Cancer surgery is often a race against time to remove as many tumor cells as possible without sacrificing healthy tissue. But even successful procedures can leave behind remnants that may Above: Dr. Mekhail Awar, MD, PhD reignite the disease, leading to additional surgeries or treatments like radiation and chemotherapy. Now, a team from UC San Francisco and UC Berkeley is developing a technology known as VISION (Versatile Chip-Scale NIR-II Imager for Single Cell Intraoperative Optical Navigation) that could revolutionize how surgeons detect and remove cancer cells during an operation.
Led by UCSF’s Mekhail Anwar, MD, PhD, and funded by an award of up to $15.1 million from the Advanced Research Projects Agency for Health (ARPA-H), this project combines cutting-edge advances in cancer diagnostics, molecular imaging, and optical engineering. The goal is to build a miniature scanner—small enough to fit onto a postage stamp—that enables surgeons to see and remove individual cancer cells in real time.
Currently, surgeons rely on bulky microscopes and visual inspection to guide incisions. In many cases, 10% of surgeries leave behind enough cells to allow cancer to regrow, a statistic that rises to 10-25% for breast cancer and 20-30% for advanced prostate cancer. Once the tumor is removed, it goes to a pathology lab for thorough examination—often too late to prevent the need for further intervention during the operation.
Built on a platform developed in Anwar’s lab, VISION aims to place the power of a pathology lab directly into the surgeon’s hands. Its core is an array of thousands of pixel-sized sensors paired with molecular labels that can distinguish cancerous from healthy cells. These labels bind to tumor-specific enzymes, then emit near-infrared light that penetrates a few millimeters into tissue. The scanner, placed on exposed tissue during surgery, detects these signals, pinpointing areas that may harbor lingering cancer.
This innovation hinges on breakthroughs in multiple fields. UCSF researchers Charly Craik, PhD, and Mike Evans, PhD, are improving the molecular labels, focusing first on breast and prostate cancers but aiming for broad applicability. On the hardware side, the microfabricated imager developed by Dr. Anwar, designed to “see” individual cancer cells, is being refined through integration with a “lensless microscope” approach developed by UC Berkeley’s Laura Waller, PhD. This method helps sharpen images and paves the way for compact 3D imaging.
Bringing this technology to the operating room requires a seamless interface. Surgeons, including UCSF’s Matthew Cooperberg, MD, Carlos Corvera, MD, and Jasmine Wong, MD, are collaborating to ensure the scanner fits easily into today’s standard surgical tools and workflows. Pathologists Ron Balassanian, MD, and Brad Storr, MD, are involved in validating the device’s accuracy in identifying cancer cells. The team also plans to develop user-friendly software so surgeons can quickly interpret results, adjusting their strategy on the fly.
Looking ahead, the VISION project stands to drastically reduce the number of re-operations and improve survival rates by giving surgeons a live map of cancer cells. While the initial focus is on prostate and breast cancer, the team’s broader objective is to create a platform that can be adapted to various cancer types. By harnessing near-infrared imaging, molecular labeling, and microfabrication, the device could one day transform how surgeons approach tumors, helping to ensure every last malignant cell is taken out in a single procedure.
If successful, VISION may herald a future in which surgeons have near-instantaneous feedback on whether cancer remains in the surgical field, bringing unprecedented precision to one of medicine’s most challenging tasks.