Neuroblastoma is a devastating form of childhood cancer that accounts for 8-10% of all childhood cancers and roughly 15% of all childhood deaths from cancer. Sadly, in almost one-third of cases, the cancer has already metastasized to other areas of the body at the time of diagnosis, making treatment more challenging. The standard treatment for neuroblastoma involves surgery aimed at removing all cancerous cells, which can be difficult to distinguish from healthy tissue. The procedure carries certain risks, as striking the right balance between removing enough but not too much tumor tissue is crucial. Surgeons need to be careful not to damage surrounding blood vessels, nerves, and other vital organs. Now, a new technique that combines highly-detailed, real-time images of inside the body with a type of infrared light has been successfully used for the first time to differentiate between cancerous tumors and healthy tissue during surgery.

The pioneering technique, demonstrated in mice, that has been developed by engineers at University College London (UCL, London, UK) may have significant implications for treating neuroblastoma in children, which is the most common form of solid cancer tumor, apart from brain tumors, found in children. The scientists utilized a novel method- molecular imaging - during surgery, whereby chemicals were injected into the bloodstream to act as imaging probes. These chemicals are attracted to cancerous cells in the body, and once attached, the probes light up via a process called ‘fluorescence’, thus lighting up the tumor area. The engineers used the technique during preclinical testing in mice to successfully identify part of a tumor that had not been removed during surgery.

In addition, the research team aimed to examine whether it was possible to enhance the visual quality of the images by using short-wave-infrared light (SWIR), which was previously inaccessible to scientists. To achieve this, they utilized a special, high-definition camera for capturing SWIR fluorescence. SWIR remains invisible to the naked eye and has a longer wavelength compared to visible light, enabling it to penetrate deeper into the tissue to provide more detailed and sharper images. In preclinical tests, the technique enabled surgeons to differentiate between healthy and cancerous tissue successfully. Unlike X-ray or MRI, molecular imaging captures detailed photos of biological processes live during surgery. This means that clinical teams no longer need to wait for biopsy or culture results when screening for diseases. The SWIR further enhances these images in real time. The scientists aim to expedite the use of this technology in operating rooms within the next year for the benefit of children with cancerous tumors.

“Pediatric surgical oncology faces an ever-increasing need for novel technologies and devices that can help visualize tumors intraoperatively,” said Dr. Laura Privitera, UCL Great Ormond Street Institute of Child Health. “By using targeted fluorescence-guided surgery, we demonstrate the possibility of safely and specifically delineating tumor margins, allowing its differentiation from surrounding healthy tissue. Fluorescence-guided surgery is a game-changing innovation that will help surgeons to obtain safer and more complete resection. It is exciting to be part of this project, and I look forward to seeing this technology translated into the clinical environment.” 

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