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Fluorescent molecular imaging helps identify lung adenocarcinomas
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Fluorescent molecular imaging helped surgeons visually identify lung adenocarcinomas during pulmonary resection, according to study results.
If refined, this technique could enable real-time optical imaging during surgery and improve the identification of cancer cells, according to the researchers.
Sunil Singhal
“This approach may allow surgeons to perform resections with confidence that the entire tumor burden has been eliminated,” researcher Sunil Singhal, MD, director of the thoracic surgery research laboratory at University of Pennsylvania Health System, said in a press release. “In the future, with improved devices and molecular contrast agents, this approach may reduce the local recurrence rate and improve intraoperative identification of metastatic cancer cells.”
Singhal and colleagues conducted a proof-of-concept study to determine if a targeted molecular contrast agent could cause lung adenocarcinomas to fluoresce during surgery.
The study included 50 patients aged 25 to 85 years with a biopsy-proven lung adenocarcinoma. Patients received 0.1 mg/kg of a fluorescent folate receptor alpha and fluorescein-isothiocyanate (On Target Laboratories) combination 4 hours before surgery.
Seven tumors fluoresced in situ before surgeons removed them. Of the remaining 43 tumors, 39 appeared fluorescent after removal and direct exposure of the tumor. This resulted in 92% of adenocarcinomas being detected by fluorescence.
Fluorescent imaging appeared safe for the patients and clinicians, and it could benefit minimally invasive surgery, Singhal said.
“The use of a visible-wavelength fluorophore avoids ionizing radiation and confers no risk to the patient, surgeon, or operating room personnel,” he said in the press release. “In our experience, only one patient had a mild allergic reaction to the contrast agent that was easily managed with diphenhydramine. With miniaturization of imaging devices, this method will be particularly useful in minimally invasive surgery, such as [video assisted thoracic surgery] or robotic surgery.”
In an accompanying editorial, Michael I. Ebright, MD, assistant clinical professor of surgery at NewYork-Presbyterian/Columbia University Medical Center, expressed disappointment that only 14% of tumors could be identified prior to resection.
Michael I. Ebright
However, he expressed optimism about the potential of the technique evaluated by Singhal and colleagues, noting they demonstrated the ability to “make 92% of all adenocarcinomas glow to the naked eye,” allowing for easy identification with no special training.
“Imagine the possibility of having positive lymph nodes glow from beneath the mediastinal pleura, or glow during a mediastinoscopy,” Ebright wrote. “Sampling error might be greatly reduced, and full dissections or even random sampling might no longer be necessary. Involved lymph nodes within the hilar dissection of a video-assisted thoracoscopic surgical or robotic resection may be more easily visualized.”
Those prospects “are certainly exciting,” Ebright said.
“Imagination is an essential component of any technologic progress,” Ebright wrote. “This study should be viewed as a launching pad rather than be judged solely on practicality in its current form.” – by Ryan McDonald
Disclosure: Okusanya reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.
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