Page 116 - Fluorescence-guided cancer surgery

114
Chapter 8
ABSTRACT
Objective: In ovarian cancer, two of the most important prognostic factors for survival are completeness of staging and completeness of cytoreductive surgery. Therefore, intra-operative visualization of tumor lesions is of great importance. Preclinical data already demonstrated tumor visualization in a mouse-model using near-infrared (NIR) uorescence imaging and indocyanine green (ICG) as a result of enhanced permeability and retention (EPR). The aim of this study was to determine feasibility of intraoperative ovarian cancer metastases imaging using NIR uorescence imaging and ICG in a clinical setting.
Methods: Ten patients suspected of ovarian cancer scheduled for staging or cytoreductive surgery were included. Patients received 20 mg ICG intravenously after opening the abdominal cavity. The mini-FLARE NIR uorescence imaging system was used to detect NIR uorescent lesions.
Results: 6 out of 10 patients had malignant disease of the ovary or fallopian tube, of which 2 had metastatic disease outside the pelvis. Eight metastatic lesions were detected in these 2 patients, which were all NIR uorescent. However, 13 non-malignant lesions were also NIR uorescent, resulting in a false-positive rate of 62%. There was no signi cant di erence in tumor-to- background ratio between malignant and benign lesions (2.0 vs 2.0; P=0.99).
Conclusions: This is the rst clinical trial demonstrating intraoperative detection of ovarian cancer metastases using NIR uorescence imaging and ICG. Despite detection of all malignant lesions, a high false-positive rate was observed. Therefore, NIR uorescence imaging using ICG based on the EPR e ect is not satisfactory for the detection of ovarian cancer metastases. The need for tumor-speci c intraoperative agents remains.