Photoacoustic imaging of tumor vascular involvement and surgical margin pathology for feedback-guided intraoperative tumor resection

Surgery represents the mainstream therapeutic modality in oncology. Aggressive radical surgery to achieve no residual tumor would improve survival, which is mainly affected by vascular involvement and accuracy of judging the negative margin of tumor resection. However, there is currently no intraoperative tool that can simultaneously perform microscopic analysis of the peritumoral vasculature in vivo and the surgical margin pathology of the tumor ex vivo, which leads to the randomness of one-time complete resection of the tumor, and the patient may have to undergo secondary surgery. To address this critical need, we developed a 532/266 nm dual-wavelength photoacoustic (PA) microscopy imaging (532/266-PAI) system that enables both in vivo tumor regional vascular involvement analysis and pathological margin assessment of fresh ex vivo tumor samples. A mammary tumor animal model was established to mimic the process of tumor resection, from in vivo imaging vascular involvement of tumor to intraoperative judgment of negative tumor margins. It is proved that the 532/266-PAI technology can identify the tumor vascular involvement through vascular visualization, determine the surgical plan, and then judge whether the tumor is completely removed through ultraviolet PA (UPA) tumor pathological imaging. Re-excision and secondary margin evaluation are performed when margin positive is diagnosed in the intraoperation UPA imaging. The 266/532-PAI technique has great potential for complete tumor resection in surgical navigation.