title: Intraoperative detection and removal of microscopic residual sarcoma using wide-field imaging.
abstract: BACKGROUND
  The goal of limb-sparing surgery for a soft tissue sarcoma of the extremity is to remove all malignant cells while preserving limb function. After initial surgery, microscopic residual disease in the tumor bed will cause a local recurrence in approximately 33% of patients with sarcoma. To help identify these patients, the authors developed an in vivo imaging system to investigate the suitability of molecular imaging for intraoperative visualization.
  
  
  METHODS
  A primary mouse model of soft tissue sarcoma and a wide field-of-view imaging device were used to investigate a series of exogenously administered, near-infrared (NIR) fluorescent probes activated by cathepsin proteases for real-time intraoperative imaging.
  
  
  RESULTS
  The authors demonstrated that exogenously administered cathepsin-activated probes can be used for image-guided surgery to identify microscopic residual NIR fluorescence in the tumor beds of mice. The presence of residual NIR fluorescence was correlated with microscopic residual sarcoma and local recurrence. The removal of residual NIR fluorescence improved local control.
  
  
  CONCLUSIONS
  The authors concluded that their technique has the potential to be used for intraoperative image-guided surgery to identify microscopic residual disease in patients with cancer.
authors.affiliation: Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, NC 27708, USA.
authors.forename: Jeffrey K
authors.initials: JK
authors.lastname: Mito
authors.forename: Jorge M
authors.initials: JM
authors.lastname: Ferrer
authors.forename: Brian E
authors.initials: BE
authors.lastname: Brigman
authors.forename: Chang-Lung
authors.initials: CL
authors.lastname: Lee
authors.forename: Rebecca D
authors.initials: RD
authors.lastname: Dodd
authors.forename: William C
authors.initials: WC
authors.lastname: Eward
authors.forename: Lisa F
authors.initials: LF
authors.lastname: Marshall
authors.forename: Kyle C
authors.initials: KC
authors.lastname: Cuneo
authors.forename: Jessica E
authors.initials: JE
authors.lastname: Carter
authors.forename: Shalini
authors.initials: S
authors.lastname: Ramasunder
authors.forename: Yongbaek
authors.initials: Y
authors.lastname: Kim
authors.forename: W David
authors.initials: WD
authors.lastname: Lee
authors.forename: Linda G
authors.initials: LG
authors.lastname: Griffith
authors.forename: Moungi G
authors.initials: MG
authors.lastname: Bawendi
authors.forename: David G
authors.initials: DG
authors.lastname: Kirsch
mesh_terms: D000818:Animals; D005456:Fluorescent Dyes; D007259:Infrared Rays; D007432:Intraoperative Period; D051379:Mice; D018365:Neoplasm, Residual / Q000601:surgery*; D012509:Sarcoma / Q000601:surgery*; D012513:Sarcoma, Experimental / Q000601:surgery; D012983:Soft Tissue Neoplasms / Q000601:surgery*; D025321:Surgery, Computer-Assisted
chemical_list: D005456:Fluorescent Dyes