Carcinoembryonic antigen-specific, fluorescent image-guided cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for metastatic colorectal cancer

Schaap, Dennis P.; Valk, Kim S. de; Deken, Marion M.; Meijer, R.P.; Burggraaf, Jacobus; Vahrmeijer, Alexander L.; Kusters, Miranda

doi:10.1002/bjs.11523

Cited by 42 publications

(26 citation statements)

References 20 publications

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“…Spot FI measurements and dynamic mean values were compared from tumours versus control tissue using Mann-Whitney U. FI signals from videos were plotted against time and examined for distinctions regarding speci c curve milestones and variables adapted from previously described methodologies. 16,17 An intensity rise of 5 grey units was marked as the end of the latency period and the starting block for the incline. Following the rapid in ow period, the point of maximum uorescence intensity (F max ), time to achieve this summit (T max ) and respective gradient (F max /T max ) were calculated along with the time taken (T ½max ) to achieve half the maximum (F ½max ) intensity.…”

Section: Methodsmentioning

confidence: 99%

Digital Dynamic Discrimination of Primary Colorectal Cancer Using Systemic Indocyanine Green with Near-Infrared Endoscopy.

Dalli

Loughman

Hardy

et al. 2021

Preprint

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Introduction: As indocyanine green (ICG) with near-infrared (NIR) endoscopy enhances real-time intraoperative tissue microperfusion appreciation, it may also dynamically reveal neoplasia distinctively from normal tissue especially with video software fluorescence analysis.Methods: Colorectal tumours of patients were imaged mucosally following ICG administration (0.25 mg/kg i.v.) using an endo-laparoscopic NIR system (PINPOINT Endoscopic Fluorescence System, Stryker) including immediate, continuous in situ visualization of rectal lesions transanally for up to 20 minutes. Spot and dynamic temporal fluorescence intensities (FI) were quantified using ImageJ (including videos at one frame per second, fps) and by a bespoke MATLAB® application that provided digitalized video tracking and signal logging at 30fps (Fluorescence Tracker App, FTA, downloadable via MATLAB® file exchange). Statistical analysis of FI-time plots compared tumours (benign and malignant) against control during FI curve rise, peak and decline from apex. Results: Early kinetic FI signal measurement (n=20, 16 males, 9 cancers) delineated discriminative temporal signatures from tumours offering rich data for analysis versus delayed spot measurement (n=10 patients with cancer). Malignant lesion curves peaked significantly later with a shallower gradient than normal tissue while benign lesions showed significantly greater and faster intensity drop from apex versus cancer. Automated tracker quantification efficiently expanded manual results and provided algorithmic KNN clustering. Conclusions Analysis of a continuous stream of intraoperatively acquired early ICG fluorescence data can act as an in situ tumour-identifier with greater detail than later snapshot observation alone. Software quantification of such kinetic signatures may distinguish invasive from non-invasive neoplasia with potential for real-time in silico diagnosis.

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Section: Methodsmentioning

confidence: 99%

Digital Dynamic Discrimination of Primary Colorectal Cancer Using Systemic Indocyanine Green with Near-Infrared Endoscopy.

Dalli

Loughman

Hardy

et al. 2021

Preprint

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“…Overall, in a 14-patient study, PPV was 82.3% and negative predictive value (NPV) was 95.8%. 20 Dr. Vahrmeijer then focused his discussion on the ongoing phase 3 study of SGM-101. This is a multinational, multi-intuitional study that includes centers from Italy, Germany, the Netherlands, and the United States.…”

Section: (Sgm-101) Cea Colon Cancer Trialmentioning

confidence: 99%

“…Overall, in a 14-patient study, PPV was 82.3% and negative predictive value (NPV) was 95.8%. 20 …”

Section: Phase 3/4 Trialmentioning

confidence: 99%

Intraoperative molecular imaging clinical trials: a review of 2020 conference proceedings

et al. 2021

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Significance: Surgery is often paramount in the management of many solid organ malignancies because optimal resection is a major factor in disease-specific survival. Cancer surgery has multiple challenges including localizing small lesions, ensuring negative surgical margins around a tumor, adequately staging patients by discriminating positive lymph nodes, and identifying potential synchronous cancers. Intraoperative molecular imaging (IMI) is an emerging potential tool proposed to address these issues. IMI is the process of injecting patients with fluorescenttargeted contrast agents that highlight cancer cells prior to surgery. Over the last 5 to 7 years, enormous progress has been achieved in tracer development, near-infrared camera approvals, and clinical trials. Therefore, a second biennial conference was organized at the University of Pennsylvania to gather surgical oncologists, scientists, and experts to discuss new investigative findings in the field. Our review summarizes the discussions from the conference and highlights findings in various clinical and scientific trials.Aim: Recent advances in IMI were presented, and the importance of each clinical trial for surgical oncology was critically assessed. A major focus was to elaborate on the clinical endpoints that were being utilized in IMI trials to advance the respective surgical subspecialties.Approach: Principal investigators presenting at the Perelman School of Medicine Abramson Cancer Center's second clinical trials update on IMI were selected to discuss their clinical trials and endpoints.Results: Multiple phase III, II, and I trials were discussed during the conference. Since the approval of 5-ALA for commercial use in neurosurgical malignancies, multiple tracers and devices have been developed to address common challenges faced by cancer surgeons across

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“…Sensitivity was 98.5% and specificity 62.2%. The positive predictive value was 82.3% and the negative predictive value was 95.8%[ 106 ].…”

Section: Peritoneal Metastasis Detection and Tumor Resectionmentioning

confidence: 99%

Real-time fluorescence image-guided gastrointestinal oncologic surgery: Towards a new era

Martínez-López¹,

Martínez-Pérez²,

Navarro-Martínez³

et al. 2021

WJGO

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Technological improvements are crucial in the evolution of surgery. Real-time fluorescence-guided surgery (FGS) has spread worldwide, mainly because of its usefulness during the intraoperative decision-making processes. The success of any gastrointestinal oncologic resection is based on the anatomical identification of the primary tumor and its regional lymph nodes. FGS allows also to evaluate the blood perfusion at the gastrointestinal stumps after colorectal or esophageal resections. Therefore, a reduction on the anastomotic leak rates has been postulated as one of the foreseeable benefits provided by the use of FGS in these procedures. Although the use of fluorescence in lymph node detection was initially described in breast cancer surgery, the technique is currently applied in gastric or splenic flexure cancers, as they both present complex and variable lymphatic drainages. FGS allows also to perform intraoperative lymphograms or sentinel lymph node biopsies. New applications of FGS are being developed to assist in the detection of peritoneal metastases or in the evaluation of the tumor resection margins. The present review aims to provide a general overview of the current status of real-time FGS in gastrointestinal oncologic surgery. We put a special focus on the different applications of FGS, discussing the main findings and limitations found in the contemporary literature and also the promising near future applications.

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Carcinoembryonic antigen-specific, fluorescent image-guided cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for metastatic colorectal cancer

Cited by 42 publications

References 20 publications

Digital Dynamic Discrimination of Primary Colorectal Cancer Using Systemic Indocyanine Green with Near-Infrared Endoscopy.

Digital Dynamic Discrimination of Primary Colorectal Cancer Using Systemic Indocyanine Green with Near-Infrared Endoscopy.

Intraoperative molecular imaging clinical trials: a review of 2020 conference proceedings

Real-time fluorescence image-guided gastrointestinal oncologic surgery: Towards a new era

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