Next-Generation Imaging Techniques for Surgical Guidance in Pediatric Tumors

Complete surgical resection remains the mainstay of cure for many childhood solid tumors. However, certain cancers exhibit intensely invasive growth patterns, often encasing vital structures such as blood vessels and invading adjacent organs. Furthermore, the degree of metastatic or regional spread may not be clear to the surgical oncologist at the time of resection. Intraoperative real-time imaging has the potential to improve successful localization and resection, with conservation of adjacent and involved but salvageable structures and organs. Exploiting surface markers of tumor cells before and during operative imaging of these tumors can enhance surgical acumen and facilitate safer and more complete resection. This report describes several novel techniques including advanced three-dimensional (3D) models based on diffusion-weighted magnetic resonance and metaiodobenzylguanidine (MIBG) imaging as well as intraoperative molecular imaging guidance targeting GD2 and the folate receptor. These techniques offer exciting promise for enhanced surgical resection of challenging and metastatic tumors.