Illuminating lung cancer earlier, at the cellular level

A Penn Medicine study reveals that technology combined with an imaging agent can light up microscopic cancer cells, allowing physicians to see cancer cells not typically visible during a biopsy.

Researchers at the Abramson Cancer Center have found a way to identify lung cancer at the cellular level in real time during a biopsy, offering promise in the ability to detect the disease earlier and with more confidence. The findings, which build on previous Penn research, demonstrate that an imaging agent detected via guided technology during biopsies in real time can effectively light up cancer cells that may have been too small to detect using existing technology. Based on the more easily identifiable presence of fluorescent cancer cells generated by the new imaging approach, five nonexpert raters diagnosed the malignant or nonmalignant tissue biopsies with 96% accuracy and made no false negatives on the 20 human biopsy specimens they reviewed. The research is published in Nature Communications.

X-ray of a biopsy with a cancerous cell circled in red.
Scan of a patient in the Penn Medicine led-study with a lung nodule, circled in red. (Image: Penn Medicine News)

The Penn team examined human cancer cells from patients who had a history of smoking. Researchers took the cancer cells and grew them with the normal cells in the laboratory to see how small a quantity of cell could be detected. Then, with an investigational imaging agent, paired with a probe and needle-based imaging platform, they discovered that integrating the technologies allowed researchers to detect cancer at the cellular level in real time during biopsy in various preclinical models, including in culture, small animal models, and human tissue from patients undergoing surgery for lung cancer as part of an ongoing clinical trial.

Biopsies of suspicious tissue are not always effective, because many times the concerning nodules may be too small to see and to remove for further testing. Not only does this leave many patients and physicians uncertain about whether cancer is present, it requires the need for additional biopsies and radiological surveillance until the nodule is big enough to see for removal and evaluation via a histopathologic evaluation, which can take several days to complete. Current medical technology does not provide real-time diagnostic information during biopsy.

Methods like NIR-nCLE, which aim to find these microscopic nodules, can offer greater precision in the identification and, later, removal of 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,” says Gregory T. Kennedy, a resident in general surgery at Penn. “This unique approach has the potential to improve the information we get from biopsies and it may increase our chances of identifying cancer early.”

According to the Centers for Disease Control and Prevention (CDC), lung cancer is the third most common cancer in the United States.

Read more at Penn Medicine News.