Emory researchers awarded up to $17.6M from ARPA-H to innovate cancer surgery, improve outcomes

Emory University, including researchers at Winship Cancer Institute of Emory University, has been awarded up to $17.6 million from the Advanced Research Projects Agency for Health (ARPA-H) to develop innovative technology aimed at improving outcomes for patients with cancer requiring surgery. The project, titled “MarginCall,” is set to transform how surgical margins are evaluated during cancer surgeries, with an initial focus on breast and ovarian cancer.

Two Emory University researchers will lead the project as co-principal investigators. Anant Madabhushi, PhD, a researcher in the Cancer Immunology Research Program at Winship Cancer Institute of Emory University, leads the Emory Empathetic AI for Health Institute as executive director, in addition to his role as the Robert W. Woodruff Professor in the Wallace H. Coulter Department of Biomedical Engineering at Georgia Institute of Technology and Emory University. His co-PI is Farzad Fereidouni, PhD, who recently joined the Emory University team from UC Davis. Fereidouni’s new role is as associate professor of pathology at Emory University School of Medicine, and also as faculty in the Emory AI.Health Institute. Also contributing to the research is Sunil Badve, MD, FRCPath, vice chair of pathology at Emory University School of Medicine, and member of the Cell and Molecular Biology Research Program at Winship Cancer Institute.

The research combines technological innovations in surgery, imaging, pathology, medicine and artificial intelligence (AI). The project centers on a new imaging method known as Fluorescence Imitating Brightfield Imaging (FIBI), created by Fereidouni and his team. FIBI allows for rapid and precise evaluation of surgical margins—the areas around a tumor that are removed during surgery to ensure all cancerous cells are excised. Current methods of margin assessment can be slow and sometimes unreliable, even requiring a second surgery if cancer cells are later found near the margin.

“MarginCall” aims to create a fully integrated system that can provide surgeons with real-time, highly accurate assessments of surgical margins during the operation, reducing the likelihood of cancerous cells being left behind. This approach promises to be faster and more cost-effective than existing techniques, making it accessible for broader clinical use.

One of the critical advantages of this technology is that it does not require the presence of a pathologist on site. Traditional methods often necessitate the preparation of frozen slides, a time-consuming process that requires stopping the surgery and waiting for a pathologist to analyze the margins. This can be stressful for both the surgical team and the patient, as it prolongs the procedure and increases the risk of complications.

The new imaging system will generate high-resolution images of the margins in near-real-time, allowing surgeons to continue the operation without interruption. “We are developing a truly game-changing technology that has the potential to change the paradigm for how cancer surgery will take place going forward,” says Madabhushi. “By leveraging power and fast tissue imaging technology with the state-of-the-art AI technologies being developed within Emory AI.Health, we will be able to provide rapid feedback to surgeons in the OR, enabling them to adjust their surgical management.”

Madabhushi further emphasizes the importance of the project, noting, “Critically, we are able to develop, deploy and validate this very powerful integrative technology in the context of breast and ovarian cancer within Winship Cancer Institute.”

Fereidouni states, "The current practice of histopathology, while considered the gold standard for diagnosis, falls short in providing timely intraoperative guidance due to its inherently time-consuming and labor-intensive processes for both tissue processing and the diagnosis itself by the pathologist. By integrating advanced near-real-time microscopic tissue imaging technologies and robust AI diagnostic capabilities, we aim to revolutionize this field. Our goal is to condense the functions of an entire histopathology lab and diagnosis into a single, reliable and user-friendly system, significantly enhancing the efficiency and effectiveness of intraoperative surgical guidance."

"This transformative research exemplifies the innovative approach to cancer care that we prioritize at Winship Cancer Institute. By integrating advanced imaging technologies with artificial intelligence, this project has the potential to improve surgical precision while also enhancing outcomes and quality of life for patients with cancer,” says Suresh Ramalingam, MD, executive director of Winship Cancer Institute. “We appreciate this funding and support from ARPA-H, which will enable our researchers and collaborators to bring this cutting-edge solution to the forefront of cancer treatment."

The accessibility of this technology also holds promise for underserved areas where access to specialized pathologists may be limited. By eliminating the need for traditional frozen slides and the associated delay, this system could make advanced surgical care more widely available, potentially improving outcomes for patients in rural or underserved communities.

Initially, the research will focus on breast and ovarian cancers, where the need for precise margin detection is critical. However, the technology has the potential to be expanded to other types of cancer surgeries, including those for pancreatic and head and neck cancers.

The collaborative effort includes contributions from experts at UC Davis, Indiana University and Technische Universiteit Eindhoven, who will bring their expertise in imaging, AI and medical technology to the project.

As “MarginCall” progresses, the research team hopes to see its application in clinical settings, improving surgical outcomes for patients with cancer worldwide.