Intraoperative Molecular Imaging Agents

The primary treatment for early-stage cancer remains surgery. Clinical decision-making for curative surgical excision of solid tumors could significantly benefit from intraoperative visualization of disease. Although conventional preoperative imaging such as computed tomography, magnetic resonance imaging, and positron emission tomography plays an important role in preoperative diagnosis and disease staging, these modalities mostly lack the opportunity to be deployed intraoperatively. Optical molecular imaging has been a subject of extensive research for over a decade and represents a powerful technique that could potentially fill this gap in the field of surgical oncology. A range of innovative optical agents and imaging platforms that provide a high degree of intraoperative tumor sensitivity and specificity are under clinical evaluation. These agents, targeted to specific cancer cells (through antigen/proteases, etc.), tumor angiogenesis, and the tumor microenvironment, show potential to assist surgeons in achieving more radical resections and thus impact survival rates. This chapter will review the current stage of intraoperative agents and the imaging systems that make visualization possible. In addition, the chapter will elaborate on FDA-approval pathways for imaging agents and camera systems.