2.1.

Synthesis of Avidin-Conjugated Green Fluorescence Dyes

Avidin was purchased from Pierce Biochemical Inc. (Milwaukee, Wisconsin), bovine serum albumin (BSA) and galactosamine-conjugated bovine serum albumin (GmSA), which contained 23 galactosamine molecules on a single albumin molecule, were purchased from Sigma Chemical (St. Louis, Missouri), amido-reactive RhodG was purchased from Molecular Probes Inc. (Eugene, Oregon). At room temperature, $400\mathrm{\mu }\mathrm{g}$ $\left(5.9\mathrm{nmol}\right)$ of GmSA, BSA, and avidin in $196\mathrm{\mu }\mathrm{L}$ of ${\mathrm{Na}}_2{\mathrm{HPO}}_4$ was incubated with $24\mathrm{nmol}$ $(4\mathrm{\mu }\mathrm{L}∕6\mathrm{mM})$ of RhodG-succinoimidyl ester, respectively, in dimethyl sulfoxide (DMSO) for $15\min$ . The mixture was purified with Sephadex G50 (PD-10; GE Healthcare, Milwaukee, Wisconsin). GmSA-, BSA-, and avidin-conjugated RhodG samples (GmSA-RhodG, BSA-RhodG, and Av-RhodG, respectively) were kept at $4°\mathrm{C}$ in the refrigerator as stock solutions.

The protein concentration of GmSA-RhodG, BSA-RhodG, and Av-RhodG samples was determined with Coomassie Plus protein assay kit (Pierce Chemical Company, Rockford, Illinois) by measuring the absorption at $595\mathrm{nm}$ with a visible ultraviolet (UV-vis) system (8453 Value UV-Bis system, Agilent Technologies, Palo Alto, California) using GmSA, BSA, and avidin standard solutions of known concentrations (100, 200, and $400\mathrm{\mu }\mathrm{g}∕\mathrm{mL}$ ). Then, the RhodG concentrations were measured by the absorption at $503\mathrm{nm}$ , respectively, with a UV-vis system to confirm the number of fluorophore molecules conjugated with each avidin, BSA, or GmSA molecule. By changing the concentration of the avidin, BSA, or GmSA solution, the number of fluorophore molecules per avidin, BSA, or GmSA was adjusted to be 2.0.

2.2.

Cell Culture

An established ovarian cancer cell line SHIN3 Ref. 8 was used for in vitro fluorescence microscopy, flow cytometry, and in vivo optical imaging for intraperitoneal disseminated cancer implants. The cell lines were grown in RPMI 1640 medium (Gibco, Gaithersberg, Maryland) containing 10% fetal bovine serum (FBS) (Gibco), 0.03% L-glutamine at $37°\mathrm{C}$ , 100 units/mL penicillin, and $100\mathrm{\mu }\mathrm{g}∕\mathrm{mL}$ streptomycin in 5% ${\mathrm{CO}}_2$ .

2.3.

Transfection of Red Fluorescence Protein (DsRed2) to the SHIN3 Cell

The red fluorescence protein (RFP DsRed2)–expressing plasmid was purchased from Clontech Laboratories Inc. (Mountain View, California). The plasmid was transfected into the SHIN3 cells to validate the results with the targeted fluorophores (vide infra). The transfection of RFP was performed with the electroporation method using Gene Plus II (Bio-Rad Laboratories, Hercules, California). Briefly, $3\mathrm{\mu }\mathrm{g}$ of DsRed2-express plasmid was mixed with 2 million SHIN3 cells in $400\mathrm{\mu }\mathrm{L}$ of the cell culture media (RPMI 1640 with 10% FCS). Then the cell suspension was put in a pulse cuvette (Bio-Rad Laboratories) and 250-V pulses were delivered after 950 cycles.

2.4.

