Image-guided Surgery

Molecular Imaging has the promise to improve surgical procedures by increasing the visual information available to the surgeon. Near-infrared (NIR) fluorescent probes are being developed for several procedures, including:

  • Angiography
  • Location and mapping of lymphatics
  • Identification of positive lymph nodes
  • Precise resection of a tumor margin
  • Identification of normal vital structures (i.e. ducts, nerves, lymphatics)

Neurosurgery (fluorescence-based angiography)

Several commercial systems are used in conjunction with ICG fluorescent agent to view cerebrovascular blood flow. The systems allow surgeons to determine the patency of vessels during surgery through surgical microscope eyepieces or on a video monitor.

Cancer Surgery

Surgery is considered the cornerstone of modern cancer treatment for solid tumors. Many people who are diagnosed with cancer will undergo some type of surgery during treatment. If the cancer has not spread to other parts of the body, surgery offers the greatest chance for cure with 60-90% effectiveness.

The goal of surgery as treatment for cancer is to remove all of the tumorous tissue. Tumor-free margins (margin of tissue surrounding the tumors) are critical for a good prognosis for the patient. The challenge for the surgeon using only visual appearance and palpation is differentiating tumorous tissue from healthy tissues. Molecular imaging has the potential to reduce the frequency of positive margins and, therefore, the number of second surgeries, by marking or highlighting cancerous tissue for the surgeon. For example, 20-85% of breast cancer patients have positive resection margins from surgery.

Molecular imaging also has the potential to reduce the need for radical resection that would result in eliminating unnecessary damage to healthy tissue. Unaffected lymph nodes are removed in approximately 45% of breast cancer cases. The identification of positive nodes during surgery could reduce this overtreatment.

Near-infrared optical imaging and targeting probes are well suited for imaging during surgery where intra-operative tumor visualization could improve resection with less damage to healthy tissue.

An example is the work of Dr. Go van Dam, a surgeon specializing in oncology at the Groningen University Medical Center in the Netherlands. A key focus of van Dam's research is to explore new tools, such as targeted fluorescent imaging probes that will help address the challenges facing oncology surgeons. In an interview with LI-COR, he discusses his research using near-infrared fluorescent imaging during surgery to develop improvements for cancer patient outcomes.

MAMMOTH Project: Center for Translational Molecular Medicine, the Netherlands (Mammary Carcinoma Molecular Imaging for Diagnosis and Therapeutics)

The MAMMOTH Project aims to meet the twin requirements of early detection of breast cancer and new patient-tailored therapies to treat it. This process works to develop innovative imaging techniques capable of detecting alterations in cell biology that indicate presence of disease, including: hypoxic tissue, angiogenesis and changes in the expression of hormone and growth factor receptors.

Optical molecular imaging will be evaluated both in the laboratory and in patients as a new method for screening optimization of patient-tailored therapy, along with PET/SPECT molecular imaging. Several types of ligand (i.e. antibodies and nanobodies) will be developed for relevant therapeutic targets (i.e. angiogenesis targets, HER2, EGFR and ER). This project will use IRDye® 800CW to label several optical agents for investigational use.

[ Learn more about the MAMMOTH Project ]

MUSIS Project: Center for Translational Molecular Medicine, the Netherlands

The MUSIS Project aims to develop new technologies that will enable rapid implementation of intra-operative NIRF imaging of tumor tissue in surgical oncology by developing the following methods:

  • Tumor-specific NIRF probes based on existing tumor-directed antibodies or drugs that recognize up-regulated tumor receptors or membrane markers, to which a non-toxic NIRF dye can be coupled
  • Sensitive NIRF camera systems that are capable of detecting these NIRF probes during surgical operations

[ Learn more about the MUSIS Project ]

NCI Cancer Imaging Program

The mission of the National Cancer Institute's Cancer Imaging Program is to promote and support the following:

  • Cancer-related basic, translational and clinical research in imaging sciences and technology
  • Integration and applications of these imaging discoveries and developments to the understanding of cancer biology and to the clinical management of cancer and cancer risk

[ Learn more about the NCI Cancer Research Program ]

Network for Translational Research (NTR): Optical Imaging in Multimodality

Optical Imaging in Multimodality is one of several studies being conducted within the Cancer Imaging Program. The hallmark of this network is its emphasis on early-stage imaging technology. By combining optical methods with more traditional imaging techniques, it is anticipated that the optical methods can be brought quickly to clinical trials where they can compete with other imaging methods.

[ Learn more about the Network for Translational Research ]