Near-Infrared Fluorescence Tumor-Targeted Imaging in Lung Cancer: A Systematic Review

Abstract

Lung cancer is the most common cancer type worldwide, with non-small cell lung cancer (NSCLC) being the most common subtype. Non-disseminated NSCLC is mainly treated with surgical resection. The intraoperative detection of lung cancer can be challenging, since small and deeply located pulmonary nodules can be invisible under white light. Due to the increasing use of minimally invasive surgical techniques, tactile information is often reduced. Therefore, several intraoperative imaging techniques have been tested to localize pulmonary nodules, of which near-infrared (NIR) fluorescence is an emerging modality. In this systematic review, the available literature on fluorescence imaging of lung cancers is presented, which shows that NIR fluorescence-guided lung surgery has the potential to identify the tumor during surgery, detect additional lesions and prevent tumor-positive resection margins.

State of the Art in Lung Nodule Localization

“…The agent indocyanine green (ICG) has been used with near-infrared fluorescence imaging to help visualize lesions intraoperatively [ 22 ]. Most commonly, peritumoral lung parenchyma is injected with ICG via percutaneous or bronchoscopic approaches [ 23 ].…”

“…Intraoperative use of specialized cameras allows the visualization of these areas, targeting resection. Reports of its use have been associated with an 86%–100% localization rate [ 22 , 24 ]. Success appears to be related to the depth of the tumor to the lung edge.…”

A New Urokinase Plasminogen Activator Receptor‐Targeted Near‐Infrared Fluorescence (NIR) Probe for Glioma Imaging

“…Moreover, fluorescence imaging (FLI) in the second near-infrared window (NIR-II) of ICG has been further investigated and utilized in recent years. [5][6][7][8][9][10] Despite the advantages mentioned above, the features such as passive tumor uptake and the short half-life of free ICG still limit its clinical application in accurate tumor imaging, especially the accurate identification of tumor margins in tumor operation. Therefore, developing ICG-labeled probes for tumorspecific targets will conquer the obstacles in clinical practice.…”

“…[5] ICG can be stored in tumor tissue due to its ability of non-specific tumor targeting, known as the enhanced permeability and retention (EPR) effect. [6] Since ICG was initially applied to guide the resection of brain tumors, its application in tumor diagnosis and surgical navigation has been pursued actively. Moreover, fluorescence imaging (FLI) in the second near-infrared window (NIR-II) of ICG has been further investigated and utilized in recent years.…”

“…Since ICG was initially applied to guide the resection of brain tumors, its application in tumor diagnosis and surgical navigation has been pursued actively. Moreover, fluorescence imaging (FLI) in the second near‐infrared window (NIR‐II) of ICG has been further investigated and utilized in recent years [5–10] …”