Cerenkov Luminescence Imaging in prostate cancer: not the only light that shines.
Cerenkov luminescence imaging (CLI) is a novel imaging technology that might have the ability to assess surgical margins intra-operatively during prostatectomy using Gallium-68 prostate-specific membrane antigen ([68Ga]Ga-PSMA-11). This study evaluates the accuracy of CLI compared to histopathology and as exploratory objective investigates the characteristics of the identified chemiluminescence signal. Materials and Methods: After intravenous injection of a mean 68Ga-PSMA-11 activity of 69MBq intraoperatively, all excised specimens were imaged with CLI. Areas of increased signal were marked for histopathological comparison and scored for likelihood of being a positive surgical margin (PSM) using a 5-point Likert scale. In addition, the chemiluminescence signal was investigated in three radioactive and three non-radioactive specimens using CLI. Results: In 15 patients, the agreement between CLI and histopathology was 60%; this improved to 83% when including close surgical margins (≤1mm). In six hotspots, CLI correctly identified PSMs on histopathology, located at the apex and mid-prostate. In all 15 patients an increased signal at the prostate base was observed, without the presence of the primary tumor in this area in eight patients. This chemiluminescence signal was also observed in non-radioactive prostate specimens, with a half-life of 48±11min. The chemiluminescence hampered the visual interpretation of four PSMs at the base. Conclusion: CLI is able to correctly identify margin status, including close margins, in 83% of the cases. The presence of a diathermy-induced chemiluminescent signal hampered image interpretation, especially at the base of the prostate. In the current form, CLI is most applicable to detect PSMs and close margins in the apex and mid-prostate.
['Olde Heuvel|Judith|J|http://orcid.org/0000-0003-3219-8608', 'de Wit-van der Veen|Berlinda Jantina|BJ|http://orcid.org/0000-0002-7860-2904', 'van der Poel|Henk G|HG|', 'van Leeuwen|Pim J|PJ|', 'Bekers|Elise M|EM|', 'Grootendorst|Maarten R|MR|', 'Vyas|Kunal N|KN|http://orcid.org/0000-0002-9670-0233', 'Slump|Cornelis H|CH|', 'Stokkel|Marcel P M|MPM|']
Cerenkov Luminescence Imaging prostate cancer surgical margins 68-Gallium-PSMA Molecular Imaging Oncology: GU Optical intra-operative assessment