Feredun Azari1, Gregory Kennedy1, Kevin Zhang1, Elizabeth Bernstein1, Ashley Chang1, Bilal Nadeem1, Alix Segil1, Charuhas Desphande2, James Delikatny3, John Kucharczuk1, Sunil Singhal4. 1. Department of Thoracic Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA. 2. Department of Pathology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA. 3. Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA. 4. Department of Thoracic Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA. sunil.singhal@pennmedicine.upenn.edu.
Abstract
BACKGROUND: One of the novel advancements to enhance the visual aspects of lung cancer identification is intraoperative molecular imaging (IMI), which can reliably detect tumors that would otherwise be missed by standard techniques such as tactile and visual feedback, particularly for sub-centimeter or ground-glass nodules. However, there remains a subset of patients who do not benefit from IMI due to excessive background fluorescence secondary to parenchymal light-absorbing carbon deposition. Our goal was to identify the effects of these carbonaceous materials on the quality of IMI-guided lung cancer resections. STUDY DESIGN AND METHODS: Between July 2014 and May 2021, a total of 311 patients were included in the study. Patients underwent infusion of the study drug OTL38 or ICG up to 24 h prior to VATS for lung cancer. Several factors such as age, tumor subtype, PET SUV, smoking, demographics, chronic lung conditions, patient domicile, and anthracosis were analyzed with respect to lung fluorescence during IMI. P values < 0.05 were considered statistically significant. RESULTS: Variables such as age, sex, and race had no statistical correlation to IMI success. However, smoking status and pack year had a statistically significant correlation with background parenchymal fluorescence and lung inflammation (p < 0.05). MFI of background (lung parenchyma) correlated with smoking history (p < 0.05) which led to decreased tumor-to-background ratio (TBR) measurements for all patients with proven malignancy (p < 0.05). Patients with chronic lung disease appear to have increased background parenchymal fluorescence regardless of smoking history (287 vs. 154, p < 0.01). City dwellers compared to other groups appear to be exposed to higher pollutant load and have higher rates of anthracosis, but living location's impact on fluorescence quantification appears to be not statistically significant. CONCLUSION: Smokers with greater than 10 PPY and those with chronic lung disease appear to have decreased lesion-to-background discrimination, significant anthracosis, and reduced IMI efficacy secondary to light-absorbing carbon deposition.
BACKGROUND: One of the novel advancements to enhance the visual aspects of lung cancer identification is intraoperative molecular imaging (IMI), which can reliably detect tumors that would otherwise be missed by standard techniques such as tactile and visual feedback, particularly for sub-centimeter or ground-glass nodules. However, there remains a subset of patients who do not benefit from IMI due to excessive background fluorescence secondary to parenchymal light-absorbing carbon deposition. Our goal was to identify the effects of these carbonaceous materials on the quality of IMI-guided lung cancer resections. STUDY DESIGN AND METHODS: Between July 2014 and May 2021, a total of 311 patients were included in the study. Patients underwent infusion of the study drug OTL38 or ICG up to 24 h prior to VATS for lung cancer. Several factors such as age, tumor subtype, PET SUV, smoking, demographics, chronic lung conditions, patient domicile, and anthracosis were analyzed with respect to lung fluorescence during IMI. P values < 0.05 were considered statistically significant. RESULTS: Variables such as age, sex, and race had no statistical correlation to IMI success. However, smoking status and pack year had a statistically significant correlation with background parenchymal fluorescence and lung inflammation (p < 0.05). MFI of background (lung parenchyma) correlated with smoking history (p < 0.05) which led to decreased tumor-to-background ratio (TBR) measurements for all patients with proven malignancy (p < 0.05). Patients with chronic lung disease appear to have increased background parenchymal fluorescence regardless of smoking history (287 vs. 154, p < 0.01). City dwellers compared to other groups appear to be exposed to higher pollutant load and have higher rates of anthracosis, but living location's impact on fluorescence quantification appears to be not statistically significant. CONCLUSION: Smokers with greater than 10 PPY and those with chronic lung disease appear to have decreased lesion-to-background discrimination, significant anthracosis, and reduced IMI efficacy secondary to light-absorbing carbon deposition.
Authors: Jarrod D Predina; Andrew D Newton; Christopher Corbett; Leilei Xia; Michael Shin; Lydia Frenzel Sulfyok; Olugbenga T Okusanya; Keith A Cengel; Andrew Haas; Leslie Litzky; John C Kucharczuk; Sunil Singhal Journal: Ann Thorac Surg Date: 2018-07-17 Impact factor: 4.330
Authors: Peter B Bach; Michael W Kattan; Mark D Thornquist; Mark G Kris; Ramsey C Tate; Matt J Barnett; Lillian J Hsieh; Colin B Begg Journal: J Natl Cancer Inst Date: 2003-03-19 Impact factor: 13.506
Authors: Feredun Azari; Gregory Kennedy; Elizabeth Bernstein; Constantinos Hadjipanayis; Alexander Vahrmeijer; Barbara Smith; Eben Rosenthal; Baran Sumer; Jie Tian; Eric Henderson; Amy Lee; Quyen Nguyen; Summer Gibbs; Brian Pogue; Daniel Orringer; Cleopatra Charalampaki; Linda Martin; Janos Tanyi; Major Lee; John Y Lee; Sunil Singhal Journal: J Biomed Opt Date: 2021-05 Impact factor: 3.170
Authors: Daniel J O'Shannessy; Gordon Yu; Robert Smale; Yao-Shi Fu; Sunil Singhal; Robert P Thiel; Elizabeth B Somers; Anil Vachani Journal: Oncotarget Date: 2012-04