Toward Curative Fluorescence-Guided Surgery of Pancreatic Cancer.

BACKGROUND/AIMS: Negative surgical margins are critical to prevent recurrence in cancer surgery. We review the use of fluorophore-labeled monoclonal antibodies to aid in cancer visualization in orthotopic nude mouse models of human pancreatic cancer in order to achieve negative margins in fluorescence-guided surgery (FGS).
METHODOLOGY: Anti-CEA or anti-CA 19-9 antibodies were conjugated with fluorophores of visible and near-infrared wavelengths. Orthotopic primary and metastatic human pancreatic tumors in nude mouse models were readily visualized with fluorescence imaging after administration of fluorophore conjugated anti-CEA or anti-CA 19-9.
RESULTS: The fluorescence signal was detectable 30 minutes after systemic antibody delivery and remained present for two weeks, with minimal in vivo photobleaching after exposure to standard operating room lighting. There was greatly improved ability to resect labeled tumor tissue using FGS.
CONCLUSIONS: Fluorophore-labeled anti-CEA or anti-CA 19-9 antibodies enable enhanced visualization of tumors for FGS of pancreatic cancer when CEA or CA 19-9 expression is present. The choice of fluorophore significantly affects the signal intensity in the labeled tumor. The technologies described herein have the potential to change the paradigm of surgical oncology to engender significantly improved outcomes.