First Ovarian Cancer Surgeries Performed with Fluorescent-Guidance

Surgeons may be one step closer to being able to identify and remove all cancerous cells in a tumor, thanks to the work of a collaborative team of researchers and clinicians from The Netherlands, Germany, and Indiana. The team just reported the results of the first ovarian cancer surgeries performed with live fluorescence guidance.

In brief, the team relied on the fact that ovarian cancer cells express folate receptors that can be used to ferry in fluorescent tags. Surgeons were then able to spot the problematic cells by viewing the surgical field under a multispectral fluorescence camera that literally lights them up (cool video below).

Here’s the relevant info from the announcement:

Philip Low, the Ralph C. Corely Distinguished Professor of Chemistry who invented the technology, said surgeons were able to see clusters of cancer cells as small as one-tenth of a millimeter, as opposed to the earlier average minimal cluster size of 3 millimeters in diameter based on current methods of visual and tactile detection.

“Ovarian cancer is notoriously difficult to see, and this technique allowed surgeons to spot a tumor 30 times smaller than the smallest they could detect using standard techniques,” said Low, who also is a member of the Purdue University Center for Cancer Research. “By dramatically improving the detection of the cancer – by literally lighting it up – cancer removal is dramatically improved.”

The technique attaches a fluorescent imaging agent to a modified form of the vitamin folic acid, which acts as a “homing device” to seek out and attach to ovarian cancer cells. Patients are injected with the combination two hours prior to surgery and a special camera system, called a multispectral fluorescence camera, then illuminates the cancer cells and displays their location on a flat-screen monitor next to the patient during surgery.

The surgeons involved in this study reported finding an average of 34 tumor deposits using this technique, compared with an average of seven tumor deposits using visual and tactile observations alone. A paper detailing the study was published online Sunday (Sept. 18) in Nature Medicine.

Gooitzen van Dam, a professor and surgeon at the University of Groningen in The Netherlands where the surgeries took place, said the imaging system fits in well with current surgical practice.

“This system is very easy to use and fits seamlessly in the way surgeons do open and laparoscopic surgery, which is the direction most surgeries are headed in the future,” said van Dam, who is a surgeon in the division of surgical oncology and Bio-Optical Imaging Center at the University of Groningen. “I think this technology will revolutionize surgical vision. I foresee it becoming a new standard in cancer surgery in a very short time.”

Press release: Purdue technology used in first fluorescence-guided ovarian cancer surgery

Abstract in Nature Medicine: Intraoperative tumor-specific fluorescence imaging in ovarian cancer by folate receptor-? targeting: first in-human results