Intraoperative Imaging in Ovarian Cancer: Fact or Fiction?

Abstract

Tumor-targeted fluorescence imaging for cancer diagnosis and treatment is an evolving field of research that is on the verge of clinical implementation. As each tumor has its unique biologic profile, selection of the most promising targets is essential. In this review, we focus on target finding in ovarian cancer, a disease in which fluorescence imaging may be of value in both adequate staging and in improving cytoreductive efforts, and as such may have a beneficial effect on prognosis. Thus far, tumor-targeted imaging for ovarian cancer has been applied only in animal models. For clinical implementation, the five most prominent targets were identified: folate receptor α, vascular endothelial growth factor, epidermal growth factor receptor, chemokine receptor 4, and matrix metalloproteinase. These targets were selected based on expression rates in ovarian cancer, availability of an antibody or substrate aimed at the target approved by the Food and Drug Administration, and the likelihood of translation to human use. The purpose of this review is to present requirements for intraoperative imaging and to discuss possible tumor-specific targets for ovarian cancer, prioritizing for targets with substrates ready for introduction into the clinic.

Analysis of biomarker expression in severe endometriosis and determination of possibilities for targeted intraoperative imaging

“…Enhanced intraoperative detection of endometriotic lesions may help to improve the success of radical excision, as is also the case in oncologic surgery [4]. Furthermore, an imaging tool to specifically identify endometriotic lesions intraoperatively could spare normal structures and prevent surgical injury.…”

Biologically-Targeted Detection of Primary and Micro-Metastatic Ovarian Cancer

“…The value of PET16-18 and optical imaging19, 20 have been evaluated in ovarian cancer, although separately. Nevertheless, translation of such probes to the clinic requires the development of improved contrast agents to increase tumor sensitivity and specificity.…”

Targeted imaging of ovarian cancer cells using viral nanoparticles doped with indocyanine green

“…Cytoreduction is a partially effective method, it entails physically removing visible growths and because of human limitations tumors smaller than 3mm in diameter are often missed [3]. Enhancing the ability to visually detect tumors during cytoreductive surgery by using fluorescence imaging could help reduce metastasis, and improve resection success rates [4].…”

“…Near infrared fluorescence imaging provides the advantage of deep optical imaging [4]. Indocyanine green (ICG), an FDA-approved NIR fluorescent dye, has been shown to provide enough contrast, when delivered intravenously at large concentrations to detect implanted small ovarian cancer tumors in mice [5].…”