Fluorescence Guidance in Surgical Oncology: Challenges, Opportunities, and Translation

Abstract

Surgical resection continues to function as the primary treatment option for most solid tumors. However, the detection of cancerous tissue remains predominantly subjective and reliant on the expertise of the surgeon. Surgery that is guided by fluorescence imaging has shown clinical relevance as a new approach to detecting the primary tumor, tumor margins, and metastatic lymph nodes. It is a technique to reduce recurrence and increase the possibility of a curative resection. While significant progress has been made in developing this emerging technology as a tool to assist the surgeon, further improvements are still necessary. Refining imaging agents and tumor targeting strategies to be a precise and reliable surgical strategy is essential in order to translate this technology into patient care settings. This review seeks to provide a comprehensive update on the most recent progress of fluorescence-guided surgery and its translation into the clinic. By highlighting the current status and recent developments of fluorescence image-guided surgery in the field of surgical oncology, we aim to offer insight into the challenges and opportunities that require further investigation.

Improved antibody-guided surgery with a near-infrared dye on a PEGylated linker for CEA-positive tumors

“…Antigen-specific fluorescent-guided surgery has demonstrated the potential to identify positive tumor margins and metastatic sites of disease in early stage clinical trials. [1][2][3] Although there are many challenges to advancing this promising field, we have focused on antitumor antibody-IR800 probe development to increase tumor accumulation and pharmacokinetic properties. Our previous work with M5A-IRDye800CW showed excellent tumor imaging but with high liver background and relatively fast blood clearance.…”

“…Fluorescence-guided surgery (FGS) using tumor-specific antibodies conjugated with near-infrared fluorophores (NIR) have demonstrated the potential to visualize solid tumor lesions in preclinical and early stage clinical trials. [1][2][3] Several commercial cancer therapeutic monoclonal antibodies (mAbs) have been repurposed as molecular optical imaging agents by their conjugation with NIR dyes and are in early-stage clinical trials. [4][5][6] Compared to visible light fluorophores, NIR fluorophores have reduced light scattering, increased depth of penetration, and minimal autofluorescence.…”

A Raman Imaging Approach Using CD47 Antibody-Labeled SERS Nanoparticles for Identifying Breast Cancer and Its Potential to Guide Surgical Resection

“…More recently, image guided surgery has generated quite a bit of interest in the field of molecular imaging, with several investigators assessing various contrast agents along with various imaging techniques [ 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 ]. Both preclinical and clinical studies have shown the benefits that image guidance can offer during all sorts of surgical applications.…”

Image‐guided tumor surgery: The emerging role of nanotechnology

“…These characteristics result in low tumor signal and contrast (Alander et al, ; Schaafsma et al, ; H. Wang et al, ). Therefore, other NIR dyes such as cyanine‐based and novel fluorophores are being investigated for FGS, and seek to improve tumor signal and contrast (Figure ; Hernot, van Manen, Debie, Mieog, & Vahrmeijer, ; Olson et al, ).…”