Fluorescence Microscopy

SHIN3 cells $(1\times {10}^4)$ were plated on a cover glass bottom culture well and incubated for $16\mathrm{h}$ . BSA-RhodG, GmSA-RhodG, or Av-RhodG was added to the medium $(5\mathrm{nmol}∕\mathrm{L})$ and the cells were incubated for 1 or $3\mathrm{h}$ . Cells were washed one time with phosphate-buffered solution (PBS) and fluorescence microscopy was performed using an Olympus BX51 microscope (Olympus America Inc., Melville, New York) equipped with the following filters: excitation wavelength 470 to $490\mathrm{nm}$ and emission wavelength 515-nm long pass. Transmitted light differential interference contrast (DIC) images were also acquired.

2.5.

Flow Cytometry

One-color flow cytometry was performed for the assessment of the fluorescing capability of Av-RhodG, GmSA-RhodG, and BSA-RhodG in SHIN3 cancer cells. SHIN3 cells $(1\times {10}^5)$ were plated on a 12-chamber culture well and incubated for $16\mathrm{h}$ . Av-RhodG, GmSA-RhodG, or BSA-Rhod was added to the medium $(20\mathrm{nmol}∕\mathrm{L})$ and the cells were incubated for 1, 3, and $6\mathrm{h}$ . For the assessment of competitive binding of GmSA-RhodG and avidin-RhodG, SHIN3 cancer cells were incubated with a large amount of excess GmSA $(143\mathrm{\mu }\mathrm{mol}∕\mathrm{L})$ for $1\mathrm{h}$ . At $1\mathrm{h}$ after incubation with or without GmSA, Av-RhodG was added to a concentration of $300\mathrm{nmol}∕\mathrm{L}$ and incubated for an additional $3\mathrm{h}$ . Cells were washed once with PBS and trypsinized, and then flow cytometry was performed. A 488-nm argon ion laser was employed for excitation. Signals from cells were collected using a 530/30-nm band pass filter. Cells were analyzed in a FACScan cytometer (Becton Dickinson, Franklin Lakes, New Jersey), and all data were analyzed using CellQuest software (Becton Dickinson). The fluorescence intensity of each fluorophore was termed the mean fluorescence index (MFI). A regression line was calculated from the data sets of incubation time and common logarithmic value of MFI, and then plotted as a function of incubation time using Microsoft Excel 2003 (Microsoft, Redmond, Washington). The MFI value at each time point and the slope of the regression line were compared among the three fluorophores.

2.6.

Measurement of Fluorescence Intensity of Fluorophore Conjugates In Vitro

To compare the fluorescing capability of Av-RhodG, GmSA-RhodG, and BSA-RhodG in vitro, fluorescence intensity and emission spectra of Av-RhodG, GmSA-RhodG, and BSA-RhodG were measured by the ${\mathrm{Maestro}}^{™}$ In-Vivo Imaging System (CRI Inc., Woburn, Massachusetts) in arbitrary units [(a.u.)]. Av-RhodG, GmSA-RhodG, and BSA-RhodG ( $50\mathrm{pmol}∕400\mathrm{\mu }\mathrm{L}$ PBS) were put in a nonfluorescent 96-well plate (Costar, Corning Incorporated, Corning, New York) and spectral fluorescence imaging was performed. A bandpass filter from 445 to $490\mathrm{nm}$ and a long pass filter over $515\mathrm{nm}$ were used for emission and excitation light, respectively. The tunable filter was automatically stepped in 10-nm increments from 500 to $800\mathrm{nm}$ while the camera captured images at each wavelength interval with constant exposure. Spectral unmixing algorithms were applied to create the unmixed image of the three probes. A region of interest (ROI) as large as each well was drawn to determine the emission spectra and the fluorescence intensity of three probes using commercial software (Maestro).

2.7.

