Jane J Keating1, Olugbenga T Okusanya1, Elizabeth De Jesus1, Ryan Judy1, Jack Jiang1, Charuhas Deshpande2, Shuming Nie3, Philip Low4, Sunil Singhal5,6. 1. Division of Thoracic Surgery, Department of Surgery, University of Pennsylvania and Philadelphia VA Medical Center, Philadelphia, PA, USA. 2. Department of Pathology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. 3. Departments of Biomedical Engineering and Chemistry, Emory University, Atlanta, GA, USA. 4. Department of Chemistry, Purdue University, West Lafayette, IN, USA. 5. Division of Thoracic Surgery, Department of Surgery, University of Pennsylvania and Philadelphia VA Medical Center, Philadelphia, PA, USA. sunil.singhal@uphs.upenn.edu. 6. Division of Thoracic Surgery, University of Pennsylvania School of Medicine, 6 White Building, 3400 Spruce Street, Philadelphia, PA, 19104, USA. sunil.singhal@uphs.upenn.edu.
Abstract
PURPOSE: During lung surgery, identification of surgical margins is challenging. We hypothesized that molecular imaging with a fluorescent probe to pulmonary adenocarcinomas could enhance residual tumor during resection. PROCEDURES: Mice with flank tumors received a contrast agent targeting folate receptor alpha. Optimal dose and time of injection was established. Margin detection was compared using traditional methods versus molecular imaging. A pilot study was then performed in three humans with lung adenocarcinoma. RESULTS: The peak tumor-to-background ratio (TBR) of murine tumors was 3.9. Fluorescence peaked at 2 h and was not improved beyond 0.1 mg/kg. Traditional inspection identified 30% of mice with positive margins. Molecular imaging identified an additional 50% of residual tumor deposits (p < 0.05). The fluorescent probe visually enhanced all human tumors with a mean TBR of 3.5. CONCLUSIONS: Molecular imaging is an important adjunct to traditional inspection to identify surgical margins after tumor resection.
PURPOSE: During lung surgery, identification of surgical margins is challenging. We hypothesized that molecular imaging with a fluorescent probe to pulmonary adenocarcinomas could enhance residual tumor during resection. PROCEDURES: Mice with flank tumors received a contrast agent targeting folate receptor alpha. Optimal dose and time of injection was established. Margin detection was compared using traditional methods versus molecular imaging. A pilot study was then performed in three humans with lung adenocarcinoma. RESULTS: The peak tumor-to-background ratio (TBR) of murinetumors was 3.9. Fluorescence peaked at 2 h and was not improved beyond 0.1 mg/kg. Traditional inspection identified 30% of mice with positive margins. Molecular imaging identified an additional 50% of residual tumor deposits (p < 0.05). The fluorescent probe visually enhanced all humantumors with a mean TBR of 3.5. CONCLUSIONS: Molecular imaging is an important adjunct to traditional inspection to identify surgical margins after tumor resection.
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