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  • Review Article
  • Published:

Image-guided cancer surgery using near-infrared fluorescence

Nature Reviews Clinical Oncology volume 10, pages 507–518 (2013)Cite this article

Subjects

Key Points

  • Near-infrared (NIR) fluorescence imaging has been demonstrated to be feasible during cancer surgery using available imaging systems and contrast agents

  • Clinical applicability has been described in sentinel lymph-node mapping, tumour imaging, visualization of vital structures and imaging of vascularization and perfusion

  • NIR fluorescence image-guided surgery has properties that make it a good candidate for clinical acceptance, as it fulfils a clinical need, is versatile and is fast

  • Targeted contrast agents, necessary for full evaluation of this technique, are in advanced stages of clinical approval

  • As novel contrast agents are developed and camera systems are optimized, the technique should prove its true clinical value

  • Well-designed outcomes studies have yet to be performed in the field

Abstract

Paradigm shifts in surgery arise when surgeons are empowered to perform surgery faster, better and less expensively than current standards. Optical imaging that exploits invisible near-infrared (NIR) fluorescent light (700–900 nm) has the potential to improve cancer surgery outcomes, minimize the time patients are under anaesthesia and lower health-care costs largely by way of its improved contrast and depth of tissue penetration relative to visible light. Accordingly, the past few years have witnessed an explosion of proof-of-concept clinical trials in the field. In this Review, we introduce the concept of NIR fluorescence imaging for cancer surgery, examine the clinical trial literature to date and outline the key issues pertaining to imaging system and contrast agent optimization. Although NIR seems to be superior to many traditional imaging techniques, its incorporation into routine care of patients with cancer depends on rigorous clinical trials and validation studies.

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Figure 1: The mechanics of NIR fluorescence imaging.
Figure 2: Examples of intraoperative NIR fluorescence imaging.
Figure 3: Administration, biodistribution and clearance of an NIR fluorescent contrast agent.
Figure 4: NIR fluorescence imaging alone or in combination with other imaging modalities.

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Acknowledgements

The authors are supported by the NIH (award numbers R01-CA-115296, R01-EB-011523, R01-EB-010022 and R21-CA-130297), The Dutch Cancer Society (grant UL2010-4732) and The Center for Translational Molecular Medicine (DeCoDe project, grant 03O-101). The content is solely the responsibility of the authors and does not necessarily represent the official views of these agencies.

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Authors and Affiliations

  1. Department of Surgery, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, Netherlands

    Alexander L. Vahrmeijer, Merlijn Hutteman, Joost R. van der Vorst & Cornelis J. H. van de Velde

  2. Department of Medicine and Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, 02215, MA, USA

    John V. Frangioni

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  1. Alexander L. Vahrmeijer
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Contributions

A. L. Vahrmeijer and M. Hutteman researched the data for the Review. A. L. Vahrmeijer, M. Hutteman and J. V. Frangioni wrote the manuscript. All authors contributed to the discussion of the manuscript content and edited the manuscript before submission.

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Correspondence to Alexander L. Vahrmeijer.

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Competing interests

J. V. Frangioni is a founding member of the following companies: Curadel, Curadel ResVet Imaging, Curadel Surgical Innovations, and the founder and chairman of the FLARE Foundation, which licenses the FLARE technology from Beth Israel Deaconess Medical Center, Harvard Medical School. J. V. Frangioni has elected to surrender postmarket royalties for FLARE, which he would otherwise be entitled to as inventor, and has elected to donate premarket proceeds to the FLARE Foundation.

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Vahrmeijer, A., Hutteman, M., van der Vorst, J. et al. Image-guided cancer surgery using near-infrared fluorescence. Nat Rev Clin Oncol 10, 507–518 (2013). https://doi.org/10.1038/nrclinonc.2013.123

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