Abstract
We developed a linear ultrasound array-based real-time photoacoustic imaging system with a compact coaxial excitation handheld photoacoustic imaging probe for guiding sentinel lymph node (SLN) needle biopsy. Compared with previous studies, our system and probe have the following advantages: (1) the imaging probe is quite compact and user-friendly; (2) laser illumination and ultrasonic detection are achieved coaxially, enabling high signal-to-noise ratio; and (3) GPU-based image reconstruction enables real-time imaging and displaying at a frame rate of 20 Hz. With the system and probe, clear visualization of the SLN at the depth of 2 cm (~human SLN depth) was demonstrated on a living rat. A fine needle was pushed towards the SLN based on the guidance of real-time photoacoustic imaging. The proposed photoacoustic imaging system and probe was shown to have great potential to be used in clinics for guiding SLN needle biopsy, which may reduce the high morbidity rate related to the current gold standard clinical SLN biopsy procedure.
Highlights
Sentinel lymph node biopsy (SLNB) is a standard clinical procedure for breast cancer staging in patients [1,2]
The probe and system possess the following unique features: (1) the probe is physically compact, making it very convenient and user-friendly for potential clinical applications; (2) the probe is based on a design to achieve co-axial laser illumination and ultrasonic detection, resulting in high delivery efficiency of laser energy into the ultrasound detection volume, high signal-to-noise ratio, and large imaging depth; (3) GPU-based data processing acceleration is applied to the system to achieve 20 Hz frame rate real-time image reconstruction and display, limited by the pulse repetition rate of the laser source; and (4) the photoacoustic imaging system modified on the commercial ultrasound platform retains the inherent ultrasound imaging of the platform, enabling photoacoustic and ultrasound dual modality imaging capability
The performance of the photoacoustic imaging probe and system in this study was validated both in vitro and in vivo using human hairs and black tape stripes placed at different imaging depths as well as the Indocyanine green (ICG)-injected rat sentinel lymph node (SLN)
Summary
Sentinel lymph node biopsy (SLNB) is a standard clinical procedure for breast cancer staging in patients [1,2]. During the SLNB procedure, surgeons generally first inject a radioactive substance and blue dye in the tissue site near the breast tumor. The breast is surgically opened, and the SLN can be precisely identified macroscopically due to the blue dye staining. Once the accurate position of the SLN is identified, the SLN is removed and examined histologically to determine whether metastatic tumor cells are present. Open surgery and lymph node removal are necessary during this procedure, which is associated with potential postoperative complications, such as seroma formation, lymphedema, and sensory nerve injury [5]
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