Animal Model of Peritoneal Metastases

All procedures were carried out in compliance with the Guide for the Care and Use of Laboratory Animal Resources (1996), National Research Council, and approved by the National Cancer Institute Animal Care and Use Committee. The intraperitoneal tumor xenografts were established by intraperitoneal injection of $2\times {10}^6$ SHIN3 or SHIN3 transfected with RFP DsRed2 cells suspended in $200\mathrm{\mu }\mathrm{L}$ of PBS in female nude mice (National Cancer Institute Animal Production Facility, Frederick, Maryland). Experiments with tumor-bearing mice were performed at 14 days after injection of the cells.

2.8.

In Vivo Spectral Fluorescence Imaging

$500\mathrm{pmol}$ Av-RhodG, GmSA-RhodG, and BSA-RhodG were diluted in $300\mathrm{\mu }\mathrm{L}$ PBS and injected into the peritoneal cavities of mice with peritoneally disseminated cancer implants. Each set of three mice (one for each fluorophore) was repeated in triplicate. Three hours after intraperitoneal injection, all three mice were sacrificed with carbon dioxide inhalation. Immediately after sacrifice, the abdominal cavity was exposed and the three mice were placed side by side on a nonfluorescent plate to compare the fluorescence intensity of the tumors. Spectral fluorescence images were obtained using Maestro. Whole abdominal images as well as closeup images of the peritoneal membrane were obtained. A bandpass filter from 445 to $490\mathrm{nm}$ and a long pass filter over $515\mathrm{nm}$ were used for emission and excitation light, respectively. The tunable filter was automatically stepped in 10-nm increments from 500 to $800\mathrm{nm}$ while the camera captured images at each wavelength interval with constant exposure. The spectral fluorescence images consisting of autofluorescence spectra and the spectra from the probes were obtained, and then, unmixed based on their spectral patterns using commercial software (Maestro).

Using the unmixed fluorescence image of the three peritoneal membranes, fluorescence intensity of the cancer implants was semiquantitatively compared among the three probes. A ROI as large as the peritoneal membrane was drawn inside the bowel, and a histogram (number of pixels at specific fluorescence intensity) was created using ImageJ software (http://rsb.info.nih.gov/ij/plugins/mri-analysis.html). Then, a threshold was set in the fluorescence intensity above which a pixel is counted. The total number of pixels $\left(N\right)$ within the threshold range was calculated at a threshold value of $t$

2.9.

Assessment of the Sensitivity and Specificity of GmSA-RhodG for the Detection of Peritoneal Cancer Foci

The sensitivity and specificity of GmSA-RhodG imaging for the detection of peritoneal disseminated cancer foci were studied using three tumor-bearing mice. The intraperitoneal tumor xenografts were established 14 days after intraperitoneal injection of $2\times {10}^6$ RFP-transfected SHIN3 cancer cells suspended in $200\mathrm{\mu }\mathrm{L}$ of PBS in female nude mice (National Cancer Institute Animal Production Facility). Three hours after intraperitoneal injection of $500\mathrm{pmol}$ GmSA-RhodG diluted in $300\mathrm{\mu }\mathrm{L}$ PBS, spectral fluorescence images of the peritoneal membranes were obtained by Maestro. For each mouse, two different parts of the peritoneal membranes were randomly selected and spread out on a nonfluorescent plate and closeup spectral fluorescence imaging was performed. ROIs were drawn both within the nodules depicted by RFP spectral unmixed images (standard reference for cancer foci) and in the surrounding adjacent areas (standard reference for noncancerous foci), and the average fluorescence intensity of each ROI was calculated both on the RFP and the GmSA-RhodG spectral unmixed images using commercial software (Maestro version 2). The number of ROIs drawn in the noncancerous areas was the same as that drawn in the cancer foci. All visible nodules with short-axis diameters $\ge 1\mathrm{mm}$ and average fluorescence intensities $\ge 2$ (a.u.) on RFP spectral unmixed images were included for analysis, because the minimum possible diameter for ROI drawing was $1\mathrm{mm}$ and the minimum visible fluorescence intensity was 2 (a.u.). Then, additional ROIs were drawn in the nodules depicted only by the spectral unmixed GmSA-RhodG images to count the number of false positive lesions. The average fluorescence intensities of false positive foci were calculated both on the RFP and the GmSA-RhodG unmixed images. Positivity for GmSA-RhodG was defined as average fluorescence intensity $\ge 10$ (a.u.), whereas for a negative for GmSA-RhodG was defined as average fluorescence intensity $<10$ (a.u.) on the spectral unmixed GmSA-RhodG images. The numbers of foci positive for both GmSA-RhodG and RFP, negative for both GmSA-RhodG and RFP, and positive only for GmSA-RhodG or RFP were counted. Sensitivity of GmSA-RhodG for the detection of peritoneal cancer foci was defined as the number of peritoneal foci positive for both GmSA-RhodG and RFP divided by number of peritoneal foci positive for RFP. Specificity of GmSA-RhodG was defined as the number of peritoneal foci negative for both RFP and GmSA-RhodG divided by number of peritoneal foci negative for RFP.

