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Chapter 8
than that of malignant lesions. This lack of discriminative power makes NIR uorescence imaging based on the EPR e ect unsuitable for further clinical implementation in ovarian cancer.
CONCLUSIONS
This is the rst clinical trial demonstrating the feasibility of intraoperative detection of ovarian cancer metastases using NIR uorescence imaging and ICG. However, a high number of false-positive lesions that could be explained by the lack of speci city of the EPR e ect was found. Moreover, no distinction between malignant, reactive, or benign tissue based on TBR of the di erent lesions could be made. Therefore, the use of ICG, even when optimized, is not satisfactory for intraoperative NIR uorescence imaging of ovarian cancer metastases and the need for more tumor-speci c targeting agents remains. These results should be con rmed in other solid tumors where intraoperative NIR uorescence imaging based on the EPR e ect is being contemplated.
ACKNOWLEDGEMENTS
We thank Margriet J.G. Löwik and Dorien M.A. Berends-van der Meer for their assistance during the patient inclusion process and David J. Burrington, Jr. for editing.