Revolutionary Imaging Technique Could Improve Pancreatic Cancer Surgery

Pancreatic cancer, known for being particularly challenging to cure, often goes undetected at the microscopic level due to typically absent early symptoms. This often leads to late diagnosis when the cancer has already spread, resulting in dire survival rates — approximately a 9% overall chance. The best chances for patient survival currently hinge on surgery and chemotherapy, with the effectiveness of surgery dependent on the complete removal of the cancer, a task complicated by the limitations of current imaging techniques like CT scans, which only detect cancer at a more advanced stage. A groundbreaking imaging approach can now enhance the detection of pancreatic cancer cells at the microscopic level, around 200 microns in size, similar to the thickness of an eyelash, potentially improving surgery outcomes and extending patient survival.

At OU Health Stephenson Cancer Center at the University of Oklahoma (Norman, OK, USA), researchers have launched an innovative study combining a novel contrast agent, specifically designed to target pancreatic cancer cells, with Multispectral Optoacoustic Tomography (MSOT). This approach promises to detect cancer cells at a magnitude approximately 10 times smaller than current capabilities. In the lab, the team developed a unique contrast agent that reacts specifically to the acidic environment of pancreatic cancer cells. Delivered intravenously, this agent can distinguish pancreatic cancer cells from others by activating its dye in the cancer's acidic environment.

Image: The technique can distinguish arteries (red) and veins (blue) at the level of 200 microns (Photo courtesy of University of Oklahoma)

The MSOT device complements this contrast agent by emitting infrared light into the body, which activates the dye. This interaction produces sound waves that the MSOT device captures and translates into a color-coded image. The resulting images are so detailed that they can reveal cancer cells usually undetectable by other means, potentially revolutionizing pancreatic cancer surgery. This is particularly vital for older patients, who are more commonly affected by pancreatic cancer and face higher risks from major operations, often unable to undergo a second surgery. In such cases, this new imaging technique could significantly inform surgical planning. For instance, if the MSOT detects cancer invasion in critical blood vessels near the pancreas, it would impact the surgical approach. It can also assess the effectiveness of pre-surgical chemotherapy, indicating whether cancer cells on blood vessels are alive or if microscopic cancer remains. Going forward, this innovative imaging method holds the potential to become a screening tool for those at heightened risk of developing pancreatic cancer, such as individuals with a family history or genetic predisposition to the disease.

“This is a hybrid approach that accomplishes what a CT cannot,” said Lacey McNally, Ph.D., professor of surgery at the OU College of Medicine. “Pancreatic cancer often creates tentacles that spread out beyond the primary tumor. Currently, there is no way for the surgeon to know where they are. But if the surgery team can use this MSOT approach in the operating room, it can tell them in real time where the cancer has metastasized so they can remove it.”

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