3.1.

Optical Characteristics of Av-RhodG, GmSA-RhodG, and BSA-RhodG

Prior to in vivo study, preinjection fluorescence intensities as well as the emission spectra of $50\mathrm{pmol}$ Av-RhodG, GmSA-RhodG, and BSA-RhodG in $400\mathrm{\mu }\mathrm{L}$ PBS were assessed. The fluorescence intensities of Av-RhodG, GmSA-RhodG, and BSA-RhodG were 181, 211, and 180 (a.u.), respectively (Fig. 1 ). The emission spectra of these three probes were comparable with the same emission peak at $550\mathrm{nm}$ (Fig. 1). GmSA-RhodG showed the highest and BSA-RhodG showed the lowest fluorescence intensity. The difference of fluorescence intensity between BSA-RhodG and GmSA-RhodG was within 15% of GmSA-RhodG fluorescence intensity.

Fig. 1

Av-RhodG, GmSA-RhodG, and BSA-RhodG have the similar fluorescing capability and emission spectra. The fluorescence signal intensities (SI) of $50\mathrm{pmol}$ Av-RhodG, GmSA-RhodG, and BSA-RhodG in $400\mathrm{\mu }\mathrm{L}$ PBS were 181, 211, and 180 (a.u.), respectively. All 3 probes have the same emission peak at $550\mathrm{nm}$ when the tunable filter was stepped in 10-nm increments using the Maestro.

3.2.

Flow Cytometry Analysis Demonstrates that GmSA-RhodG Cellular Uptake is Significantly Higher than Av-RhodG

At 1, 3, and $6\mathrm{h}$ after incubation with $20\mathrm{nmol}∕\mathrm{L}$ Av-RhodG, GmSA-RhodG, or BSA-RhodG, one-color flow cytometry was performed. GmSA-RhodG showed a significant rightward shift ( $>\mathrm{one}$ order shift) as compared with SHIN3 control cells at 3 and $6\mathrm{h}$ after incubation, while BSA-RhodG showed a minimal shift at all time points [Fig. 2a ]. The percent of positive cells (M1) in Av-RhodG, GmSA-RhodG, and BSA-RhodG were 9.3, 96.4, and 2.1% for $1\mathrm{h}$ ; 15.3, 99.8, and $2.8\%$ for $3\mathrm{h}$ , 39.4, 99.8, and 2.8% for $6\mathrm{h}$ , respectively. The rate of uptake, as shown by the slope of regression lines calculated from the data sets of incubation times and common logarithm values of the MFI, were 0.043, 0.147, and 0.004 (a.u./h) for Av-RhodG, GmSA-RhodG, and BSA-RhodG, respectively. The absolute MFI values at all time points and the increase rates of MFI uptake values were consistently higher for GmSA-RhodG than Av-RhodG, whereas BSA-RhodG showed little or no increase in MFI values. These results indicate that the GmSA-RhodG more effectively accumulates within SHIN3 cancer cells and that the accumulation of GmSA-RhodG is mediated by galactosylation on albumin because the chemically similar BSA-RhodG had substantially reduced uptake.

