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Azari F, Zhang K, Kennedy GT, Chang A, Nadeem B, Delikatny EJ, Singhal S. Precision Surgery Guided by Intraoperative Molecular Imaging. J Nucl Med 2022; 63:1620-1627. [PMID: 35953303 PMCID: PMC9635678 DOI: 10.2967/jnumed.121.263409] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 08/11/2022] [Indexed: 11/16/2022] Open
Abstract
Intraoperative molecular imaging (IMI) has recently emerged as an important tool in the armamentarium of surgical oncologists. IMI allows real-time assessment of oncologic resection quality, margin assessment, and occult disease detection during real-time surgery. Numerous tracers have now been developed for use in IMI-guided tissue sampling. Fluorochromes localize to the tumor by taking advantage of their disorganized capillary milieu, overexpressed receptors, or upregulated enzymes. Although fluorescent tracers can suffer from issues of autofluorescence and lack of depth penetration, these challenges are being addressed through hybrid radioactive/fluorescent tracers and new tracers that fluoresce in the near-infrared (NIR-II [wavelength > 1,000 nm]) range. IMI is already being used to treat numerous cancers, with demonstrated improvement in cancer recurrence and patient outcomes without incurring significant burden on either clinicians or patients. In this comprehensive review, we discuss history, mechanism, current oncologic applications, and future directions of IMI-guided optical biopsy.
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Affiliation(s)
- Feredun Azari
- Department of Thoracic Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Kevin Zhang
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Gregory T. Kennedy
- Department of Thoracic Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Ashley Chang
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Bilal Nadeem
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Edward J. Delikatny
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sunil Singhal
- Department of Thoracic Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania;
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Wang LG, Barth CW, Kitts CH, Mebrat MD, Montaño AR, House BJ, McCoy ME, Antaris AL, Galvis SN, McDowall I, Sorger JM, Gibbs SL. Near-infrared nerve-binding fluorophores for buried nerve tissue imaging. Sci Transl Med 2020; 12:12/542/eaay0712. [DOI: 10.1126/scitranslmed.aay0712] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 09/24/2019] [Accepted: 03/17/2020] [Indexed: 01/06/2023]
Abstract
Nerve-binding fluorophores with near-infrared (NIR; 650 to 900 nm) emission could reduce iatrogenic nerve injury rates by providing surgeons precise, real-time visualization of the peripheral nervous system. Unfortunately, current systemically administered nerve contrast agents predominantly emit at visible wavelengths and show nonspecific uptake in surrounding tissues such as adipose, muscle, and facia, thus limiting detection to surgically exposed surface-level nerves. Here, a focused NIR fluorophore library was synthesized and screened through multi-tiered optical and pharmacological assays to identify nerve-binding fluorophore candidates for clinical translation. NIR nerve probes enabled micrometer-scale nerve visualization at the greatest reported tissue depths (~2 to 3 mm), a feat unachievable with previous visibly emissive contrast agents. Laparoscopic fluorescent surgical navigation delineated deep lumbar and iliac nerves in swine, most of which were invisible in conventional white-light endoscopy. Critically, NIR oxazines generated contrast against all key surgical tissue classes (muscle, adipose, vasculature, and fascia) with nerve signal-to-background ratios ranging from ~2 (2- to 3-mm depth) to 25 (exposed nerve). Clinical translation of NIR nerve-specific agents will substantially reduce comorbidities associated with surgical nerve damage.
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Affiliation(s)
- Lei G. Wang
- Biomedical Engineering Department, Oregon Health & Science University, Portland, OR 97201, USA
| | - Connor W. Barth
- Biomedical Engineering Department, Oregon Health & Science University, Portland, OR 97201, USA
| | - Catherine H. Kitts
- Biomedical Engineering Department, Oregon Health & Science University, Portland, OR 97201, USA
| | - Mubark D. Mebrat
- Biomedical Engineering Department, Oregon Health & Science University, Portland, OR 97201, USA
| | - Antonio R. Montaño
- Biomedical Engineering Department, Oregon Health & Science University, Portland, OR 97201, USA
| | - Broderick J. House
- Biomedical Engineering Department, Oregon Health & Science University, Portland, OR 97201, USA
| | - Meaghan E. McCoy
- Biomedical Engineering Department, Oregon Health & Science University, Portland, OR 97201, USA
| | | | | | | | | | - Summer L. Gibbs
- Biomedical Engineering Department, Oregon Health & Science University, Portland, OR 97201, USA
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97201, USA
- Center for Spatial Systems Biomedicine, Oregon Health & Science University, Portland, OR 97201, USA
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