Page 186 - Fluorescence-guided cancer surgery

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Chapter 11
Chapter 4 described the identi cation of hepatic metastases from uveal melanoma during laparoscopic liver surgery. ICG was administered 24 hours before surgery. The dye gets excreted by healthy liver into bile, but is trapped in the transition zone between healthy liver and metastatic lesions. At the day of surgery, a clear uorescent rim around the tumor was seen. Even lesions not detected by pre-operative CT-scan, intraoperative inspection or laparoscopic ultrasound were identi ed. Therefore, NIR uorescence imaging during laparoscopic liver surgery is a minimal invasive way to determine whether patients could potentially bene t from a metastasectomy. Moreover, it might help to obtain clear resection margins.
In chapter 5, ICG was administered to patients su ering from a pituitary gland adenoma. We hypothesized that ICG could improve distinction between normal and abnormal pituitary gland tissue during transnasal transsphenoidal selective adenomectomy, based on di erences in tissue vascularization. In nine out of 10 patients with a histologically proven pituitary adenoma, the normal pituitary gland showed a stronger uorescent signal than the adenoma. In two patients, adenoma resection actually took place under direct NIR uorescence guidance. The available endoscopic imaging system didn’t allow simultaneous imaging of color video and uorescence, which limited the additional value of uorescence imaging. Introduction of ligand-speci c contrast agents and improved imaging systems could further improve uorescence-guided pituitary gland surgery.
Chapter 6 described a clinical case in which MB was used to identify a paraganglioma, a rare neuro-endocrine tumor. It even allowed the detection of a local metastasis, which was not detected by preoperative imaging and intraoperative inspection.
Based on the principle of comparable biodistribution of MB and the 99mTc- MIBI tracer, chapter 7 elaborated on the intraoperative uorescence guidance during parathyroid surgery. MB allowed not only identi cation of parathyroid adenomas, but also identi ed normal parathyroid glands that were otherwise not detectable. Although promising results with newly developed structure inherent contrast agents are reported, MB can play a vital role in parathyroid surgery until newer probes enter the clinic.
In chapter 8, the enhanced permeability and retention (EPR) e ect in ovarian cancer was explored. This e ect is based on the fact that macromolecules, such as protein bound ICG, accumulate in tumor tissue due to increased vascular