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The Status of Contemporary Image-Guided Modalities in Oncologic Surgery

Rosenthal, Eben L. MD*,†; Warram, Jason M. PhD*; Bland, Kirby I. MD*; Zinn, Kurt R. DVM, PhD*,†

doi: 10.1097/SLA.0000000000000622
Reviews

Objective: To review the current trends in optical imaging to guide oncologic surgery.

Background: Surgical resection remains the cornerstone of therapy for patients with early stage solid malignancies and more than half of all patients with cancer undergo surgery each year. The technical ability of the surgeon to obtain clear surgical margins at the initial resection remains crucial to improve overall survival and long-term morbidity. Current resection techniques are largely based on subjective and subtle changes associated with tissue distortion by invasive cancer. As a result, positive surgical margins occur in a significant portion of tumor resections, which is directly correlated with a poor outcome.

Methods: A comprehensive review of studies evaluating optical imaging techniques is performed.

Results: A variety of cancer imaging techniques have been adapted or developed for intraoperative surgical guidance that have been shown to improve functional and oncologic outcomes in randomized clinical trials. There are also a large number of novel, cancer-specific contrast agents that are in early stage clinical trials and preclinical development that demonstrate significant promise to improve real-time detection of subclinical cancer in the operative setting.

Conclusions: There has been an explosion of intraoperative imaging techniques that will become more widespread in the next decade.

Surgical resection remains the cornerstone of therapy for solid malignancies, but the ability of the surgeon to obtain clear surgical margins is limited by the subjective tissue changes associated with invasive cancer. Improvements in optical imaging technology and chemistry have resulted in a variety of cancer imaging techniques that have been adapted or developed for intraoperative surgical guidance.

*Departments of Surgery and

Radiology, The University of Alabama at Birmingham, Birmingham, AL.

Reprints: Eben L. Rosenthal, MD, Department of Surgery, Division of Otolaryngology, BDB Ste 563, 1720 2nd Ave South, Birmingham, AL 35294. E-mail: oto@uab.edu.

Disclosure: Funding for this work has been provided by NIH/NCI (R21CA179171 and R21DE019232-02). Equipment loan has been provided by LI-COR biosciences (Lincoln, NE) and a grant from Novadaq (Vancouver, Canada). The authors declare no conflicts of interest.

© 2015 by Lippincott Williams & Wilkins.