Application of Fluorescence-Guided Surgery to Subsurface Cancers Requiring Wide Local Excision: Literature Review and...

Area of Science:

• Surgical Oncology
• Medical Imaging
• Molecular Imaging

Background:

• Wide local excision of tumors is difficult without direct visualization, leading to high positive margin rates (20-35%) in sarcoma resection.
• Positive margins in sarcoma surgery correlate with increased recurrence and decreased patient survival.
• Fluorescence-guided surgery (FGS) has shown promise in enhancing surgical accuracy across various specialties.

Purpose of the Study:

• To address the challenges of achieving tumor-free margins in sarcoma resection.
• To explore the potential of fluorescence-guided surgery (FGS) for sarcoma resection.
• To introduce a novel indirect FGS technique for visualizing tumors through intervening normal tissue.

Main Methods:

• Review of current and past applications of FGS in surgical procedures.
• Introduction of a novel concept for indirect FGS using ABY-029 (anti-EGFR Affibody conjugated to IRDye 800CW).
• Proposal of a technique for imaging tumors through a margin of normal tissue.

Main Results:

• Current FGS methods are not directly applicable to sarcoma resection due to the need for surface visualization.
• A novel indirect FGS approach is proposed to overcome limitations of direct visualization.
• The proposed method aims to enable visualization of the tumor through surrounding normal tissue.

Conclusions:

• Indirect FGS offers a potential solution for improving tumor margin assessment in sarcoma surgery.
• This technique could aid in the complete excision of sarcoma lesions as a single mass.
• Achieving tumor-free margins via indirect FGS may lead to better patient outcomes and reduced recurrence rates.