Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Real-time imaging of lung lesions during surgery helps localize tumors and improve precision

30.07.2015

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.


Intraoperative imaging detects a lung adenocarcinoma during a pulmonary resection.

Credit: The Journal of Thoracic and Cardiovascular Surgery

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.

Media Contact

Nicole Baritot
press@aats.org
978-299-4520

http://www.aats.org

Nicole Baritot | EurekAlert!

More articles from Health and Medicine:

nachricht Diabetes mellitus: A risk factor for early colorectal cancer
27.05.2020 | Nationales Centrum für Tumorerkrankungen (NCT) Heidelberg

nachricht Ultra-thin fibres designed to protect nerves after brain surgery
27.05.2020 | Martin-Luther-Universität Halle-Wittenberg

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Small Protein, Big Impact

In meningococci, the RNA-binding protein ProQ plays a major role. Together with RNA molecules, it regulates processes that are important for pathogenic properties of the bacteria.

Meningococci are bacteria that can cause life-threatening meningitis and sepsis. These pathogens use a small protein with a large impact: The RNA-binding...

Im Focus: K-State study reveals asymmetry in spin directions of galaxies

Research also suggests the early universe could have been spinning

An analysis of more than 200,000 spiral galaxies has revealed unexpected links between spin directions of galaxies, and the structure formed by these links...

Im Focus: New measurement exacerbates old problem

Two prominent X-ray emission lines of highly charged iron have puzzled astrophysicists for decades: their measured and calculated brightness ratios always disagree. This hinders good determinations of plasma temperatures and densities. New, careful high-precision measurements, together with top-level calculations now exclude all hitherto proposed explanations for this discrepancy, and thus deepen the problem.

Hot astrophysical plasmas fill the intergalactic space, and brightly shine in stellar coronae, active galactic nuclei, and supernova remnants. They contain...

Im Focus: Biotechnology: Triggered by light, a novel way to switch on an enzyme

In living cells, enzymes drive biochemical metabolic processes enabling reactions to take place efficiently. It is this very ability which allows them to be used as catalysts in biotechnology, for example to create chemical products such as pharmaceutics. Researchers now identified an enzyme that, when illuminated with blue light, becomes catalytically active and initiates a reaction that was previously unknown in enzymatics. The study was published in "Nature Communications".

Enzymes: they are the central drivers for biochemical metabolic processes in every living cell, enabling reactions to take place efficiently. It is this very...

Im Focus: New double-contrast technique picks up small tumors on MRI

Early detection of tumors is extremely important in treating cancer. A new technique developed by researchers at the University of California, Davis offers a significant advance in using magnetic resonance imaging to pick out even very small tumors from normal tissue. The work is published May 25 in the journal Nature Nanotechnology.

researchers at the University of California, Davis offers a significant advance in using magnetic resonance imaging to pick out even very small tumors from...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

VideoLinks
Industry & Economy
Event News

Dresden Nexus Conference 2020: Same Time, Virtual Format, Registration Opened

19.05.2020 | Event News

Aachen Machine Tool Colloquium AWK'21 will take place on June 10 and 11, 2021

07.04.2020 | Event News

International Coral Reef Symposium in Bremen Postponed by a Year

06.04.2020 | Event News

 
Latest News

Why developing nerve cells can take a wrong turn

04.06.2020 | Life Sciences

The broken mirror: Can parity violation in molecules finally be measured?

04.06.2020 | Physics and Astronomy

Innocent and highly oxidizing

04.06.2020 | Life Sciences

VideoLinks
Science & Research
Overview of more VideoLinks >>>