Page 151 - Fluorescence-guided cancer surgery

Imaging FRα positive ovarian and breast cancer 149
total of 15 images to be analyzed. First, only colour images were used to score the number of observed metastatic lesions. When this was completed, colour images supplemented with uorescence images were scored.
Surgical procedure in breast cancer
Patients underwent standard of care breast ablation or BCS both combined with SLN biopsy. The Artemis uorescence imaging system was used to identify uorescent signal during surgery and on resected specimens transferred to the pathology department. Intra-operative images of SLNs, the surgical eld, resected specimen, and wound bed after resection were obtained. Following standard procedure, the resected specimen was dissected at the pathology department, where images from the dissected tumor were obtained as well. The resected specimens were routinely examined by a pathologist for tumor status. In addition, IHC staining for FRα expression and uorescence microscopy (Leica DM5500B uorescence microscope) were performed to evaluate binding site of EC17 (Supplementary Methods, online available).
Artemis uorescence imaging system
Imaging procedures were performed using the Artemis uorescence imaging system (Quest Medical Imaging, The Netherlands). The system consists of 3 wavelength isolated light sources: a “white” light source, and a two di erent “near-infrared” light sources. For this study, the camera and light engine were optimized for EC17 to generate 7.5 mW/cm2 at 490 nm light. Color video and uorescence images are simultaneously acquired on separate sensors and displayed in real time using custom optics and software showing the separate the color video and NIR uorescence images. A pseudo-colored (lime green) merged image of the color video and uorescence images is also displayed. The intensities of the light sources could be controlled from the Artemis software. The camera can be attached to a freely moveable arm head. For intraoperative use, the camera and freely moveable arm were wrapped in a sterile shield and drape (Medical Technique Inc., Tucson, AZ).
Statistical and Image Analysis
SPSS statistical software package (Version 20.0, Chicago, IL) was used. Patient characteristics were reported in median, standard deviation (SD), and range. PK parameters (AUC, Cmax, tmax) were statistically summarized including number