Page 188 - Fluorescence-guided cancer surgery
P. 188
186
Chapter 11
GENERAL CONCLUSION
Intraoperative NIR uorescence imaging using ICG and MB was explored in multiple important indications in cancer surgery. Imaging using ICG resulted in accurate tumor imaging of liver metastases and SLN detection in gastric cancer, with high TBRs and a prolonged uorescent signal. For these indications, our data suggests that uorescence imaging should be implemented in the clinic to improve patient care. MB allowed successful imaging of parathyroid adenomas, neuro-endocrine tumors and breast cancer lesions, but accuracy and imaging characteristics can probably be improved by the introduction of more tumor-speci c contrast agents. However, in the meantime MB can be used for intraoperative guidance in for instance di cult cases.
Intraoperative imaging of ovarian cancer using the FRĪ± speci c EC17 and OTL38 showed highly speci c and accurate tumor imaging with a high TBR and prolonged uorescent signal in malignant lesions. Administration of these low molecular weight contrast agents resulted in rapid accumulation in tumor tissue and fast clearance from the rest of the body. Moreover, with the NIR uorescent contrast agent OTL38 almost no background signal or auto uorescence was seen. Clinical translation using both healthy subjects and patients allowed a rapid determination of the optimal dose, formulation, and time window for intraoperative imaging, facilitating a fast clinical introduction of newly developed contrast agents in clinical trials.
