Intraoperative molecular imaging: 3rd biennial clinical trials update

Abstract

Significance: This third biennial intraoperative molecular imaging (IMI) conference shows how optical contrast agents have been applied to develop clinically significant endpoints that improve precision cancer surgery.

Aim: National and international experts on IMI presented ongoing clinical trials in cancer surgery and preclinical work. Previously known dyes (with broader applications), new dyes, novel nonfluorescence-based imaging techniques, pediatric dyes, and normal tissue dyes were discussed.

Approach: Principal investigators presenting at the Perelman School of Medicine Abramson Cancer Center's third clinical trials update on IMI were selected to discuss their clinical trials and endpoints.

Results: Dyes that are FDA-approved or currently under clinical investigation in phase 1, 2, and 3 trials were discussed. Sections on how to move benchwork research to the bedside were also included. There was also a dedicated section for pediatric dyes and nonfluorescence-based dyes that have been newly developed.

Conclusions: IMI is a valuable adjunct in precision cancer surgery and has broad applications in multiple subspecialties. It has been reliably used to alter the surgical course of patients and in clinical decision making. There remain gaps in the utilization of IMI in certain subspecialties and potential for developing newer and improved dyes and imaging techniques.

Keywords: clinically significant events; contrast agents; intraoperative molecular imaging; precision surgery.

Fig. 1

Utilizing IMI for tumor visualization. (a) CT scan shows location of lesion of interest. (b) Lesion assessed initially with standard white light on thoracoscope in vivo, then under NIR light to localize lesion. An overlay image is also created by the imaging system. The specimen is then evaluated on the back table and bisected to confirm fluorescence in the suspected area. (c) H&E stain showing tumor and normal with fluorescence microscopy showing the corresponding area of fluorescence. All animal and human research has had the approval of Institutional Review Boards and corresponding committees in each institution.