Fig. 2

Flow cytometry analysis shows that uptake of GmSA-RhodG is higher than that of Av-RhodG but GmSA-RhodG and Av-RhodG competitively bind to the same receptor. (a) Serial flow cytometry was performed 1, 3, and $6\mathrm{h}$ after incubation with $20\mathrm{nmol}∕\mathrm{L}$ Av-RhodG (red), GmSA-RhodG (green), and BSA-RhodG (blue) as well as unstained control (black). The percents of positive cells (M1) of Av-RhodG, GmSA-RhodG, and BSA-RhodG were 9.3, 96.4, and 2.1% at $1\mathrm{h}$ , 15.3, 99.8, and 2.8% at $3\mathrm{h}$ , 39.4, 99.8, and 2.8% at $6\mathrm{h}$ after incubation, respectively. The MFI values of GmSA-RhodG were higher and plot overlay of GmSA-RhodG demonstrated larger rightward shift than Av-RhodG or BSA-RhodG at any time point. The slopes of regression lines, calculated from the data sets of incubation time and common logarithm value of MFI, were 0.043, 0.147, and 0.004 [(a.u.)/h] for Av-RhodG, GmSA-RhodG, and BSA-RhodG, respectively. (b) Flow cytometry analysis of Av-RhodG accumulation into SHIN3 cancer cells with (green) or without (red) preincubation with high dose GmSA. Both MFI values and percents of positive cells (M1) were suppressed by 1-h preincubation with $143\mathrm{\mu }\mathrm{mol}∕\mathrm{L}$ GmSA. The percents of positive cells and the MFI values decreased from 99.5% and 77.5 (a.u.) to 55.5% and 13.0 (a.u.), respectively by GmSA administration.

3.3.

Competitive Inhibition of Binding between GmSA-RhodG and Av-RhodG

To assess whether Av-RhodG and GmSA-RhodG compete for the same receptor, the D-galactose (asialoglycoprotein) receptor on the SHIN3 cancer cell, the competitive inhibition of Av-RhodG binding and internalization was evaluated by adding a large amount of GmSA prior to incubation with Av-RhodG. Flow cytometry analysis demonstrated that in the absence of GmSA, the MFI of Av-RhodG in SHIN3 cancer cells increased from 4.9 to 77.5 (a.u.) during 3-h incubation, whereas, when GmSA was administered prior to Av-RhodG, the MFI only increased from 4.9 to 13.0 (a.u.) (83% reduction) [Fig. 2b]. The percent of positive cells was 99.5% for those without preincubation with GmSA, and the percentage of positive cells was 55.5% (44% reduction) for those with preincubation with GmSA. These results indicate that Av-RhodG and GmSA-RhodG compete for the same receptor of SHIN3 cancer cell.

3.4.

Fluorescence Microscopy of Internalized GmSA-RhodG and Av-RhodG in SHIN3 Ovarian Cancer Cells

To study the cellular location of each probe, fluorescence microscopy and DIC imaging were performed 1 and $3\mathrm{h}$ after incubation with $5\mathrm{nmol}∕\mathrm{L}$ Av-RhodG, GmSA-RhodG, or BSA-RhodG. Fluorescence microscopy of SHIN3 cells cultured with GmSA-RhodG and Av-RhodG showed a large number of fluorescent dots within the cytoplasm as early as $1\mathrm{h}$ after incubation (Fig. 3 ). The number of fluorescent dots increased over 3-h incubation with GmSA-RhodG and Av-RhodG; however, the number of GmSA-RhodG dots was larger and more apparent than Av-RhodG dots both at 1 and $3\mathrm{h}$ after incubation. BSA-RhodG showed no fluorescent dots within the cells at any time. These results indicate that both GmSA-RhodG and Av-RhodG are internalized within SHIN3 cancer cells and are likely located within the endoplasmic vesicles or lysosomes,⁴ but GmSA-RhodG are more effectively internalized into the cells based on the number and size of internalized dots.

