Cancer Check During Surgery

Ultrafast lasers may better distinguish cancerous tissue during surgery, defining tumor margins and helping improve outcomes.
Karin Heineman, Executive Producer

(Inside Science) -- An interview with Michael Giacomelli, a postdoctoral fellow from the Massachusetts Institute of Technology, on a new, faster cancer imaging technology.

“The diagnosis of cancer and especially the evaluation of cancer that is removed from the body is 100-and-something-year-old technique that has advanced very little. We’ve developed a technology based on ultrafast lasers where we scan specimens as they’re cut out of women undergoing surgery for breast cancer. The advantage is we can generate images in seconds.”

Why do current cancer-identifying techniques need improvement?

“So, a typical histology requires overnight processing. So, patients are sent home basically after their surgery, and then after a processing delay, a physician looks at the tissue that was removed from the patient and determines whether or not they removed sufficient tissue. And if they did not, they actually bring the patient back. And in the case of breast cancer, they bring quite a lot of patients back and they re-operate on them if they didn’t cut enough tissue out. So, it’s a major problem actually, to try and make sure that an entire tumor is removed on the first go, if at all possible.

“If you want to evaluate a piece of tissue during surgery, you have very limited options. And as a result, a lot of surgeries, and especially surgeries for breast cancer, are done almost entirely based on how the tissue looks to the surgeon’s eye and how it feels to their hand. There’s no microscopic imaging or advanced diagnostics that are readily available for the operating room.

“The technology we’ve developed uses a technique called multiphoton microscopy, in which femtosecond laser pulses are focused deep in the tissue. What we’ve developed is a portable system. And it can be used to survey huge pieces of tissue in a matter of minutes.”

What does the technology mean for breast cancer patients?

“The entire reason that we have this problem with multiple surgeries is just that the slides take a day to generate. So, if you can make the slides in real time, or you can make an image that’s equivalent to the slides, you can simply look at the tissue as it is cut out of the patient and determine whether or not you got all of the cancer, or whether or not you’ve left some of the tumor in the patient.”

Can it be used for other types of cancers?

“There is a group at Memorial Sloan Kettering that is looking at skin cancer surgery using a related technique, and they are having a very high level of success. There are people looking at related techniques for things like prostate cancer as well.”

Future Developments

“In terms of technical developments, I think miniaturization is very important. The prototype instrument we’re running now is about 250 pounds and it looks about the size of a refrigerator. We’re working on versions now that are just a few pounds. I’m also looking into ways that we can do in vivo imaging. So, rather than cut tissue out and then look at it on a microscope, are there ways that we can translate this technology into imaging tissue while it’s still in the patient?”


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Karin Heineman is the executive producer of Inside Science TV.