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Single-institution experience of 500 pulmonary resections guided by intraoperative molecular imaging.
Kennedy, Gregory T; Azari, Feredun S; Chang, Ashley; Nadeem, Bilal; Bernstein, Elizabeth; Segil, Alix; Din, Azra; Desphande, Charuhas; Okusanya, Olugbenga; Keating, Jane; Predina, Jarrod; Newton, Andrew; Kucharczuk, John C; Singhal, Sunil.
Afiliação
  • Kennedy GT; Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pa.
  • Azari FS; Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pa.
  • Chang A; Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pa.
  • Nadeem B; Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pa.
  • Bernstein E; Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pa.
  • Segil A; Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pa.
  • Din A; Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pa.
  • Desphande C; Department of Pathology, University of Pennsylvania School of Medicine, Philadelphia, Pa.
  • Okusanya O; Department of Surgery, Jefferson University Hospital, Philadelphia, Pa.
  • Keating J; Department of Surgery, Hartford Hospital, Hartford, Conn.
  • Predina J; Department of Surgery, Massachusetts General Hospital, Boston, Mass.
  • Newton A; Department of Surgery, MD Anderson Cancer Center, Houston, Tex.
  • Kucharczuk JC; Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pa.
  • Singhal S; Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pa. Electronic address: sunil.singhal@pennmedicine.upenn.edu.
J Thorac Cardiovasc Surg ; 165(6): 1928-1938.e1, 2023 06.
Article em En | MEDLINE | ID: mdl-36863974
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.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Neoplasias Pleurais / Neoplasias Pulmonares Tipo de estudo: Observational_studies / Risk_factors_studies Limite: Humans Idioma: En Revista: J Thorac Cardiovasc Surg Ano de publicação: 2023 Tipo de documento: Article País de publicação: Estados Unidos
Texto completo
Adicionar na Minha BVS
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Neoplasias Pleurais / Neoplasias Pulmonares Tipo de estudo: Observational_studies / Risk_factors_studies Limite: Humans Idioma: En Revista: J Thorac Cardiovasc Surg Ano de publicação: 2023 Tipo de documento: Article País de publicação: Estados Unidos