According to the World Health Organization, there were almost 18 million patients living with cancer in 2020. It is estimated that over 14 million patients will require oncologic surgery in 2040. This is a 52% increase from 2018 estimations.¹ Due to the importance of a complete (R0) resection on survival and the increase in detection of early-stage disease, surgical resection remains an important treatment of solid tumors.^2,3 Achieving an R0 resection and identifying disease in lymph nodes or synchronous lesions has been shown repeatedly to improve oncologic outcomes and is a mainstay of curative-intent treatment.⁴ However, achieving these margins and finding residual disease during surgery remains a challenge for surgical oncologists. This is mainly due to the inability to see microscopic disease left behind and, at times, uncertainty about involvement of vital structures.

Purpose: To evaluate the utility of two‐dimensional (2D) Localized Correlated Spectroscopy (L‐COSY) in metabolic profiling of the human brain at 7 Tesla (T).Materials and Methods: The 2D L‐COSY sequence was implemented at 7T and its reliability was assessed by test–retest studies of a metabolite phantom and a healthy volunteer. L‐COSY data were acquired from the occipital lobe of healthy subjects (n = 6; all male; age, 30–72 years) to assess intersubject variability. Additionally, two subjects underwent scans from the parieto‐occipital region, basal ganglia, frontal lobe or dorsolateral prefrontal cortex to test the versatility of L‐COSY in studying differing anatomy. Integral/volume measurements of L‐COSY spectra were used to estimate normalized metabolite‐to‐creatine concentrations.Results: Phantom test–retest studies revealed coefficients of variation (CVs) of 3–20% for most metabolites. Human 2D L‐COSY spectra permitted detection of several metabolite resonances from multiple locations and inter‐subject variation studies demonstrated CVs of 4–26%. Cross‐peaks from gamma‐aminobutyric acid (GABA), isoleucine (Ile), lysine (Lys) and Ethanolamine (Eth) were quantified, which are not readily resolvable with conventional one‐dimensional (1D) MR spectroscopy.Conclusion: 2D L‐COSY at 7T demonstrated improved sensitivity in detecting additional metabolites with reliability comparable to established techniques at lower fields, which may aid in the metabolic assessment of diseased states. J. Magn. Reson. Imaging 2014;40:1319–1327. © 2013 Wiley Periodicals, Inc.

Cytosolic phospholipase A2α (cPLA2α) has been shown to be elevated in breast cancer and is a potential biomarker in the differentiation of molecular sub-types. Using a cPLA2α activatable fluorophore, DDAO arachidonate, we explore its ability to function as a contrast agent in fluorescence-guided surgery. In cell lines ranging in cPLA2α expression and representing varying breast cancer sub-types, we show DDAO arachidonate activates with a high correlation to cPLA2α expression level. Using a control probe, DDAO palmitate, in addition to cPLA2α inhibition and genetic knockdown, we show that this activation is a result of cPLA2α activity. In mouse models, using an ex vivo tumor painting technique, we show that DDAO arachidonate activates to a high degree in basal-like versus luminal-like breast tumors and healthy mammary tissue. Finally, we show that using an in vivo model, orthotopic basal-like tumors give significantly high probe activation compared to healthy mammary fat pads and surrounding tissue. Together we conclude that cPLA2α activatable fluorophores such as DDAO arachidonate may serve as a useful contrast agent for the visualization of tumor margins in the fluorescence-guided surgery of basal-like breast cancer.

Fluorescence molecular imaging (FMI) is becoming a powerful tool to improve surgical precision and diagnostics. Although significant advances have been made in imaging technology and contrast agents, debate continues regarding suitable standards for FMI. Standardizing all FMI aspects is crucial for adoption in clinical procedures and routine practice. Currently, the lack of clear-cut guidelines on FMI study reporting complicates comparison between studies and impedes standardization. This work presents community-driven REFLECT guidelines for FMI study reporting for fluorescence-guided surgery and interventions, covering preclinical, translational, and clinical studies. It aims to improve quality of reporting, enable comparison between studies, and enhance interpretation of results. The resulting structured checklist encompasses all essential details for reporting on the contrast agent, imaging device, imaging protocol, and image processing and analysis methods. Adoption of this framework is encouraged to enhance reproducibility and establish alignment with standardization efforts in the field - thus fostering advancements in FMI.