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Intraoperative imaging in pathology-assisted surgery

  • Perspective
  • Published:

From Nature Biomedical Engineering

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Abstract

The pathological assessment of surgical specimens during surgery can reduce the incidence of positive resection margins, which otherwise can result in additional surgeries or aggressive therapeutic regimens. To improve patient outcomes, intraoperative spectroscopic, fluorescence-based, structural, optoacoustic and radiological imaging techniques are being tested on freshly excised tissue. The specific clinical setting and tumour type largely determine whether endogenous or exogenous contrast is to be detected and whether the tumour specificity of the detected biomarker, image resolution, image-acquisition times or penetration depth are to be prioritized. In this Perspective, we describe current clinical standards for intraoperative tissue analysis and discuss how intraoperative imaging is being implemented. We also discuss potential implementations of intraoperative pathology-assisted surgery for clinical decision-making.

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Fig. 1: Flowchart for IPAS.
Fig. 2: Flowchart for small-tissue analysis by IPAS.
Fig. 3: Flowchart for margin assessment by IPAS.

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Acknowledgements

We thank G.W.’t Hooft (Philips Research) and M. Pleitez (Helmholtz Zentrum Munich) for useful discussions on nonlinear imaging techniques and Raman imaging, respectively. V.N. received funding from the EU grants SENSITIVE, funded by the European Union’s Horizon 2020 research and innovation programme under grant agreement no. 801347, and ESCEND, funded by the Bundesministerium für Bildung und Forschung, Bonn, Germany (01KT1809) under the EU framework programme Horizon 2020 (TRANSCAN-2; grant agreement no. 643638).

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Author notes

  1. Pieter J. van der Zaag

    Present address: Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands

  2. Pieter J. van der Zaag

    Present address: Molecular Biophysics, Zernike Institute, University of Groningen, Groningen, The Netherlands

  3. These authors contributed equally: Floris J. Voskuil, Jasper Vonk.

Authors and Affiliations

  1. Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands

    Floris J. Voskuil, Jasper Vonk & Max J. H. Witjes

  2. Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands

    Floris J. Voskuil & Bert van der Vegt

  3. Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands

    Schelto Kruijff

  4. Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands

    Schelto Kruijff & Gooitzen M. van Dam

  5. Chair for Biological Imaging, Center for Translational Cancer Research, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany

    Vasilis Ntziachristos

  6. Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany

    Vasilis Ntziachristos

  7. Phillips Research Laboratories, Eindhoven, The Netherlands

    Pieter J. van der Zaag

  8. AxelaRx/TRACER BV, Groningen, The Netherlands

    Gooitzen M. van Dam

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Contributions

F.J.V., J.V., M.J.H.W. and G.M.v.D. designed the study. F.J.V. and J.V. performed literature research and drafted the manuscript. P.J.v.d.Z. and V.N. provided technical input on imaging techniques. B.v.d.V. and S.K. provided input on clinical implementation. P.J.v.d.Z., M.J.H.W. and G.M.v.D. supervised the study and the writing of the manuscript. All authors contributed to revising the manuscript.

Corresponding author

Correspondence to Gooitzen M. van Dam.

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Competing interests

B.v.d.V. is a member of the Scientific Advisory Board of Visiopharm, for which compensation is received by the University Medical Center Groningen. V.N. is an equity owner and consultant of iThera Medical GmbH, an owner of Spear UG and a member of the Scientific Advisory Board of SurgVision B.V./Bracco Sp.A. P.J.v.d.Z. is an employee of Philips Research, The Netherlands. G.M.v.D. is CEO, founder and shareholder of TRACER Europe BV/AxelaRx. The other authors declare no competing interests.

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Voskuil, F.J., Vonk, J., van der Vegt, B. et al. Intraoperative imaging in pathology-assisted surgery. Nat. Biomed. Eng 6, 503–514 (2022). https://doi.org/10.1038/s41551-021-00808-8

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