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Three-Dimensional Near-Infrared Specimen Mapping Can Identify the Distance from the Tumor to the Surgical Margin During Resection of Pulmonary Ground Glass Opacities

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Abstract 

Background

Lung cancers can recur locally due to inadequate resection margins. Achieving adequate margin distances is challenging in pulmonary ground glass opacities (GGOs) because they are not easily palpable. To improve margin assessment during resection of GGOs, we propose a novel technique, three-dimensional near-infrared specimen mapping (3D-NSM).

Methods

Twenty patients with a cT1 GGO were enrolled and received a fluorescent tracer preoperatively. After resection, specimens underwent 3D-NSM in the operating room. Margins were graded as positive or negative based upon fluorescence at the staple line. Images were analyzed using ImageJ to quantify the distance from the tumor edge to the nearest staple line. This margin distance calculated by 3D-NSM was compared to the margin distance reported on final pathology several days postoperatively.

Results

3D-NSM identified 20/20 GGOs with no false positive or false negative diagnoses. Mean fluorescence intensity for lesions was 110.92 arbitrary units (A.U.) (IQR: 77.77–122.03 A.U.) compared to 23.68 A.U. (IQR: 19.60–27.06 A.U.) for background lung parenchyma (p < 0.0001). There were 4 tumor-positive or close margins in the study cohort, and all 4 (100%) were identified by 3D-NSM. 3D-NSM margin distances were nearly identical to margin distances reported on final pathology (R2 = 0.9362). 3D-NSM slightly under-predicted margin distance, and the median difference in margins was 1.9 mm (IQR 0.5–4.3 mm).

Conclusions

3D-NSM rapidly localizes GGOs by fluorescence and detects tumor-positive or close surgical margins. 3D-NSM can accurately quantify the resection margin distance as compared to formal pathology, which allows surgeons to rapidly determine whether sublobar resection margin distances are adequate.

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Funding

Dr. Kennedy was supported by the American Philosophical Society and the National Institutes of Health (grant F32 CA254210-01). Dr. Azari was supported by the Society for Thoracic Surgeons. Dr. Singhal was supported by the National Institutes of Health (grant P01 CA254859) and the State of Pennsylvania Health Research Fund.

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Authors and Affiliations

  1. Department of Surgery, University of Pennsylvania School of Medicine, 3400 Spruce Street, 6 White Building, Philadelphia, PA, 19104, USA

    Gregory T. Kennedy, Feredun S. Azari, Elizabeth Bernstein, John C. Kucharczuk & Sunil Singhal

  2. Department of Pathology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA

    Charuhas Deshpande

  3. Department of Radiology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA

    Edward J. Delikatny

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  1. Gregory T. Kennedy
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  2. Feredun S. Azari
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  3. Elizabeth Bernstein
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  4. Charuhas Deshpande
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  5. John C. Kucharczuk
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  7. Sunil Singhal
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Correspondence to Sunil Singhal.

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Ethics Approval

IRB approval number: 822153.

IRB approval date: 5/1/2015.

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All the patients provided written, informed consent prior to enrollment in the study.

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The authors declare no competing interests.

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Kennedy, G.T., Azari, F.S., Bernstein, E. et al. Three-Dimensional Near-Infrared Specimen Mapping Can Identify the Distance from the Tumor to the Surgical Margin During Resection of Pulmonary Ground Glass Opacities. Mol Imaging Biol 25, 203–211 (2023). https://doi.org/10.1007/s11307-022-01750-0

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  • DOI: https://doi.org/10.1007/s11307-022-01750-0

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