Page 13 - Fluorescence-guided cancer surgery

Over the past decades multiple preoperative imaging modalities have become available that have the ability to non-invasively detect tumors, improve accuracy of staging and preoperative planning, and can identify sentinel lymph nodes (SLN) of various tumor types or vital structures1;2.
However, during surgery, translation of these preoperative obtained images can be challenging due to altering in body position and tissue manipulation by the surgeon. Therefore surgeons mainly have to rely on their eyes and hands to identify structures that need to be resected or spared. Distinction between malignant and healthy tissue based on inspection and palpation can often be very di cult. Therefore, incomplete resections (R1) still occur in a signi cant number of cancer patients. In breast cancer for example, the number of patients with positive resection margins ranges from 11% to 46% after resection of the primary tumor3. Because complete resections are the cornerstone of curative cancer surgery, this leads to unfavorable patient outcomes, resulting in additional surgical procedures, delays in adjuvant treatment, increased morbidity rates and increased healthcare costs, and most likely decreased quality of life.
Next to imaging solitary tumors, improving the detection of metastasized disease could also improve patient outcomes. In metastasized ovarian cancer for example, identi cation of malignant lesions can improve staging procedures and facilitate treatment decisions between primary surgery and systemic therapy. Moreover, it can increase the number of optimal debulking procedures resulting in prolonged survival4-6. In metastasized uveal melanoma, intraoperative identi cation of hepatic metastases can assist in selecting patients that will bene t from resection, and expedite adjuvant systemic therapies for patients with miliary disease7-9.
Moreover, minimally invasive procedures are increasingly applied in daily clinical practice, limiting the possibility to palpate tissue and making the visual inspection more important for identi cation of malignant tissue and normal structures. Therefore, there is a clear unmet need for imaging modalities that facilitate the detection of cancer tissue and vital structures in real time during the surgical procedure.
Fluorescence imaging
Fluorescence imaging is an innovative optical imaging technique that can assist in the intraoperative identi cation of tumor tissue, SLNs, and vital
General introduction and thesis outline 11