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Back-Table Fluorescence-Guided Imaging for Circumferential Resection Margin Evaluation Using Bevacizumab-800CW in
Steven J de Jongh1, Jolien J J Tjalma1, Marjory Koller2
1Department of Gastroenterology and Hepatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Summary
Optical molecular imaging using bevacizumab-800CW shows promise for evaluating resection margins in locally advanced rectal cancer (LARC) after neoadjuvant therapy. This technique could improve tumor-negative margin rates and guide surgical decisions.
Area of Science:
- Oncology
- Surgical Oncology
- Medical Imaging
Background:
- Achieving negative circumferential resection margins (CRM) is critical for curative treatment of locally advanced rectal cancer (LARC).
- Tumor-positive resection margins occur in up to 18.6% of LARC patients despite neoadjuvant therapy.
- Accurate intraoperative margin assessment is needed to improve outcomes.
Purpose of the Study:
- To investigate the feasibility of optical molecular imaging for evaluating CRM status immediately after surgical resection in LARC patients.
- To assess the potential of fluorescence-guided imaging (FGI) using bevacizumab-800CW to improve tumor-negative CRM rates.
Main Methods:
- LARC patients received bevacizumab-800CW, a fluorescent tracer, intravenously 2-3 days before surgery.
- Back-table FGI of fresh surgical specimens (n=8) was performed to evaluate CRM.
- Fluorescence intensity of formalin-fixed tissue slices (n=42) was analyzed to determine sensitivity and specificity for tumor detection.
Main Results:
- Back-table FGI correctly identified a tumor-positive CRM in 1 of 2 patients (50%) and 5 of 6 tumor-negative CRM (83%).
- Receiver operating characteristic analysis of formalin-fixed tissue yielded a sensitivity of 96.19% and specificity of 80.39% for tumor detection.
- Bevacizumab-800CW demonstrated clear tumor vs. normal tissue differentiation with a tumor-to-background ratio of 4.7 ± 2.5.
Conclusions:
- Back-table FGI using bevacizumab-800CW shows potential for evaluating CRM status in LARC patients.
- Optimization of FGI could enhance perioperative decision-making, potentially leading to extended resections or intraoperative radiation therapy for positive margins.
