Targeted molecular agents cause lung adenocarcinomas to fluoresce during surgery, according to pilot report in The Journal of Thoracic and Cardiovascular Surgery
Summary: New molecular tools are emerging to identify lung adenocarcinomas during pulmonary resection. The results of a proof-of-concept study suggest that lung cancer fluorescent imaging during surgery using targeted molecular agents may soon be a reality. While the methodology still needs refinement, the technique holds the possibility of precise visualization of tumor margins, detection of other tumors or metastases, localization of small malignant ground glass opacities, and accurate identification of lymph nodes containing metastatic cancer cells.
Beverly, MA, July 29, 2015 - More than 80,000 people undergo resection of a pulmonary tumor each year, and currently the only method to determine if the tumor is malignant is histologic analysis. A new study reports that a targeted molecular contrast agent can be used successfully to cause lung adenocarcinomas to fluoresce during pulmonary surgery. This enables real-time optical imaging during surgery and the identification of cancer cells. The results are reported in The Journal of Thoracic and Cardiovascular Surgery, the official publication of the American Association for Thoracic Surgery (AATS).
"This approach may allow surgeons to perform resections with confidence that the entire tumor burden has been eliminated. In the future, with improved devices and molecular contrast agents, this approach may reduce the local recurrence rate and improve intraoperative identification of metastatic cancer cells," explained lead investigator Sunil Singhal, MD, of the Department of Surgery, University of Pennsylvania Perelman School of Medicine (Philadelphia).
In this proof-of-concept study, 50 patients (ages 25-85 years) with diagnosed adenocarcinoma received 0.1 mg/kg of a fluorescent folate receptor alpha (FRα)-targeted molecular contrast agent (On Target Laboratories) four hours before surgery. This agent binds to folate receptor α, a protein found on the surface of most lung adenocarcinoma cells. This resulted in fluorescence of 92% of pulmonary adenocarcinomas, allowing surgeons to visually identify tumor cells during surgery.
Upon opening the chest cavity, the primary lesion was located using traditional methods of visual inspection and manual palpation. The cancer was imaged and photo-documented with a specialized imaging system [Artemis Fluorescence Imaging System (Quest Medical Imaging) and the FloCam system (developed in their laboratory)].
In seven of the 50 cases (14%), the tumor could easily be identified by its fluorescence. The tumors ranged in size from 1.1 to 8.0 cm, but size did not influence fluorescence. All of these tumors were within 1.2 cm of the lung surface.
Of the remaining 43 tumors, 39 appeared fluorescent after the overlying tissue was opened and the tumor exposed. The fluorescence was uniform across the tumor's surface, and the demarcation between tumor and normal surrounding tissue was clearly visible. On average, the optical imaging was quick, ranging from five to 15 minutes.
The technique proved to be particularly helpful in two cases. In a 50-year old man thought to have a 2.1 cm primary lung adenocarcinoma in the right upper pulmonary lobe, molecular imaging of the excised lobe identified a second pulmonary nodule that was fluorescent, leading to re-staging of the patient. In another patient, who was thought to have no evidence of metastatic disease, molecular imaging showed evidence of cancer elsewhere.
Four tumors (8%) did not exhibit fluorescence, and further analysis showed that these tumors did not express FRα antigens to allow localization of the contrast agent to the tumor. Thus, the FRα imaging agent is not useful for all lung adenocarcinomas.
"This technology is safe," stated Dr. Singhal. "The use of a visible-wavelength fluorophore avoids ionizing radiation and confers no risk to the patient, surgeon, or operating room personnel. In our experience, only one patient had a mild allergic reaction to the contrast agent that was easily managed with diphenhydramine. With miniaturization of imaging devices, this method will be particularly useful in minimally invasive surgery, such as VATS and robotic surgery."
