Real-time intraoperative detection of breast cancer using near-infrared fluorescence imaging and Methylene Blue

Tummers, Quirijn R.J.G.; Verbeek, F.P.R.; Schaafsma, Boudewijn E.; Boonstra, Martin C.; Vorst, Joost R. van der; Liefers, G.J.; Velde, C. J. H. van de; Frangioni, John V.; Vahrmeijer, Alexander L.

doi:10.1016/j.ejso.2014.02.225

Cited by 117 publications

(121 citation statements)

References 30 publications

Supporting

Mentioning

121

Contrasting

Order By: Relevance

“…This study enabled identification of 20 out of 24 cancers (21 were invasive and three were in situ) within the resected specimens using the near-infrared fluorescence imaging. 67 Therefore, this technique clearly has the potential to enable margin assessment intra-operatively, but remains at an early stage of development.…”

Section: Magnetically Guided Localizationmentioning

confidence: 99%

“…67 In a small feasibility study in 24 patients with invasive breast cancer, methylene blue was administered intravenously within 3 h of surgery. 67 A fluorescence-assisted resection and exploration imaging system (mini-FLARE™, FLARE Foundation, USA) was used to identify the fluorescent signal during surgery and within excised specimens. This study enabled identification of 20 out of 24 cancers (21 were invasive and three were in situ) within the resected specimens using the near-infrared fluorescence imaging.…”

Section: Magnetically Guided Localizationmentioning

confidence: 99%

See 1 more Smart Citation

Surgical treatment of nonpalpable primary invasive and in situ breast cancer

et al. 2015

View full text Add to dashboard Cite

Breast cancer is the most-common cancer among women worldwide, and over one-third of all cases diagnosed annually are nonpalpable at diagnosis. The increasingly widespread implementation of breast-screening programmes, combined with the use of advanced imaging modalities, such as magnetic resonance imaging (MRI), will further increase the numbers of patients diagnosed with this disease. The current standard management for nonpalpable breast cancer is localized surgical excision combined with axillary staging, using sentinel-lymph-node biopsy in the clinically and radiologically normal axilla. Wire-guided localization (WGL) during mammography is a method that was developed over 40 years ago to enable lesion localization preoperatively; this technique became the standard of care in the absence of a better alternative. Over the past 20 years, however, other technologies have been developed as alternatives to WGL in order to overcome the technical and outcome-related limitations of this technique. This Review discusses the techniques available for the surgical management of nonpalpable breast cancer; we describe their advantages and disadvantages, and highlight future directions for the development of new technologies.

show abstract

Section: Magnetically Guided Localizationmentioning

confidence: 99%

Section: Magnetically Guided Localizationmentioning

confidence: 99%

Surgical treatment of nonpalpable primary invasive and in situ breast cancer

et al. 2015

View full text Add to dashboard Cite

show abstract

“…Non-targeted agents provide contrast due general properties of tumors, rather than presence of a specific antigen, and they include unconjugated fluorescent dyes and a subset of nanoparticles. Unconjugated fluorescent dyes such as fluorescein [23], methylene blue [24], or indocyanine green [23, 25] can be delivered locally or systemically, and accumulate in areas of tumor tissue that have disrupted or altered tumor vasculature and drainage.…”

Section: Non-targeted Imaging Agentsmentioning

confidence: 99%

Image-Guided Tumor Resection

2015

View full text Add to dashboard Cite

Each year, millions of individuals undergo cancer surgery that is intended to be curative or at least a necessary component of a curative regimen. Particularly for those patients whose cancer harbors cells that are resistant to chemotherapy or radiation, the extent of surgery often defines whether they will be a survivor or casualty of the disease. For many solid tumor types, the difference in survival between patients who undergo gross total resection and those who have residual bulky disease is often profound. With surgery being central to cancer survivorship, it is stunning how few resources have been invested in improving surgical outcomes, particularly in comparison to chemotherapeutic research and discovery. This article reviews recent advances related to developing targeted fluorescent agents to guide surgeons during cancer removal. The goal of these drugs and devices is to clearly distinguish cancer from normal tissue to improve surgical outcome for cancer patients.

show abstract

“…Methylene blue is a third clinically available imaging agent that has been tested for its ability to label tumor tissues. Tummers et al reported a study in which patients with breast cancer patients were administered intravenous methylene blue prior to tumor resection, and subsequent fluorescence imaging of the resected tissue showed a tumor to background fluorescence ratio of 2.4 (28). Nonspecific fluorescent contrast agents provide one reasonable option for intraoperative imaging as they are clinically available.…”

Section: Optical Imagingmentioning

confidence: 99%

Tailoring Adjuvant Radiation Therapy by Intraoperative Imaging to Detect Residual Cancer

Whitley

Weissleder

Kirsch

2015

Seminars in Radiation Oncology

View full text Add to dashboard Cite

For many solid cancers, radiation therapy is offered as an adjuvant to surgical resection in order to lower rates of local recurrence and improve survival. However, a subset of patients treated with surgery alone will not have a local recurrence. Currently, there is no way to accurately determine which patients have microscopic residual disease in the tumor bed after surgery and therefore are most likely to benefit from adjuvant radiation therapy. To address this problem, a number of technologies have been developed to try to improve margin assessment of resected tissue and to detect residual cancer in the tumor bed. Moreover, some of these approaches have been translated from the preclinical arena into clinical trials. Here, we review different types of intraoperative molecular imaging systems for cancer. Optical imaging techniques like epi-illumination, fluorescence molecular tomography and optoacoustic imaging can be coupled with exogenous fluorescent imaging probes that accumulate in tumors passively via the enhanced permeability and retention effect or are targeted to tumor tissues based on affinity or enzyme activity. In these approaches, detection of fluorescence in the tumor bed may indicate residual disease. Protease activated probes have generated great interest because of their potential for leading to high tumor to normal contrast. Recently, the first Phase I clinical trial to assess the safety and activation of a protease activated probe was conducted. Spectroscopic methods like radiofrequency spectroscopy and Raman spectroscopy, which are based on energy absorption and scattering respectively, have also been tested in humans and are able to distinguish between normal and tumors tissues intraoperatively. Most recently, multi-modal contrast agents have been developed that target tumors and contain both fluorescent dyes and MRI contrast agents, allowing for preoperative planning and intraoperative margin assessment with a single contrast agent. Further clinical testing of these various intraoperative imaging approaches may lead to more accurate methods for margin assessment and the intraoperative detection of microscopic residual disease, which could guide further resection and the use of adjuvant radiation therapy.

show abstract

Real-time intraoperative detection of breast cancer using near-infrared fluorescence imaging and Methylene Blue

Cited by 117 publications

References 30 publications

Surgical treatment of nonpalpable primary invasive and in situ breast cancer

Surgical treatment of nonpalpable primary invasive and in situ breast cancer

Image-Guided Tumor Resection

Tailoring Adjuvant Radiation Therapy by Intraoperative Imaging to Detect Residual Cancer

Contact Info

Product

Resources

About