A color/near-infrared camera inspired by the mantis shrimp visual system enables tumor detection and lymph node mapping during cancer surgery.

Near-infrared fluorescence image-guided surgery is often posed as a spectral imaging problem since surgeons must view color images of the surgical site and fluorescence images of critical anatomy. From this spectrum-centric perspective, in which cameras must capture three channels in the visible spectrum and one or more channels in the near-infrared spectrum, a large channel count is valuable because it permits the surgeon to distinguish more fluorophores and discriminate more tissue types.^{1 – 9} But near-infrared fluorescence image-guided surgery is rarely posed as a multiscale imaging problem even though surgeons must switch between zoomed-out images of the surgical site and zoomed-in images of the critical anatomy. From this scale-centric perspective, in which cameras must capture everything from the macroscopic to the microscopic, a camera with a large field of view and small spatial resolution is valuable because it permits the surgeon to see a larger region of the surgical site in more detail, facilitating a seamless transition from structures larger than organs to structures smaller than tissues.^5,7

BACKGROUND: Accurate assessment of HER-2 is imperative in selecting patients for targeted therapy. Most commonly used test methods for HER-2 are immunohistochemistry (IHC) and fluorescence in situ hybridisation (FISH). We evaluated the concordance between FISH and IHC for HER-2 in breast cancer samples using Food and Drug Administration approved tests.MATERIAL AND METHODS: Archived paraffin tissue blocks from 73 breast cancer patients were used. HER-2 immunostaining was performed using Ventana anti–HER-2 monoclonal antibody. The FISH assay was performed using PathVysion™ HER-2 DNA Probe Kit.RESULTS: Of the 73 cases 68.5% were IHC 0/1+, 15.07% were IHC 2+ and 16.44% were IHC 3+. Successful hybridisation was achieved in 72 cases. HER-2 FISH amplification was determined in 16.67% cases. Ten IHC 3+ and two IHC 2+ cases were FISH positive. Two of the IHC 3+ cases were FISH negative. Concordance rate was 100%, 18.18% and 83.33% for IHC 0/1+, 2+ and 3+ group, respectively. Total concordance was 84.72%, kappa 0.598 (p < 0.0001). The sensitivity of IHC in detecting IHC 2+ and IHC 3+ cases was 16.7% and 83.3%, and the specificity was 85% and 96.67%, respectively.CONCLUSION: The consistency between the methods was highest for IHC negative and lowest for IHC equivocal cases. The immunohistochemistry showed high sensitivity for IHC 2+/3+ cases and high specificity for IHC 3+ cases. Our results support the view that false-positive rather than false-negative IHC results are a problem with HER-2/IHC testing, and that IHC should be used as an initial screening test, but IHC 2+/ 3+ results should be confirmed by FISH.

Background/Objectives: Late diagnosis and inefficient treatment regimens lead to poor prognosis, with a low 5-year survival rate for both non-small-cell lung cancer (NSCLC) and small-cell lung cancer (SCLC). New targeted therapeutic agents can be developed and introduced only by first discovering new driver oncogenes and with a thorough investigation of the known driver genes. The aim of the current study is to investigate the prevalence of alterations in the eight most frequently altered genes in lung cancer—BRAF, EGFR, KRAS, ALK, ROS1, HER2, PD-L1 and PIK3CA. Methods: Real-time polymerase chain reaction (RT-PCR) was used to detect KRAS and EGFR mutations, multiplex PCR and microarray hybridization for KRAS/BRAF/PIK3CA mutations. Immunohistochemical analysis was performed for the detection of ALK, HER2/NEU, ROS-1 and PD-L1 alterations. Results: Overall, 221/603 patients (36.65%) had at least one genetic alteration, of which 22 patients (3.65%) had two genetic alterations and two patients had more than two genetic alterations. Additionally, 50 patients were identified with one or more KRAS mutations (8.29%), 45 patients with EGFR mutations (7.46%), and 1.82% with PIK3CA mutations and 0.66% with BRAF mutations. Furthermore, 50% of the co-occurring alterations were either on KRAS and PIK3CA genes (3/6), on KRAS and BRAF genes (2/6, 33.33%) or on EGFR and PIK3CA genes (1/6, 16.67%), and 10.45% of the patients exhibited PD-L1 overexpression, 5.31% ALK rearrangements, and 2.36% HER2/NEU expression, with no ROS-1 rearrangements detected. Conclusions: Comprehensive testing for somatic alterations in EGFR, BRAF, KRAS, and PIK3CA is significant in guiding therapeutic decisions in lung cancer management. Such testing should be routinely conducted to establish a thorough genetic profile of lung cancers in a manner that is both time-efficient and cost-effective.

SignificanceWide-field fluorescence-guided imaging is inherently depth ambiguous. Multispectral imaging across NIR-I and NIR-II may encode depth because longer-wavelength fluorescence undergoes less diffuse broadening in tissue.AimThe study aims to determine whether wavelength-dependent radial spread profiles of subsurface indocyanine green (ICG) fluorescence can be used to estimate depth from a single excitation wavelength.ApproachICG phantoms (1 to 50 μM) were imaged through ex vivo chicken breast under 785 nm excitation using four emission bands spanning NIR-I and NIR-II. Radial spread profiles from high-dynamic-range images formed a multispectral dictionary, and depth was estimated with an inverse model evaluated leave-one-thickness-out across 2.2 to 6.0 mm under concentration-matched and concentration-randomized conditions, randomized exposure subsets, and spectral-band ablations, and compared with analytical and empirically calibrated scalar dual-emission fluorescence-ratio baselines of Leblond et al. Two ICG-localized sentinel lymph nodes from a breast cancer specimen were analyzed ex vivo.ResultsLonger-wavelength channels produced more compact spread profiles, and full width at 20% peak intensity increased linearly with tissue thickness for all filters (R2=0.94 to 0.95). The NIR-II-only subset (940 and 1070 nm) yielded sub-millimeter root mean square error at every held-out thickness under both concentration conditions (0.32 to 0.66 mm), whereas the analytical and empirical scalar-ratio baselines yielded 1.58 to 5.24 and 1.13 to 2.74 mm. Clinical sentinel lymph nodes preserved the wavelength-dependent profile narrowing, with phantom-to-clinical normalized-width RMSE of 3.3% to 8.5%.ConclusionsWavelength-dependent fluorescence spread profiles across NIR-I and NIR-II can encode depth information for subsurface ICG targets, providing a wide-field, single-fluorophore, single-excitation approach compatible with emerging multispectral surgical imaging platforms.