Translation of Intraoperative Molecular Imaging for Clinical Use

Intraoperative molecular imaging (IMI) is an evolving tool that enables targeted real-time visualization and delineation of tissue during surgery. IMI tracers can be fluorescent, radioactive, or dual-labeled. Their integration into the intraoperative setting is supported by several clinical trials, which led to Food and Drug Administration approval for a variety of these agents. Fluorescent tracers enable excellent spatial visualization, whereas radiotracers enable deep tissue detection, and dual-labeled tracers provide both. Novel activatable tracers that leverage properties of the tumor microenvironment are also being developed. Advances in imaging devices now permit IMI usage across diverse platforms, including minimally invasive surgery. Despite the limitations of autofluorescence, false-positive signals, and heterogeneity, the use of IMI continues to broaden in oncologic and nononcologic applications, driven by demonstrated improvements in surgical outcomes. In this review, we highlight the translation of IMI through clinical trials and future directions in IMI-guided surgery.