Abstract 2528: Bioinspired multispectral imaging for intraoperative detection of metastatic lymph nodes: enhancing precision through UV and NIR fluorescence

Intraoperative identification of metastatic lymph nodes (LNs) remains a clinical challenge, with current techniques often leading to unnecessary removal of healthy tissue or retention of cancer-positive nodes. To address this issue, we developed a bioinspired multispectral imaging system that integrates ultraviolet (UV) autofluorescence and near-infrared (NIR) fluorescence detection. This platform mimics the mantis shrimp's unique visual system, leveraging vertically stacked photodiodes and pixelated spectral filters to achieve simultaneous imaging across the UV, visible, and NIR spectral ranges without spatial misalignment or loss of resolution. The system uses indocyanine green (ICG) as an FDA-approved NIR fluorescent probe for LN localization and UV excitation to evaluate LN status via autofluorescence. The UV fluorescence leverages endogenous biomarkers, such as tryptophan, commonly enriched in tumor-associated tissues. This dual-modality imaging approach enables real-time identification of both the anatomical location and pathological status of LNs, reducing dependence on postoperative histopathological analysis. In a clinical study involving 33 breast cancer patients, the imaging system achieved a positive predictive value of 96% and a receiver operating characteristic (ROC) area under the curve (AUC) of 89% in distinguishing metastatic from non-metastatic lymph nodes. These results were corroborated by pathology, which served as the ground truth. By providing immediate and accurate feedback to surgeons, this system has the potential to improve surgical precision, reduce unnecessary excisions, and minimize the need for follow-up procedures. Unlike traditional multispectral imaging systems reliant on mechanically rotating filters or dichroic beamsplitters, our bioinspired sensor eliminates co-registration errors and significantly reduces system complexity. Its compact design and capability to perform high-resolution imaging under challenging surgical lighting conditions make it well-suited for widespread clinical adoption. Further studies are underway to validate the system’s efficacy across different cancer types and expand its applications to other surgical scenarios. This novel imaging platform offers a significant step forward in integrating real-time molecular and anatomical imaging into intraoperative workflows, addressing critical gaps in precision oncology. Citation Format: Zhongmin Zhu, Yifei Jin, Brianna Hajek, Shuming Nie, Viktor Gruev. Bioinspired multispectral imaging for intraoperative detection of metastatic lymph nodes: enhancing precision through UV and NIR fluorescence [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 2528.