Fig. 3

Av-RhodG and GmSA-RhodG are internalized into the SHIN3 cancer cells but BSA-RhodG is not. Serial fluorescence microscopy (left panel) and differential interference contrast imaging (right panel) were performed 1 and $3\mathrm{h}$ after incubation with $5\mathrm{nmol}∕\mathrm{L}$ BSA-RhodG, GmSA-RhodG, or Av-RhodG. Fluorescence microscopy of SHIN3 cancer cells cultured with GmSA-RhodG and Av-RhodG demonstrated a large number of fluorescent dots within the cytoplasm as early as $1\mathrm{h}$ after incubation. The number of fluorescent dots within the cytoplasm increased $3\mathrm{h}$ after incubation with GmSA-RhodG and Av-RhodG. However, more fluorescent dots were seen in GmSA-RhodG than Av-RhodG under the same photographic exposure time and the same magnification. BSA-RhodG showed no fluorescent dots within the SHIN3 cancer cells. Original magnification: $\times 200$ . Photographic exposure time: $1\mathrm{s}$ .

3.5.

Comparison of In Vivo Spectral Fluorescence Imaging of Ovarian Cancer Implants with Av-RhodG, GmSA-RhodG, and BSA-RhodG

To compare the fluorescence intensities of the cancer implants in vivo, spectral fluorescence imaging was performed $3\mathrm{h}$ after an intraperitoneal injection of $500\mathrm{pmol}$ Av-RhodG, GmSA-RhodG, or BSA-RhodG. Three mice injected with each of the three probes were placed side by side on a nonfluorescent plate, and spectral fluorescence images of the abdominal cavities and closeup images of the peritoneal membranes were obtained. Both GmSA-RhodG and Av-RhodG clearly depicted the aggregated tumor foci as well as submillimeter implants in vivo (Fig. 4 ). However, BSA-RhodG failed to depict the tumor foci due to the insufficient fluorescence. The visual assessment of spectral fluorescence images revealed that the signal intensity from the cancer implants exposed to GmSA-RhodG was higher than that of Av-RhodG.

Fig. 4

GmSA-RhodG visualized the peritoneal cancer foci more clearly than Av-RhodG due to the higher signal intensity from the cancer foci. Spectral fluorescence imaging of the peritoneal cavities and the closeup peritoneal membranes of tumor-bearing mice were performed $3\mathrm{h}$ after intraperitoneal injection of $500\mathrm{pmol}$ Av-RhodG, GmSA-RhodG, and BSA-RhodG. Spectral unmixed autofluorescence (upper), RhodG fluorescence (middle), and composite (lower) images of three mice instilled with Av-RhodG, GmSA-RhodG, or BSA-RhodG are shown. Aggregated tumor foci (arrows) as well as the small cancer implants on the peritoneal membranes were detected by Av-RhodG and GmSA-RhodG. However, GmSA-RhodG visualized the cancer foci more clearly than Av-RhodG because of the higher signal intensities from the cancer foci. BSA-RhodG failed to depict the cancer foci due to the insufficient signal intensities from the cancer foci.

To objectively analyze the fluorescence intensities of the peritoneal implants among the three optical probes, a ROI encompassing the peritoneal membrane and circumscribed by the colon was drawn on the unmixed RhodG fluorescence image [Fig. 5a ] and a histogram depicting the distribution of pixel intensities was created [Fig. 5b]. The dynamic range of signal intensity in the unmixed fluorescence image was set from 1 to 256 (a.u.) and the threshold value $\left(t\right)$ was changed from 31 to 241 in increments of 10, because the background signals, such as the normal peritoneal membrane excluding tumors and the nonfluorescent plate, were mostly less than 31 (a.u.). Then, the total number of pixels $\left(N\right)$ within the threshold range was calculated as a function of threshold $\left(t\right)$ , and a regression line was calculated in each ROI [Fig. 5c]. The slopes of Av-RhodG, GmSA-RhodG, and BSA-RhodG were $-0.0362$ , $-0.0092$ , and $-0.1074$ , respectively. These results indicate that the in vivo fluorescence of the GmSA-RhodG is higher than Av-RhodG, and the galactosylation of albumin is essential for binding ovarian cancer cells.

