Novel applications of near-infrared fluorescence imaging in orthopaedic surgery (Conference Presentation)

Abstract

Sarcomas are cancers of the bones, muscles, nerves, and fat that require complete surgical removal for cure. The primary surgical goal therefore is to remove the tumor with a zone of normal, non-cancerous tissue surrounding the tumor, considered a ‘negative’ surgical margin. At present, surgeons rely on radiologic imaging and visual and tactile clues to gauge cancer depth and guide surgical excision. This can result in removal of too much or too little tissue, which can lead to unnecessary removal of vital structures or incomplete cancer removal, respectively. Both results can have negative effects on ultimate patient outcome, with positive margins reported in 23% of sarcoma surgeries. Near-infrared (NIR) fluorescence probes are molecules that when stimulated with specific, known frequencies of near-infrared light will emit light of another distinct frequency. NIR light penetrates human tissue reasonably well and therefore can be used to detect the presence and location of unseen structures labeled with NIR fluorescence probes through several centimeters of tissue. Intra-operative near-infrared (NIR) fluorescence probes have been effective for this purpose in brain tumor surgery and may be applicable to sarcoma surgery. Foundational research is needed to explore the potential of this affibody probe and perfusion probes to estimate margin thickness in sarcoma surgery. In this study we will determine if sarcoma labeling using NIR fluorescence probes is superior with perfusion probes or a novel affibody probe. We will also determine whether NIR fluorescence using perfusion probes or a novel affibody probe can be correlated accurately to margin thickness.