Page 185 - Fluorescence-guided cancer surgery

SUMMARY
The quality of cancer surgery can be improved by assisting the surgeon with better and more objective, real time visual information during the procedure. Fluorescence-guided surgery can play a pivotal role in the intraoperative detection of tumor tissue, lymph nodes and vital structures.
This thesis focuses on a number of important indications in cancer surgery where clinically available near-infrared (NIR) uorescence contrast agents can be used to improve surgical practice (Part 1) and the clinical translation ( rst in human study) of newly developed tumor-speci c uorescent contrast agents to improve the real time detection of tumor tissue (Part 2).
Part 1: Exploring clinical available uorescent contrast agents in cancer surgery
In chapter 2, the detection of sentinel lymph nodes in gastric cancer is demonstrated. The lymph drainage pattern in gastric cancer is di cult to predict. Therefore, a total or partial gastrectomy is often combined with extensive lymphadenectomy. In the present study, indocyanine green (ICG) was adsorbed to nanocolloid to increase its hydrodynamic diameter and to improve retention in rst draining lymph nodes. Subsequently, the ICG-Nanocolloid complex was then subserosally injected around the tumor, followed by detection of lymphatic vessels and lymph nodes. In 21 of 22 patients, at least 1 sentinel lymph node was identi ed using this technique. Interestingly, in 8 of the 21 patients, SLNs outside the standard plane of resection were identi ed, and tumor involvement was found in 2 of these nodes (in two patients).
Chapter 3 focused on the intraoperative detection of breast cancer using methylene blue (MB). Although the exact mechanism is not exactly clear, we hypothesized that breast cancer could be visualized using MB, based on physicochemical similarities of MB and 99mTc-MIBI. 99mTc-MIBI is a SPECT radiodiagnostic agent with a sensitivity of 83 - 90% to detect breast cancer preoperatively. In 20 out of 24 patients, we successfully identi ed breast cancer lesions in the resection specimen. And in 2 patients breast cancer tissue was identi ed in the wound bed using uorescence imaging. Although MB is a promising agent for breast cancer detection, tumor-ligand speci c contrast agents could further improve the accuracy of intra-operative breast cancer imaging.
Summary and future perspectives 183