A UC Davis Well being workforce of surgeons and scientists has built-in a novel imaging expertise with robotic surgical methods to assist detect major cancerous tissue throughout head and neck most cancers surgical procedures. The expertise, often called Fluorescence Lifetime Imaging (FLIm), permits surgeons to determine and take away malignant major tumors extra exactly and completely.

Main tumors are cells the place the most cancers first begins. You will need to find these tumors for applicable therapy and to enhance the possibility for treatment.

In a examine printed in Head and Neck journal, the workforce shared the outcomes of testing FLIm in six sufferers with squamous cell carcinoma of unknown major within the head and neck.

“Relying on the diagnostic and medical capabilities of medical establishments, as much as 50% of major tumors might stay undiscovered for sufferers with the sort of most cancers,” stated Andrew Birkeland, assistant professor within the Division of Otolaryngology-Head and Neck Surgical procedure and the UC Davis Complete Most cancers Middle and coauthor of the examine. “Lacking the first tumors may put sufferers liable to most cancers unfold and loss of life.”

Technician using FLIm technology
FLIm expertise permits for augmented show of diagnostic info within the visual view of the working surgeon 

What’s squamous cell carcinoma of unknown major within the head and neck?

Carcinoma is a most cancers that varieties in epithelial tissues lining inside organs. Head and neck squamous cell carcinoma of unknown major origin, also referred to as occult major, is a medical situation when metastatic carcinoma is recognized within the neck’s lymph nodes, however the major tumor location is just not recognized by commonplace imaging or medical examination strategies.

Round 2600 new instances of occult major most cancers are recognized annually within the U.S. They symbolize roughly 3%–5% of all new instances of head and neck carcinoma.

This sort of most cancers has no recognized major website. This implies the unique website the place the most cancers began is unknown, even after exhaustive medical, radiographic and surgical analysis. Normally, particularly these associated to the human papillomavirus (HPV), the first website is suspected to be within the palatine tonsils and the lingual tonsils of the bottom of tongue. These cancers are much less prone to be related to tobacco and alcohol abuse.

Integrating imaging expertise into transoral robotic surgical procedures

Transoral robotic surgical platforms (TORS), such because the da Vinci® Surgical System, permit for minimally invasive surgical procedures to detect and take away tumors from hard-to-reach areas within the head and neck. To enhance decision-making throughout surgical procedures and improve the detection of elusive tumors, new diagnostic applied sciences suitable with TORS are wanted.

FLIm technology integrated to TORS to detect cancerous tissues
FLIm expertise built-in into TORS to detect cancerous tissues

“If surgeons can determine and visualize metabolic modifications in tissue through the operation, they will exactly take away cancerous tissues and enhance the affected person’s survival,” Birkeland stated.

What’s FLIm and the way does it work?

FLIm was developed on the College of California, Davis. The expertise permits for the target visible detection of tumors utilizing the tissue’s intrinsic fluorescence properties. The surgeon scans the tissues for fluorescent modifications associated to alterations in tissue metabolism, an element strongly linked to cancerous tumors. The FLIm system captures and analyzes the intrinsic gentle emitted by the tissues and gives visible and quantitative information of the autofluorescence gentle.

The expertise has confirmed advantages within the analysis and surgical steering in mind and breast most cancers surgical procedures and potential in figuring out coronary heart illness.

Laura Marcu

This UC Davis homegrown expertise may turn out to be the subsequent commonplace of care, adopted broadly in most cancers surgical procedures.” Laura Marcu


The workforce built-in FLIm right into a transoral robotic system to amass optical information on the oropharyngeal tissues of sufferers with head and neck carcinoma of unknown major origin. These tissues are a part of the throat behind the mouth, together with the taste bud, the bottom of the tongue and the tonsils. The mixed robotic-imaging energy captured and analyzed tissue autofluorescence to distinguish tissue sorts.

The workforce first used a dataset of 55 sufferers with identified major tumors to coach a machine studying classifier and develop a mannequin that may precisely determine the presence and placement of occult most cancers utilizing FLIm tissue autofluorescence.

Then, they checked out HPV-related cancers of unknown major origin. They examined the accuracy of the mannequin in six sufferers with occult major head and neck most cancers.

two photos showing FLIm’s prediction of cancer tissues (highlighted in red) and benign tissues (in green)

Among the many six sufferers, HPV-related occult major was surgically recognized in three sufferers, whereas three sufferers finally had no identifiable major website within the oropharynx. The FLIm mannequin appropriately detected the first most cancers website in all three sufferers and predicted benign oropharyngeal tissue for the remaining three. The imply sensitivity was 95% and specificity 89%.

Dr. Laura Marcu in a white coat in her lab
Laura Marcu, professor of biomedical engineering and a pioneer of the FLIm expertise

“A key good thing about our FLIm approach is that it might probably spotlight tumor infiltration in real-time throughout surgical procedure,” stated Laura Marcu, UC Davis professor of biomedical engineering and a pioneer of the FLIm expertise. Marcu is the co-lead writer on the examine. “This UC Davis homegrown expertise may turn out to be the subsequent commonplace of care, adopted broadly in most cancers surgical procedures.”

This venture was supported by the Nationwide Institutes of Well being (R01 CA187427). That is an academic-industry partnership grant between UC Davis and Intuitive Surgical, Inc.

Coauthors on this examine embrace Brent Weyers, Mark Marsden, Athena Tam, Julien Bec, Roberto Frusciante, Dorina Gui, Arnaud F. Bewley, Marianne Abouyared, and Donald Gregory Farwell.

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UC Davis Complete Most cancers Middle

UC Davis Complete Most cancers Middle is the one Nationwide Most cancers Institute-designated middle serving the Central Valley and inland Northern California, a area of greater than 6 million individuals. Its specialists present compassionate, complete take care of greater than 100,000 adults and youngsters yearly and entry to greater than 200 lively medical trials at any given time. Its revolutionary analysis program engages greater than 240 scientists at UC Davis who work collaboratively to advance discovery of latest instruments to diagnose and deal with most cancers. Sufferers have entry to modern care, together with immunotherapy and different focused therapies. Its Workplace of Neighborhood Outreach and Engagement addresses disparities in most cancers outcomes throughout numerous populations, and the most cancers middle gives complete schooling and workforce growth applications for the subsequent technology of clinicians and scientists. For extra info, go to most cancers.ucdavis.edu.


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