July 29, 2015 | AMERICAN ASSOCIATION FOR THORACIC SURGERY -- New molecular tools are emerging to identify lung adenocarcinomas during pulmonary resection. The results of a proof-of-concept study suggest that lung cancer fluorescent imaging during surgery using targeted molecular agents may soon be a reality. While the methodology still needs refinement, the technique holds the possibility of precise visualization of tumor margins, detection of other tumors or metastases, localization of small malignant ground glass opacities, and accurate identification of lymph nodes containing metastatic cancer cells.

Beverly, MA, July 29, 2015 - More than 80,000 people undergo resection of a pulmonary tumor each year, and currently the only method to determine if the tumor is malignant is histologic analysis. A new study reports that a targeted molecular contrast agent can be used successfully to cause lung adenocarcinomas to fluoresce during pulmonary surgery. This enables real-time optical imaging during surgery and the identification of cancer cells. The results are reported in The Journal of Thoracic and Cardiovascular Surgery, the official publication of the American Association for Thoracic Surgery (AATS).

"This approach may allow surgeons to perform resections with confidence that the entire tumor burden has been eliminated. In the future, with improved devices and molecular contrast agents, this approach may reduce the local recurrence rate and improve intraoperative identification of metastatic cancer cells," explained lead investigator Sunil Singhal, MD, of the Department of Surgery, University of Pennsylvania Perelman School of Medicine (Philadelphia).
In this proof-of-concept study, 50 patients (ages 25-85 years) with diagnosed adenocarcinoma received 0.1 mg/kg of a fluorescent folate receptor alpha (FRα)-targeted molecular contrast agent (On Target Laboratories) four hours before surgery. This agent binds to folate receptor α, a protein found on the surface of most lung adenocarcinoma cells. This resulted in fluorescence of 92% of pulmonary adenocarcinomas, allowing surgeons to visually identify tumor cells during surgery.

Upon opening the chest cavity, the primary lesion was located using traditional methods of visual inspection and manual palpation. The cancer was imaged and photo-documented with a specialized imaging system [Artemis Fluorescence Imaging System (Quest Medical Imaging) and the FloCam system (developed in their laboratory)].

More HCB News