Single-institution experience of 500 pulmonary resections guided by intraoperative molecular imaging.
Publication/Presentation Date
6-1-2023
Abstract
OBJECTIVE: Intraoperative molecular imaging (IMI) using tumor-targeted optical contrast agents can improve thoracic cancer resections. There are no large-scale studies to guide surgeons in patient selection or imaging agent choice. Here, we report our institutional experience with IMI for lung and pleural tumor resection in 500 patients over a decade.
METHODS: Between December 2011 and November 2021, patients with lung or pleural nodules undergoing resection were preoperatively infused with 1 of 4 optical contrast tracers: EC17, TumorGlow, pafolacianine, or SGM-101. Then, during resection, IMI was used to identify pulmonary nodules, confirm margins, and identify synchronous lesions. We retrospectively reviewed patient demographic data, lesion diagnoses, and IMI tumor-to-background ratios (TBRs).
RESULTS: Five hundred patients underwent resection of 677 lesions. We found that there were 4 types of clinical utility of IMI: detection of positive margins (n = 32, 6.4% of patients), identification of residual disease after resection (n = 37, 7.4%), detection of synchronous cancers not predicted on preoperative imaging (n = 26, 5.2%), and minimally invasive localization of nonpalpable lesions (n = 101 lesions, 14.9%). Pafolacianine was most effective for adenocarcinoma-spectrum malignancies (mean TBR, 2.84), and TumorGlow was most effective for metastatic disease and mesothelioma (TBR, 3.1). False-negative fluorescence was primarily seen in mucinous adenocarcinomas (mean TBR, 1.8), heavy smokers (>30 pack years; TBR, 1.9), and tumors greater than 2.0 cm from the pleural surface (TBR, 1.3).
CONCLUSIONS: IMI may be effective in improving resection of lung and pleural tumors. The choice of IMI tracer should vary by the surgical indication and the primary clinical challenge.
Volume
165
Issue
6
First Page
1928
Last Page
1938
ISSN
1097-685X
Published In/Presented At
Kennedy, G. T., Azari, F. S., Chang, A., Nadeem, B., Bernstein, E., Segil, A., Din, A., Desphande, C., Okusanya, O., Keating, J., Predina, J., Newton, A., Kucharczuk, J. C., & Singhal, S. (2023). Single-institution experience of 500 pulmonary resections guided by intraoperative molecular imaging. The Journal of thoracic and cardiovascular surgery, 165(6), 1928–1938.e1. https://doi.org/10.1016/j.jtcvs.2022.12.023
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
36863974
Department(s)
Administration and Leadership
Document Type
Article