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
