CLI regions
of interest proved to visualize tumor signaling according to standard histopathology.

Boris A. Hadaschik, PhD, director of the Clinic for Urology of the
University Medical Center Essen, added, "Radical prostatectomy could
achieve significantly higher accuracy and oncological safety, especially
in patients with high-risk prostate cancer, through the intraoperative
use of radioligands that specifically detect prostate cancer cells. In
the future, a targeted resection of lymph node metastases could also
be performed in this way. This new imaging combines urologists and
nuclear medicine specialists in the local treatment of patients with
prostate cancer." The authors of "Intraoperative 68Gallium-PSMA Cerenkov Luminescence Imaging for Surgical Margins in Radical Prostatectomy --
A Feasibility Study" include Christopher Darr, Nina N. Harke, Jan
Philipp Radtke, Leubet Yirga, Claudia Kesch and Boris A. Hadaschik,
Department of Urology, University Hospital Essen, Essen, Germany; Maarten
R. Grootendorst, Clinical Research, Lightpoint Medical Ltd., Chesham,
United Kingdom; Wolfgang P. Fendler, Peter Fragoso Costa, Christopher Rischpler, Christine Praus, Ken Herrmann and Ina Binse; Department of
Nuclear Medicine, University Hospital Essen, Essen, Germany; Johannes
Haubold, Institute of Diagnostics and Radiology, University Hospital
Essen, Essen, Germany; and Henning Reis and Thomas Hager, Institute of Pathology, University of Duisburg-Essen, Essen, Germany.

This study was made available online in February 2020 ahead of final publication in print in October 2020.


========================================================================== Story Source: Materials provided by Society_of_Nuclear_Medicine_and_Molecular_Imaging. Note: Content may be
edited for style and length.


========================================================================== Journal Reference:
1. Christopher Darr, Nina N. Harke, Jan Philipp Radtke, Leubet Yirga,
Claudia Kesch, Maarten R. Grootendorst, Wolfgang P. Fendler, Pedro
Fragoso Costa, Christoph Rischpler, Christine Praus, Johannes
Haubold, Henning Reis, Thomas Hager, Ken Herrmann, Ina Binse,
Boris Hadaschik.

Intraoperative 68Ga-PSMA Cerenkov Luminescence Imaging for Surgical
Margins in Radical Prostatectomy: A Feasibility Study. Journal of
Nuclear Medicine, 2020; 61 (10): 1500 DOI: 10.2967/jnumed.119.240424 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2020/10/201007123055.htm

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