Purpose The purpose of this study was to assess whether the vascularisation of the meniscus could be visualised intra-operatively using near-infrared fluorescence (NIRF) imaging with indocyanine... Show morePurpose The purpose of this study was to assess whether the vascularisation of the meniscus could be visualised intra-operatively using near-infrared fluorescence (NIRF) imaging with indocyanine green (ICG) in patients undergoing total knee arthroplasty (TKA). Methods The anterior horn (i.e., Cooper classification: zones C and D) of the meniscus that was least affected (i.e., least degenerative) was removed during TKA surgery in ten patients to obtain a cross section of the inside of the meniscus. Thereafter, 10 mg of ICG was injected intravenously, and vascularisation of the cross section of the meniscus was assessed using the Quest spectrum NIRF camera system. We calculated the percentage of patients in whom vascularisation was observed intra-operatively using NIRF imaging compared to immunohistochemistry. Results Meniscal vascularisation using NIRF imaging was observed in six out of eight (75%) patients in whom vascularisation was demonstrated with immunohistochemistry. The median extent of vascularisation was 13% (interquartile range (IQR) 3-28%) using NIRF imaging and 15% (IQR 11-23%) using immunohistochemistry. Conclusion This study shows the potential of NIRF imaging to visualise vascularisation of the meniscus, as vascularisation was observed in six out of eight patients with histologically proven meniscal vascularisation. Show less
Fluorescence-guided surgery (FGS) is an intraoperative imaging technique already introduced and validated in the clinic for sentinel lymph node mapping and biliary imaging. Conjugating a NIR... Show moreFluorescence-guided surgery (FGS) is an intraoperative imaging technique already introduced and validated in the clinic for sentinel lymph node mapping and biliary imaging. Conjugating a NIR-dye to a specific tumor-targeting vehicle dramatically enhances the specificity of this technique. Hence, a powerful synergy can be achieved when fluorescent imaging is combined with nuclear imaging. The (NIR) fluorescent signal aids the surgeon to accurately recognize and resect malignant tissues and detect (nearby) vital structures in real-time during surgery, while its nuclear counterpart can be used to preoperative assess tumor spread and aid in the surgical planning and guidance. Patients may benefit directly from better tumor detection as the surgical status (R0 or R1) is one of the most import parameters for morbidity and patient survival. This thesis focus on the evaluation of potential targets for image-guided surgery applications and describes the preclinical evaluation of novel tracers for (hybrid) image-guided surgery. Show less
This thesis focus on preclinical validation of novel fluorescent contrast agents for solid tumor imaging (Part I), the clinical introduction of NIR fluorescence sentinel lymph node imaging in... Show moreThis thesis focus on preclinical validation of novel fluorescent contrast agents for solid tumor imaging (Part I), the clinical introduction of NIR fluorescence sentinel lymph node imaging in several cancer types using indocyanine green (Part II) and the clinical translation of NIR fluorescence imaging using clinically available fluorescent contrast agents for solid tumor imaging (Part III) Show less
This thesis focuses on the use of near-infrared (NIR) fluorescence imaging during (cancer) surgery, using specialized intraoperative imaging systems. This technique is validated in preclinical... Show moreThis thesis focuses on the use of near-infrared (NIR) fluorescence imaging during (cancer) surgery, using specialized intraoperative imaging systems. This technique is validated in preclinical studies on intraoperative tumor identification and image-guided resection, and and then translated to clinical studies using clinically available agents. Using experimental, tumor-specific NIR fluorescent agents (probes), tumors could successfully be identified during surgery and subsequently resected under image guidance, in several tumor models. Also, the clinically available indocyanine green (ICG) could be used to identify colorectal liver metastases during surgery, in an experimental model. Clinically, NIR fluorescence imaging could be used to identify sentinel lymph nodes (SLN, the lymph nodes that drain directly from a tumor and are most likely to contain tumor cells if metastasis has occurred). SLNs could be identified after ICG injection in breast cancer, vulvar cancer and cervical cancer. SLNs could also be identified ex vivo in colorectal cancer, after HSA800, an optimized experimental probe that was injected in freshly resected specimens. After intravenous ICG injection, NIR angiography could be performed in patients undergoing breast reconstructive surgery, bile ducts could be identified intraoperatively in patients undergoing pancreaticoduodenectomy, and colorectal liver metastases could be identified in patients undergoing liver surgery. Show less
