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Updated: Mar 9, 2026
Multispectral Real-time Fluorescence Imaging for Intraoperative Detection of the Sentinel Lymph Node in Gynecologic Oncology
Published on: October 20, 2010
Oncologic Procedures Amenable to Fluorescence-guided Surgery
Kiranya E Tipirneni1, Jason M Warram, Lindsay S Moore
1*Department of Surgery, University of Alabama at Birmingham, Birmingham, AL †Department of Otolaryngology, University of Alabama at Birmingham, Birmingham, AL ‡School of Medicine, University of Alabama at Birmingham, Birmingham, AL §School of Medicine, University Medical Center Groningen, Groningen, The Netherlands ¶Department of Surgery, Stanford University, Stanford, CA ||Department of Urology, Stanford University, Stanford, CA **Division of Surgical Oncology, Department of Surgery, University of California San Diego, La Jolla, CA ††Division of Orthopedic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL ‡‡Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands §§Department of Radiology, University of Alabama at Birmingham, Birmingham, AL ¶¶Department of Otolaryngology, Stanford University, Stanford, CA.
Objective:
Although fluorescence imaging is being applied to a wide range of cancers, it remains unclear which disease populations will benefit greatest. Therefore, we review the potential of this technology to improve outcomes in surgical oncology with attention to the various surgical procedures while exploring trial endpoints that may be optimal for each tumor type.
Background:
For many tumors, primary treatment is surgical resection with negative margins, which corresponds to improved survival and a reduction in subsequent adjuvant therapies. Despite unfavorable effect on patient outcomes, margin positivity rate has not changed significantly over the years. Thus, patients often experience high rates of re-excision, radical resections, and overtreatment. However, fluorescence-guided surgery (FGS) has brought forth new light by allowing detection of subclinical disease not readily visible with the naked eye.
Methods:
We performed a systematic review of clinicatrials.gov using search terms "fluorescence," "image-guided surgery," and "near-infrared imaging" to identify trials utilizing FGS for those received on or before May 2016.
Inclusion Criteria:
fluorescence surgery for tumor debulking, wide local excision, whole-organ resection, and peritoneal metastases.
Exclusion Criteria:
fluorescence in situ hybridization, fluorescence imaging for lymph node mapping, nonmalignant lesions, nonsurgical purposes, or image guidance without fluorescence.
Results:
Initial search produced 844 entries, which was narrowed down to 68 trials. Review of literature and clinical trials identified 3 primary resection methods for utilizing FGS: (1) debulking, (2) wide local excision, and (3) whole organ excision.
Conclusions:
The use of FGS as a surgical guide enhancement has the potential to improve survival and quality of life outcomes for patients. And, as the number of clinical trials rise each year, it is apparent that FGS has great potential for a broad range of clinical applications.
Insights
Fluorescence-guided surgery (FGS) enhances cancer resection by detecting hidden disease, potentially improving patient survival and quality of life. This review explores FGS applications in surgical oncology and optimal trial endpoints for various tumor types.
Area of Science:
- Surgical Oncology
- Medical Imaging
- Cancer Research
Background:
- Surgical resection is key for cancer treatment, aiming for negative margins to improve survival.
- Historically, margin positivity rates remain high, leading to re-excision and overtreatment.
- Fluorescence-guided surgery (FGS) offers a solution by enabling visualization of subclinical disease.
Purpose of the Study:
- To review the potential of fluorescence imaging in surgical oncology.
- To identify patient populations that may benefit most from FGS.
- To explore optimal trial endpoints for FGS in different tumor types.
Main Methods:
- Systematic review of clinical trials.gov.
- Search terms included "fluorescence," "image-guided surgery," and "near-infrared imaging."
- Included trials utilizing FGS for primary tumor resection up to May 2016.
Main Results:
- The search identified 68 relevant clinical trials.
- FGS was primarily applied in three resection methods: debulking, wide local excision, and whole-organ excision.
- The review focused on FGS for tumor debulking, wide local excision, and whole-organ resection.
Conclusions:
- FGS has the potential to improve patient survival and quality of life.
- The increasing number of clinical trials indicates broad applicability of FGS.
- Further research is needed to define optimal FGS use and endpoints for specific cancers.
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