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Three-dimensional Alginate-bead Culture of Human Pituitary Adenoma Cells
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Folate Receptor Near-Infrared Optical Imaging Provides Sensitive and Specific Intraoperative Visualization of

Steve S Cho1,2, Ryan Zeh1, John T Pierce1

  • 1Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.

Operative Neurosurgery (Hagerstown, Md.)
|April 11, 2018
PubMed
Abstract

Insights

Near-infrared (NIR) imaging targeting folate receptor alpha (FRα) shows promise for detecting nonfunctional (NF) pituitary adenomas. This technique offers 100% sensitivity and specificity, potentially improving surgical resection rates.

Area of Science:

  • Neurosurgery
  • Medical Imaging
  • Oncology

Background:

  • Surgical resection is the primary treatment for nonfunctional (NF) pituitary adenomas, but achieving complete removal can be challenging.
  • NF adenomas characteristically overexpress folate receptor alpha (FRα).

Purpose of the Study:

  • To evaluate the efficacy of targeting FRα for highly sensitive and specific intraoperative detection of NF pituitary adenomas using near-infrared (NIR) imaging.

Main Methods:

  • Fourteen patients with NF pituitary adenoma received a preoperative infusion of the folate analog NIR dye OTL38.
  • Intraoperative NIR fluorescence signal-to-background ratio (SBR) was measured during tumor resection.
  • Immunohistochemistry assessed FRα expression, and postoperative MRI evaluated residual tumor.

Main Results:

  • Nine FRα-overexpressing adenomas showed significantly higher NIR SBR (3.2 ± 0.52) compared to non-overexpressing adenomas (1.5 ± 0.21).
  • NIR fluorescence demonstrated 100% sensitivity and specificity in detecting margin neoplasm, outperforming surgeon's visual assessment.
  • NIR fluorescence accurately predicted postoperative MRI findings in 78% of FRα-overexpressing patients.

Conclusions:

  • Preoperative administration of folate-tagged NIR dye enables robust visualization of NF pituitary adenomas.
  • NIR fluorescence imaging offers superior detection capabilities compared to standard white-light visualization.
  • This technology holds potential for improving gross-total resection rates in NF pituitary adenomas.

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