"What Okusanya and colleagues have discovered is that they can make 92% of all adenocarcinomas glow to the naked eye, requiring no special training at all," noted Michael I. Ebright, MD, of the Section of Thoracic Surgery, New York-Presbyterian/Columbia University Medical Center (New York) in an accompanying editorial. "The Achilles' heel of the technique is tumor depth beneath the pleural surface," as fluorescence was not detectable to the operating surgeon in tumors buried within the lung. However, he added that "this study should be viewed as a launching pad rather than be judged solely on practicality in its current form." Dr. Ebright looks forward to modification of the system so that it can be used in minimally invasive surgery.
Lung cancer is the leading cause of cancer deaths, with approximately 221,200 deaths due to lung cancer anticipated in 2015. About 85% of lung cancers are non-small cell lung cancers (NSCLC), and adenocarcinoma of the lung is one of the most common forms of NSCLC, in both smokers and nonsmokers.
Nicole Baritot | EurekAlert!
Further reports about: > Thoracic > adenocarcinoma > cancer cells > contrast agent > fluorescence > fluorescent > lung > lung adenocarcinomas > lung lesions > metastatic > metastatic cancer > metastatic cancer cells > minimally invasive surgery > pulmonary > tumors
GLUT5 fluorescent probe fingerprints cancer cells
20.04.2018 | Michigan Technological University
Scientists re-create brain neurons to study obesity and personalize treatment
20.04.2018 | Cedars-Sinai Medical Center
At the Hannover Messe 2018, the Bundesanstalt für Materialforschung und-prüfung (BAM) will show how, in the future, astronauts could produce their own tools or spare parts in zero gravity using 3D printing. This will reduce, weight and transport costs for space missions. Visitors can experience the innovative additive manufacturing process live at the fair.
Powder-based additive manufacturing in zero gravity is the name of the project in which a component is produced by applying metallic powder layers and then...
Physicists at the Laboratory for Attosecond Physics, which is jointly run by Ludwig-Maximilians-Universität and the Max Planck Institute of Quantum Optics, have developed a high-power laser system that generates ultrashort pulses of light covering a large share of the mid-infrared spectrum. The researchers envisage a wide range of applications for the technology – in the early diagnosis of cancer, for instance.
Molecules are the building blocks of life. Like all other organisms, we are made of them. They control our biorhythm, and they can also reflect our state of...
University of Connecticut researchers have created a biodegradable composite made of silk fibers that can be used to repair broken load-bearing bones without the complications sometimes presented by other materials.
Repairing major load-bearing bones such as those in the leg can be a long and uncomfortable process.
Study published in the journal ACS Applied Materials & Interfaces is the outcome of an international effort that included teams from Dresden and Berlin in Germany, and the US.
Scientists at the Helmholtz-Zentrum Dresden-Rossendorf (HZDR) together with colleagues from the Helmholtz-Zentrum Berlin (HZB) and the University of Virginia...
Novel highly efficient and brilliant gamma-ray source: Based on model calculations, physicists of the Max PIanck Institute for Nuclear Physics in Heidelberg propose a novel method for an efficient high-brilliance gamma-ray source. A giant collimated gamma-ray pulse is generated from the interaction of a dense ultra-relativistic electron beam with a thin solid conductor. Energetic gamma-rays are copiously produced as the electron beam splits into filaments while propagating across the conductor. The resulting gamma-ray energy and flux enable novel experiments in nuclear and fundamental physics.
The typical wavelength of light interacting with an object of the microcosm scales with the size of this object. For atoms, this ranges from visible light to...
Anzeige
Anzeige
Invitation to the upcoming "Current Topics in Bioinformatics: Big Data in Genomics and Medicine"
13.04.2018 | Event News
Unique scope of UV LED technologies and applications presented in Berlin: ICULTA-2018
12.04.2018 | Event News
IWOLIA: A conference bringing together German Industrie 4.0 and French Industrie du Futur
09.04.2018 | Event News
Complete skin regeneration system of fish unraveled
24.04.2018 | Life Sciences
Scientists create innovative new 'green' concrete using graphene
24.04.2018 | Materials Sciences
BAM@Hannover Messe: innovative 3D printing method for space flight
24.04.2018 | Trade Fair News