Baron Ekaterina, Patterson Ryan, Tillman Rachel, Wernberg Jessica A, Sharma Rohit
Surgical Oncology, Marshfield Medical Center, Marshfield, WI 54449, USA.
Mol Clin Oncol. 2025 Apr 16;22(6):55. doi: 10.3892/mco.2025.2850. eCollection 2025 Jun.
Occult disease in normal-appearing peritoneum is common in epithelial ovarian cancer (EOC), especially after neoadjuvant chemotherapy (NACT). Pafolacianine (Cytalux) is the first Food and Drug Administration-approved agent for targeted imaging of EOC occult disease. The current study presents its first out-of-trial use during cytoreductive surgery (CRS). This study analyzed three cases of Cytalux application in patients with EOC and peritoneal metastases who underwent CRS and hyperthermic intraperitoneal chemoperfusion. Targeted imaging with Cytalux was performed before CRS to confirm uptake by visible lesions and after to identify occult disease. The association between Cytalux-positive disease and pathology was evaluated. Patient A had primary EOC and patients B and C had recurrent disease. All patients received NACT. Patient A had a peritoneal cancer index (PCI) of 21 and a completeness of cytoreduction (CC) score of 1, while patients B and C both had PCI 9 and CC score of 0. Cytalux imaging was associated with all macroscopic lesions. In patient A, Cytalux identified 16 additional peritoneal lesions with 14 confirmed as metastases [true positive (TP) rate, 87.5%]. Two Cytalux-positive peritoneal areas were fulgurated until the signal loss but subsequently tested positive for cancer. In patients B and C, Cytalux detected two lesions in each case with 50.0% positive on pathology. Overall peritoneal-level TP and false positive (FP) rates were 80.0 and 20.0%, respectively. Cytalux can help identify occult EOC peritoneal disease and manage questionable areas of post-chemotherapy fibrosis. However, the FP rate is considerable. Cytalux signal navigation should not be used for energy destruction of lesions until more data are available.
隐匿性疾病在外观正常的腹膜中常见于上皮性卵巢癌（EOC），尤其是在新辅助化疗（NACT）之后。帕氟拉西尼（Cytalux）是首个获得美国食品药品监督管理局批准用于EOC隐匿性疾病靶向成像的药物。本研究展示了其在细胞减灭术（CRS）期间的首次非试验性应用。本研究分析了3例在接受CRS和腹腔内热灌注化疗的EOC及腹膜转移患者中应用Cytalux的情况。在CRS前进行Cytalux靶向成像以确认可见病灶的摄取情况，术后进行成像以识别隐匿性疾病。评估了Cytalux阳性疾病与病理学之间的关联。患者A为原发性EOC，患者B和C为复发性疾病。所有患者均接受了NACT。患者A的腹膜癌指数（PCI）为21，细胞减灭完全性（CC）评分为1，而患者B和C的PCI均为9，CC评分为0。Cytalux成像与所有宏观病灶相关。在患者A中，Cytalux识别出另外16个腹膜病灶，其中14个被确认为转移灶[真阳性（TP）率，87.5%]。两个Cytalux阳性的腹膜区域进行了电灼直至信号消失，但随后癌症检测呈阳性。在患者B和C中，Cytalux在每种情况下均检测到两个病灶，病理学检查阳性率为50.0%。总体腹膜层面的TP率和假阳性（FP）率分别为80.0%和20.0%。Cytalux有助于识别隐匿性EOC腹膜疾病并处理化疗后纤维化的可疑区域。然而，FP率相当高。在获得更多数据之前，不应将Cytalux信号导航用于病灶的能量破坏。
