Intraoperative Molecular Imaging of Lung Adenocarcinoma Can Identify Residual Tumor Cells at the Surgical Margins



During lung surgery, identification of surgical margins is challenging. We hypothesized that molecular imaging with a fluorescent probe to pulmonary adenocarcinomas could enhance residual tumor during resection.


Mice with flank tumors received a contrast agent targeting folate receptor alpha. Optimal dose and time of injection was established. Margin detection was compared using traditional methods versus molecular imaging. A pilot study was then performed in three humans with lung adenocarcinoma.


The peak tumor-to-background ratio (TBR) of murine tumors was 3.9. Fluorescence peaked at 2 h and was not improved beyond 0.1 mg/kg. Traditional inspection identified 30 % of mice with positive margins. Molecular imaging identified an additional 50 % of residual tumor deposits (p < 0.05). The fluorescent probe visually enhanced all human tumors with a mean TBR of 3.5.


Molecular imaging is an important adjunct to traditional inspection to identify surgical margins after tumor resection.

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This work was supported by the National Institutes of Health RO1 CA163256.

Conflict of Interest

Dr. Low is a consultant and stakeholder in OnTarget Laboratories LLC. Dr. Nie discloses a relationship as a consultant for Spectropath Inc.

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Corresponding author

Correspondence to Sunil Singhal.

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Keating, J.J., Okusanya, O.T., De Jesus, E. et al. Intraoperative Molecular Imaging of Lung Adenocarcinoma Can Identify Residual Tumor Cells at the Surgical Margins. Mol Imaging Biol 18, 209–218 (2016).

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Key words

  • Surgical oncology
  • Molecular imaging
  • Lung cancer
  • Thoracic surgery
  • Folate receptor alpha