Comprehensive Review of Fluorescence Applications in Gynecology

Połom, Joanna; Kalinowski, Leszek; Diana, Michele; Chand, Manish; Caballero, Carmela; Sawicki, Sambor; Połom, Karol

doi:10.3390/jcm10194387

Cited by 14 publications

(11 citation statements)

References 110 publications

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“…Currently, there are five FGS agents approved for intraoperative imaging by the American FDA and/or the EMA ( 10 ). These include 5-ALA for intraoperative application in patients with suspected high-grade gliomas ( 9 ).…”

Section: Discussionmentioning

confidence: 99%

“…However, as folat receptor expression represents the biological prerequisite for signal detection, this tracer is not suitable for all ovarian cancer patients ( 11 ). A further tracer, OTL38, Pafolacianine, is injected preoperatively and showed to be safe and effective in identifying additional tumor manifestations, invisible prior to near-infrared imaging ( 10 , 11 ) with identification of up to 33% additional ovarian cancer tumor manifestations ( 12 , 13 ). Of note, no false negative samples were reported.…”

Section: Discussionmentioning

confidence: 99%

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Optimized complete cytoreduction in ovarian cancer through intraoperative real-time tumor visualization by 5-ALA – a case report

Tascón Padrón,

Egger,

Ralser

et al. 2023

Front. Oncol.

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IntroductionComplete macroscopic cytoreduction represents the most important prognostic parameter for overall survival in ovarian cancer. This dogma remains tenacious despite significant improvements in adjuvant systemic treatment. Hence, optimization of surgical therapy is an overarching goal to improve patients’ outcomes. In this context, intraoperative tumor-specific imaging might facilitate optimized cytoreduction. In neurosurgery, intraoperative 5-aminolevulinic acid (5-ALA) guided imaging is applied in clinical routine to assess surgical resection margins. Here, we report the case of a patient with ovarian cancer in whom intraoperative 5-ALA tumor visualization led to optimized complete cytoreduction.ObjectiveIntraoperative administration of 5-ALA led to improved complete cytoreduction by identification and resection of additional ovarian cancer tumor manifestations.CaseThe 39-year-old patient, Jehovah`s witness, presented to our department with a left sided ovarian mass, suspicious of ovarian cancer, based on clinical examination, sonographic suspicious features and a CA12-5 elevation. The patient’s medical history and family history was unremarkable. Preoperative CT imaging of the thorax and abdomen showed no pathology besides the adnexal mass. Surgery was performed by a midline laparotomy with hysterectomy, bilateral adnexectomy, pelvic peritonectomy, omentectomy, ureterolysis, diaphragm stripping, adhesiolysis and the collection of peritoneal and rectal samples. Intraoperative 5-ALA imaging using a dedicated excitation and detection loupe system (Reveal, DVI) led to tumor detection at the diaphragm, the omentum and the rectum that was not detectable by palpation and visualization using white light. The pathology results revealed that the 5-ALA positive samples (diaphragm, rectum and omentum) obtained by intraoperative 5-ALA were positive for ovarian cancer.ConclusionIntraoperative administration of 5-ALA represents a promising approach to improve complete cytoreduction in ovarian cancer surgery thereby improving clinical outcomes. Hence, further research and clinical trials are required to investigate the potential of intraoperative 5-ALA imaging in ovarian cancer debulking surgery and its impact on long-term clinical outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Optimized complete cytoreduction in ovarian cancer through intraoperative real-time tumor visualization by 5-ALA – a case report

Tascón Padrón,

Egger,

Ralser

et al. 2023

Front. Oncol.

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“…Surgical guidance with fluorescent tracers has seen significant adoption in the last decade, 1 including the ability to image tissue perfusion. 2,3 More recently, tissue metabolism tracers have been approved for human use, such as protoporphyrin IX (PpIX), 4,5 which is induced by oral or topical administration of 5-aminolevulinic acid (ALA). 6 One of the most striking things about the ALA-PpIX system is that it is produced throughout most tissues of the body and demarcates glioma tumors in neurosurgery, skin lesions, and bladder cancers.…”

Section: Introductionmentioning

confidence: 99%

“…Surgical guidance with fluorescent tracers has seen significant adoption in the last decade, 1 including the ability to image tissue perfusion 2 , 3 . More recently, tissue metabolism tracers have been approved for human use, such as protoporphyrin IX (PpIX), 4 , 5 which is induced by oral or topical administration of 5-aminolevulinic acid (ALA) 6 .…”

Section: Introductionmentioning

confidence: 99%

Protoporphyrin IX delayed fluorescence imaging: a modality for hypoxia-based surgical guidance

2022

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. Significance Hypoxia imaging for surgical guidance has never been possible, yet it is well known that most tumors have microregional chronic and/or cycling hypoxia present as well as chaotic blood flow. The ability to image oxygen partial pressure ( ) is therefore a unique control of tissue metabolism and can be used in a range of disease applications to understand the complex biochemistry of oxygen supply and consumption. Aim Delayed fluorescence (DF) from the endogenous molecule protoporphyrin IX (PpIX) has been shown to be a truly unique reporter of the local oxygen partial pressure in tissue. PpIX is endogenously synthesized by mitochondria in most tissues, and the particular property of DF emission is directly related to low microenvironmental oxygen concentration. Here, it is shown that PpIX has a unique emission in hypoxic tumor tissue regions, which is measured as a DF signal in the red to near-infrared spectrum. Approach A time-gated imaging system was used for PpIX DF for wide field direct mapping of changes. Acquiring both prompt and DF in a rapid sequential cycle allowed for imaging oxygenation in a way that was insensitive to the PpIX concentration. By choosing adequate parameters, the video rate acquisition of images could be achieved, providing real-time tissue metabolic information. Results In this report, we show the first demonstration of imaging hypoxia signals from PpIX in a pancreatic cancer model, exhibiting contrast relative to surrounding normal oxygenated tissues. Additionally, tissue palpation amplifies the signal and provides intuitive temporal contrast based upon neoangiogenic blood flow differences. Conclusions PpIX DF provides a mechanism for tumor contrast that could easily be translated to human use as an intrinsic contrast mechanism for oncologic surgical guidance.

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“…The most recent innovation in tracers is represented by indocyanine green (ICG), a cyanine dye tracer detected by the use of near infrared imaging technologies, have emerged as feasible alternatives to the traditional methods as blue dyes and radiolabeled tracers ( 5 ).…”

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confidence: 99%