The future of surgical optical imaging

Intraoperative optical technologies such as Near-Infrared Fluorescence imaging, multispectral or hyperspectral imaging enable an improved visualization of unapparent anatomical structures, the evaluation of metabolic activities and the enhanced visualization of tumor tissue, when compared to white light evaluation alone.

Optical imaging seems an ideal candidate to improve the current state of the art of minimally invasive surgery and particularly of surgical oncology with some groundbreaking innovations, including the real-time in vivo identification of tumor tissue, thanks to cancer-specific fluorescent probes or to spectral tissue analysis.  For those reasons, optical imaging can tackle most of the challenges common to surgical oncology:

A) Improving the SCREENING yield, by augmenting the diagnostic ability of standard endoscopic evaluations;

B) Enabling an optimized STRATIFICATION of the patients, by assessing precisely the stage and thus enabling tailored and less invasive resections;

C) Improving the THERAPY, by enhancing the visualization of resection margins and by ensuring a complete removal of tumor tissue and by reducing the complications;

D) Providing an accurate FOLLOW-UP, by informing early and precisely, on a cancer recurrence or enabling the evaluation of the patient’s response after a neo-adjuvant radio-chemotherapy.

An extensive intelligence and networking activity, including main opinion leaders in the field, has allowed identifying 4 major directions for future research around optical imaging, including:

1) SOFTWARE: the integration of computer-assisted interpretation of the optically generated signal through dedicated software solution and Artificial Intelligence, machine and deep learning approaches, towards the building of an OPTOMICS paradigm, in analogy with other omics (genomics, proteomics, metabolomics, radiomics)….

2) HARDWARE: the development of improved hardware solutions (with optimized sensitivity) and with improved ergonomics (e.g. miniature flexible endoscopic platforms);

3) CHEMISTRY: the development of innovative probes, which recognize precisely biological targets or tumor cells and allow for image-guided removal of cancers by focused energy delivery or surgical ablation;

4) TECHNIQUES: improvement of state-of-the-art techniques (surgical or interventional) by the implementation of optical imaging AND development of innovative minimally-invasive organ-sparing techniques specifically enabled by optical imaging.