Newton Andrew D, Kennedy Gregory T, Predina Jarrod D, Low Philip S, Singhal Sunil
Department of Surgery, University of Pennsylvania Perelman School of Medicine, Pennsylvania, PA, USA.
Department of Chemistry, Purdue University, West Lafayette, IN, USA.
J Thorac Dis. 2016 Oct;8(Suppl 9):S697-S704. doi: 10.21037/jtd.2016.09.50.
Intraoperative molecular imaging is a promising new technology with numerous applications in lung cancer surgery. Accurate identification of small nodules and assessment of tumor margins are two challenges in pulmonary resections for cancer, particularly with increasing use of video-assisted thoracoscopic surgery (VATS). One potential solution to these problems is intraoperative use of a fluorescent contrast agent to improve detection of cancer cells. This technology requires both a targeted fluorescent dye that will selectively accumulate in cancer cells and a specialized imaging system to detect the cells. In several studies, we have shown that intraoperative imaging with indocyanine green (ICG) can be used to accurately identify indeterminate pulmonary nodules. The use of a folate-tagged fluorescent molecule targeted to the folate receptor-α (FRα) further improves the sensitivity and specificity of detecting lung adenocarcinomas. We have demonstrated this technology can be used as an "optical biopsy" to differentiate adenocarcinoma versus other histological subtypes of pulmonary nodules. This strategy has potential applications in assessing bronchial stump margins, identifying synchronous or metachronous lesions, and rapidly assessing lymph nodes for lung adenocarcinoma.
术中分子成像技术是一项很有前景的新技术，在肺癌手术中有众多应用。准确识别小结节和评估肿瘤边界是癌症肺切除术中的两大挑战，尤其是随着电视辅助胸腔镜手术（VATS）的使用越来越多。解决这些问题的一个潜在方法是术中使用荧光造影剂来提高癌细胞的检测率。这项技术既需要一种能选择性聚集在癌细胞中的靶向荧光染料，也需要一个专门的成像系统来检测细胞。在多项研究中，我们已经表明，使用吲哚菁绿（ICG）进行术中成像可用于准确识别不确定的肺结节。使用靶向叶酸受体-α（FRα）的叶酸标记荧光分子可进一步提高检测肺腺癌的敏感性和特异性。我们已经证明，这项技术可用作“光学活检”，以区分肺腺癌与肺结节的其他组织学亚型。该策略在评估支气管残端边界、识别同步或异时性病变以及快速评估肺腺癌的淋巴结方面具有潜在应用价值。
