Fluorescence-guided surgery with live molecular navigation--a new cutting edge

Abstract

A glowing new era in cancer surgery may be dawning. Using fluorescently labelled markers, surgical molecular navigation means that tumours and nerves can be displayed in real time intra-operatively in contrasting pseudocolours, which allows more complete tumour resection while preserving important structures. These advances can potentially cause a paradigm shift in cancer surgery, improving patient outcome and decreasing overall health-care costs.

Figure 1. Live molecular detection of surgical margins

a,b | Colour image captured using white light reflectance (a) with the corresponding tumour-specific fluorescence image (b) of a representative area in the abdominal cavity. c | Quantitation of the number of tumour spots using both methods. Scoring was based on three different colour images (median 7 tumour spots, range 4–22) and their corresponding fluorescence images (FLI) (median 34 tumour spots, range 8–81); P < 0.001 by five independent surgeons. Figure is reproduced, with permission, from REF. © (2011) Macmillan Publishers Ltd. All rights reserved.

Figure 2. Live molecular detection of nerves

a | A white-light reflectance image showing a sciatic nerve branching within muscle planes. The main trunk of the nerve (thin white arrow) is clearly visible but the smaller branches (thick white arrows) are much more difficult to discriminate from surrounding tissue. b | A fluorescence image following systemic injection of a nerve-highlighting agent showing clear visualization of both the main nerve trunk and small branches. c | An overlay of both fluorescence (pseudocoloured in blue) and white-light reflectance images.