Page 91 - Fluorescence-guided cancer surgery

A 123I-metaiodobenzylguanidine (MIBG) scan was performed to search for lesions located elsewhere in the body. Strong accumulation of the tracer was seen in the lesion just caudal to the aortic bifurcation, but no other uptake was seen (Figure 1).
The patient was scheduled for resection. She was successfully pretreated with doxazosine, a selective alpha1-receptor blocking sympatholytic drug, metoprolol, a beta-receptor blocking sympatholytic drug, and nifedipine, a dihydropyridine, in order to prevent a hypertensive crisis during surgery.
Intraoperative NIR uorescence imaging
The current study was approved by the Medical Ethics Committee of the Leiden University Medical Center and was performed in accordance with the clinical standards of the Helsinki Declaration of 1975. Written informed consent was obtained.
During surgery, and directly after exposure of the lesion distal to the aortic bifurcation, MB was administered intravenously (0.5 mg/kg; 33 mg in 3.3 mL of water; 10 mg/ mL nal stock solution concentration) over 5 min and NIR uorescence imaging was performed using the Mini-FLARE image-guided surgery system as described previously8. Directly after infusion, imaging was performed at xed time points (0, 1, 2, 3, 4, 5, 15, 30 and 45 min).
NIR uorescence imaging showed a strong, but patchy, uorescent signal corresponding to the suspected lesion (Figure 2A, lesion indicated by dashed circle). Moreover, the additional small lesion that was only identi ed by CT but not by MRI or by visual inspection during surgery, was clearly identi ed using NIR uorescence imaging, located approximately 5 cm cranial to the main lesion (indicated by arrow). This lesion was otherwise undetectable. Already two minutes after administration, a Tumor-to-background batio (TBR) of approximately 3.5 was reached for both lesions, which slowly decreased over the next 30 min (Figure 3).
After en bloc resection of the 2 lesions, the specimen was sent to Pathology for further evaluation. After surgical treatment, symptoms disappeared and normetanephrine levels normalized.
No surgical complication or adverse reactions associated with the use of MB or uorescence imaging were observed.
Imaging of a paraganglioma 89