Exploring novel opportunities for molecular imaging in surgery: illuminating surgical decision making

Imaging modalities play a crucial role in surgical diagnosis and have the potential to deliver critical anatomical and biological information prior and during surgery. Fluorescence imaging is a novel technique which uses tumor-specific fluorescent tracers which give the opportunity to visualize tumor cells directly during surgery. This allows the surgeon to distinguish malignant from benign tissue in the operation room. In the first part of this thesis, we describe the use of fluorescence-guided surgery using novel tracers in a variety of solid tumors like soft tissue sarcomas, head- and neck cancer and breast cancer. We use intravenously administered fluorescent tracers to enhance tumor visualization. We show that this technique allows for an improved visualization of tumor-positive surgical margins and residual disease which were initially missed during surgery. These discoveries might improve surgical decision making directly during surgery which might lead to an improved patient outcome in the future.

During vascular surgery, we try to track patients who are at risk for vascular stenosis which gives an increased risk in cerebral strokes. In the second part of this thesis we describe the use of a fluorescent tracer which is able to visualize the so-called vulnerable plaque. We show that it is possible to make an adequate distinction between a biological active and therefore vulnerable plaque and a non-vulnerable plaque. In the future, we are aiming for non-invasive imaging modalities using this technique to select patients prior to high-risk vascular interventions.