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New scanning approaches can improve cancer surgery and treatment

OCTOBER 26, 2017
Clinical Congress Daily Highlights, Thursday Edition

Imaging tests are an important part of cancer diagnosis and treatment, helping us to detect and stage tumors, guide treatment, and assess impact of therapy. The better our imaging tools, the more effectively we can diagnose and treat cancer.

Four studies presented Thursday looked at how new approaches to imaging can help detect various kinds of cancer both before and during surgery: fluorescent imaging of pancreatic cancer, near-infrared imaging during pancreatectomy, multispectral photoacoustic imaging for sentinel lymph node detection, and near-infrared fluorescence imaging of glioblastoma.

A study led by Thinzar M. Lwin, MD, University of California San Diego, La Jolla, CA, demonstrated in mice how near-infrared tumor-specific fluorescence imaging of pancreatic cancer can improve tumor visualization for oncologic resections. The Da-Vinci Firefly imaging system produced a clear fluorescence signal from orthotopic pancreatic cancer mouse models injected with anti-CEA-IRDye800CW. The authors conclude that their study demonstrates the feasibility of adapting and optimizing existing fluorescence imaging platforms to detect tumor-specific fluorophores, and that this approach can help expedite FDA approval of fluorescent probes and imaging platforms in operating rooms.

Researchers led by Andrew D. Newton, MD, Hospital of the University of Pennsylvania, Philadelphia, found that intraoperative molecular imaging with second window indocyanine green (ICG) improves residual disease detection in a murine pancreatic adenocarcinoma model. Because ICG accumulates in pancreatic adenocarcinomas in humans, the authors conclude that this approach could reduce recurrence following resection due to residual disease unrecognized at the time of surgery. These results will be tested in a new Phase I clinical trial that is enrolling patients.

Multispectral photoacoustic imaging is an effective technique for detection of lymph node metastases in a melanoma mouse model, a team led by Madalyn Neuwirth, MD, Hospital of the University of Pennsylvania, PA, reports. The authors conclude that photoacoustic imaging could be a less invasive alternative to lymphoscintigraphy and/or a pigmented dye in detecting sentinel lymph node metastases in patients with melanoma, and that further studies are warranted to establish efficacy and the prognostic value of this technique.

“First-in-Human Intraoperative Near-Infrared Fluorescence Imaging of Glioblastoma Using Cetuximab-IRDye800: Results  From a Pilot Study” led by Sarah E. Miller, Stanford University School of Medicine, Stanford, CA, is the first-in-human pilot study to demonstrate the feasibility and safety of Cetuximab-IRDye800 imaging in glioblastoma. The authors conclude that this method of intraoperative tumor detection could improve the extent of resection, a key determinant of length of survival in patients with this brain cancer. A larger prospective study is under review.

Additional Information:
These Scientific Forum studies were presented at the 2017 Clinical Congress of the American College of Surgeons Clinical Congress in San Diego, CA. Program, webcast and audio information is available online at FACS.org/clincon2017.

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