Penn Medicine Researchers Discover Coupled Imaging Technique to Detect Lung Cancer Sooner

Research scientists at the Abramson Cancer Center at the University of Pennsylvania have discovered a coupled imaging method to detect lung cancer at the cellular level in real-time when performing a biopsy. This new method, published in Nature Communications, allows physicians to detect the disease earlier, with more confidence.

The findings built on previous Penn research demonstrate that an imaging agent detected by guided technology during biopsies in real-time can effectively illuminate cancer cells that may be too small to find using existing technology.

This new imaging method more easily identifies the presence of fluorescent cancer cells. Out of the 20 human biopsy specimens reviewed, five non-expert raters diagnosed the malignant or non-malignant tissue biopsies with 96% accuracy and rendered no false negatives.

The research team analyzed human cancer cells of people with a history of smoking by growing those cancer cells with normal cells in a laboratory to determine the lowest quantity of cell that could be detected.

With the addition of pafolacianine (Cytalux), an investigational imaging agent, coupled with Cellvizio, a probe and needle-based imaging platform, the researchers found that integrating the imaging agent and platform allowed for the detection of cancer at the cellular level in real-time during a biopsy in numerous preclinical models, including in culture, small animal models, and human tissue from patients undergoing lung cancer surgery as part of an ongoing clinical trial.

This new technology (named NIR-nCLE) combines the cancer-targeted near-infrared (NIR) tracer with a needle-based confocal laser endomicroscopy (nCLE) system, which is modified to detect the NIR signal.

Because the concerning nodules can often be too tiny to see and remove for additional testing, biopsies of the suspected tissue are sometimes ineffective. This approach can leave patients and physicians questioning the existence of cancer and requires additional biopsies and radiological surveillance until the nodule is large enough to visualize for removal and histopathologic evaluation, which may take several days to finish.

Unfortunately, current medical technology does not offer real-time diagnostic informatics during biopsies.

Methods similar to NIR-nCLE focus on detecting these microscopic nodules, offering greater precision in identifying, and eventually removing cancer cells.

"The emerging ability to light up a single cell that may be invisible to the eye provides great opportunity to give patients the best chance at an early diagnosis before cancer spreads," said Gregory T. Kennedy, MD, a resident in General Surgery at Penn, to Penn Medicine News.

"This unique approach has the potential to improve the information we get from biopsies, and it may increase our chances of identifying cancer early," Kennedy added.

According to the CDC, in the United States, lung cancer is the third most common type of cancer. Lung cancer also kills more people than any other type — more than 236,000 patients are diagnosed with lung cancer annually, while more than 130,000 people die each year from the disease.

"This research shines a light on the possibility of being able to more accurately identify and diagnose lesions that could be cancerous, even those that are very small and may evade our typical diagnostic capabilities," said Sunil Singhal, MD, Chief of the Division of Thoracic Surgery, the William Maul Measey Associate Professor in Surgical Research, and director of the Center for Precision Surgery at the Abramson Cancer Center at Penn.

"The quest to diagnose lung cancer in earlier stages is a centerpiece of our research, since early detection is so closely connected to chances for successful treatment," Singhal explained.

Because the researchers are optimistic that this method could be used to detect other types of cancers earlier, Penn investigators and industry partners are focusing on additional targeted imaging technologies used to detect lung, breast, brain, head and neck, sarcoma, and urinary tract cancers.

Since 2015, the researchers from the Center for Precision Surgery and its partnered labs have developed various other targeted imaging technologies, and Penn researchers and physicians have studied these methods in clinical settings, which included over 1,200 patients.