# High speed automated intraoperative microscopy of the prostate circumference to ensure tumor-free margins in radical prostatectomy

> **NIH NIH R01** · TULANE UNIVERSITY OF LOUISIANA · 2021 · $397,823

## Abstract

Project Summary: In prostate cancer (PCa), the presence and amount of residual tumor at the surface of the
excised prostate is the only prognostic factor that is affected by surgical technique, vs. other factors, which are
fixed and non-modifiable. Yet, positive surgical margins (PSM), defined as the presence of tumor cells at the
inked surface of the removed specimen, are common, especially in advanced stage cancers, and are a strong
independent risk factor for clinical progression and secondary treatment. In addition, elevated post-operative
PSA, which is understood to be related to tumor left behind in the patient, is also associated with high risk of
progression and secondary treatment. Thus, complete tumor removal is important to achieve to improve 
patient outcomes and reduce overtreatment, yet there is a delicate balance between resection radicality and 
minimizing damage to the neurovascular bundles to preserve post-operative function. The NeuroSAFE trial
demonstrated that real-time detection and correction of PSMs by comprehensive histology of the prostate 
circumference results in improved patient outcomes, yet there are no widely adoptable methods to achieve this.
In an effort to address this technical gap, we have developed video-rate structured illumination microscopy
(VR-SIM) and demonstrated that it enables accurate diagnosis of PCa in the biopsy setting, and that it can 
rapidly deliver gigapixel microscopic images of the entire prostate surface for detection of PSMs. VR-SIM delivers
the surface area coverage and resolution needed to detect PSMs, yet it is also fast and relatively simple and
inexpensive, opening the possibility for widespread adoption. In this project, our interdisciplinary team of 
engineers and clinicians with significant prostate expertise will further advance this technology towards clinical
translation, by completing critical technology development steps and by prospectively validating it in a large
patient series. Specifically, we will increase the mechanical automation speed of the device, and will develop a
fully automated system for handling of the removed prostate, to enable gigapixel panoramas of the entire 
prostate circumferential surface to be delivered within 10 minutes of removal and with minimal tissue processing
and user intervention. We will then leverage our recently developed dual-color fluorescent stain that replicates
standard H&E with high specificity, to develop expert-validated clinical image atlases using biopsies and 
cadaveric specimens to enhance image interpretation of VR-SIM prostate panoramas. These improvements will
be combined to test the system in a prospective 250-patient clinical study, to determine the accuracy of the
device for intra-operative detection of PSMs and prediction of post-operative PSA based on measurement of
PSM extent. Finally, we will measure and model expert reviewer behavior using a novel web-enabled visual
observer tracking method, which could be used in fu...

## Key facts

- **NIH application ID:** 10172866
- **Project number:** 5R01CA222831-04
- **Recipient organization:** TULANE UNIVERSITY OF LOUISIANA
- **Principal Investigator:** JONATHAN QUINCY BROWN
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $397,823
- **Award type:** 5
- **Project period:** 2018-06-25 → 2023-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10172866

## Citation

> US National Institutes of Health, RePORTER application 10172866, High speed automated intraoperative microscopy of the prostate circumference to ensure tumor-free margins in radical prostatectomy (5R01CA222831-04). Retrieved via AI Analytics 2026-05-21 from https://api.ai-analytics.org/grant/nih/10172866. Licensed CC0.

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