Page 120 - Fluorescence-guided cancer surgery
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Chapter 8
signal was observed, the operating surgeon performed a biopsy or resection of the uorescent tissue, unless this would jeopardize patient health or success of surgery. In case of non- uorescence, only macroscopically suspected lesions were resected. Resected specimens were marked as uorescent or non- uorescent and were routinely examined by a pathologist for the presence of malignant cells.
Intraoperative near-infrared uorescence imaging
Intraoperative imaging procedures were performed using the Mini- Fluorescence-Assisted Resection and Exploration (Mini-FLARE) image- guided surgery system, as described earlier27. Brie y, the system consists of 2 wavelength isolated light sources: a “white” light source, generating 26,600 lx of 400 to 650 nm light, and a “near-infrared” light source, generating 1.08 mW/came of ≈ 760 nm light. Color video and NIR uorescence images are simultaneously acquired and displayed in real time using custom optics and software that separate the color video and NIR uorescence images. A pseudo- colored (lime green) merged image of the color video and NIR uorescence images is also displayed. The imaging head is attached to a exible gooseneck arm, which permits positioning of the imaging head at extreme angles virtually anywhere over the surgical eld. For intraoperative use, the imaging head and imaging system pole stand are wrapped in a sterile shield and drape (Medical Technique Inc., Tucson, AZ).
Statistical analysis
For statistical analysis, SPSS statistical software package (Version 20.0, Chicago, IL) was used. TBRs were calculated by dividing the uorescent signal of the tumor by uorescent signal of surrounding tissue. Patient age was reported in median, standard deviation (SD), and range, and TBR was reported in mean, SD, and range. To compare patient characteristics, independent samples t-test and chi-square tests were used. To compare TBR and background signal between malignant and benign lesions, independent samples t-test was used. P < 0.05 was considered signi cant.