Fig. 5

GmSA-RhodG showed the higher fluorescence intensity on in vivo spectral fluorescence imaging than Av-RhodG. In vivo fluorescence intensity of the peritoneal cancer foci was semiquantitatively assessed using the spectral unmixed RhodG image. (a) ROI was drawn inside the intestine of each of the peritoneal membranes instilled with three optical probes, Av-RhodG, GmSA-RhodG, and BSA-RhodG (the same image as the unmixed green fluorescence image of Fig. 4). (b) Histogram of fluorescence intensity of a ROI drawn on each peritoneal membrane instilled with Av-RhodG, GmSA-RhodG, or BSA-RhodG. The dynamic range of the fluorescence intensity was split into 256 equal-sized bins (1 to 256). Then for each bin (horizontal axis), the number of pixels from the data set that fall into each bin (vertical axis) are counted. The shape of the plot distribution $\le 30$ (a.u.) is almost the same among the three histograms. (c) Regression lines of three probes. The regression lines were calculated from the data sets (fluorescence threshold values 31 to 241, total number of pixels within the threshold range 10 to $10000$ in common logarithm). The slopes of Av-RhodG, GmSA-RhodG, and BSA-RhodG were $-0.0362$ , $-0.0092$ , and $-0.1074$ , respectively. GmSA-RhodG has the highest slope value consistent with it being the brightest fluorophore; whereas, BSA-RhodG had the lowest slope value.

3.6.

Sensitivity and Specificity of GmSA-RhodG In Vivo Spectral Fluorescence Imaging to Detect RFP-Transfected Peritoneal Cancer Foci

To investigate the effectiveness of GmSA-RhodG, sensitivity and specificity of spectral unmixed GmSA-RhodG imaging for peritoneal cancer foci was studied using dual color in vivo spectral fluorescence imaging of RFP DsRed2 and RhodG [Fig. 6a ]. A total of 283 peritoneal cancer foci in 3 mice were identified by the spectral unmixed RFP images [Fig. 6b]. An additional 283 corresponding ROIs were created in the noncancerous areas. No foci showed GmSA-RhodG fluorescence intensities $\ge 10$ (a.u.) among the 283 foci that were negative for RFP. However, another three foci were detected only by GmSA-RhodG images with no corresponding RFP focus (false positive foci). Thus, the spectral fluorescence imaging of GmSA-RhodG had a sensitivity of 100% (283/283) and a specificity of 99% (283/286).

Fig. 6

Sensitivity and specificity of GmSA-RhodG spectral fluorescence imaging to detect peritoneal cancer foci are 100 and 99%, respectively. In vivo spectral fluorescence imaging of RFP-transfected SHIN3 ovarian cancer-bearing peritoneal membrane was performed $3\mathrm{h}$ after injection with $500\mathrm{pmol}$ GmSA-RhodG. (a) The spectral fluorescence image was unmixed based on the spectral patterns of RhodG and RFP as well as the autofluorescence, and then, a composite image consisting of RhodG (yellow), RFP (blue), and autofluorescence (black and white) was made. (b) Two-color in vivo fluorescence intensity plots of cancer foci and noncancerous foci. All visible foci with signal intensities $\ge 2$ on spectral unmixed RFP images and diameters $\ge 1\mathrm{mm}$ were defined as cancer foci $(n=283)$ . For comparison, 283 ROIs were drawn in the surrounding peritumoral areas. Three foci were found only by the spectral unmixed GmSA-RhodG images. When foci positive for GmSA-RhodG were defined as those whose fluorescence intensities $\ge 10$ , sensitivity and specificity of spectral unmixed GmSA-RhodG images to detect the presence of cancer foci were 100 and 99%, respectively.