Fluorescence-Guided Oncology Surgery Applications

Fluorescence-guided surgery has emerged as a transformative approach in oncological theatre, harnessing optical contrast to delineate malignant from healthy tissue in real time. By administering tumour-targeted fluorophores or activatable probes, surgeons can visualise subclinical lesions, assess margin status intraoperatively, and adapt resections on the fly. This modality addresses the persistent challenge of positive surgical margins, a key determinant of recurrence and survival. Technological advances in probe chemistry, imaging hardware, and analytical frameworks have broadened the clinical applications across head and neck, breast, gastrointestinal and central nervous system malignancies. Collectively, these developments promise to enhance precision, reduce re-operation rates, and improve patient outcomes by integrating molecular specificity with surgical workflow.

Research from Nature Portfolio

Recent studies have demonstrated the clinical potential of targeted fluorescent tracers across a spectrum of solid tumours. In oral squamous cell carcinoma, a phase II investigation of an epidermal growth factor receptor-targeted agent conjugated to a near-infrared dye achieved 100% sensitivity and 85.9% specificity in margin detection, enabling real-time guidance of intraoperative resections with quantitative signal-to-background thresholds. A complementary nanoparticle approach has yielded an ultra-pH-sensitive probe that fluoresces upon encountering the acidic tumour microenvironment, facilitating detection of positive margins and occult lesions across breast, head and neck, and oesophageal cancers. Moreover, an integrated analytical framework has been established to standardise the clinical translation and multicentre evaluation of macroscopic and microscopic tracer performance, paving the way for harmonised assessment of novel molecular imaging agents in diverse tumour types.

Fluorescence-Guided Oncology Surgery Applications publication trend

The graph below shows the total number of articles in fluorescence-guided oncology surgery applications across all publications each year (not limited to Nature Index journals).

Technical terms

Fluorescence-guided surgery (FGS): surgical technique using fluorescent agents to visualise tumour tissue intraoperatively.

Signal-to-background ratio (SBR): quantitative measure comparing fluorescent signal intensity of tumour to surrounding tissue.

Near-infrared fluorescence (NIRF): imaging modality using fluorophores that emit light in the 700–900 nm spectrum for deeper tissue penetration.

Enhanced permeability and retention (EPR) effect: phenomenon in which macromolecules preferentially accumulate in tumours owing to leaky vasculature and impaired lymphatic drainage.

pH-activatable probe: agent that becomes fluorescent in acidic microenvironments, providing tumour-specific contrast.

References

1. EGFR-targeted fluorescence molecular imaging for intraoperative margin assessment in oral cancer patients: a phase II trial. Nature Communications (2023).
2. Exploiting metabolic acidosis in solid cancers using a tumor-agnostic pH-activatable nanoprobe for fluorescence-guided surgery. Nature Communications (2020).
3. Implementation and benchmarking of a novel analytical framework to clinically evaluate tumor-specific fluorescent tracers. Nature Communications (2018).
4. Fluorescent Probes for Imaging in Humans: Where Are We Now?. ACS Nano (2023).
5. Review of fluorescence guided surgery systems: identification of key performance capabilities beyond indocyanine green imaging. Journal of Biomedical Optics (2016).
6. Safety of panitumumab-IRDye800CW and cetuximab-IRDye800CW for fluorescence-guided surgical navigation in head and neck cancers. Theranostics (2018).