Margin control.

Top Line: Where have we come in the last several decades in the pursuit of negative margins?

The Study: Enter intraoperative molecular imaging, the stuff of 21st century medicine. It uses tumor-targeted probes intravenously injected 6-24 hours prior to surgery that are fluorescently tagged for visualization with a near-infrared camera. The tumor target in this instance was the folate receptor alpha, overexpressed 90% of lung adenos and 70% of squamous cell carcinomas. This prospective trial of 40 patients assessed the feasibility of intraop molecular imaging during resection of clinical T1 lung tumors in (1) localizing nonpalpable in situ tumor extent and (1) quantifying margin distance. Intraop molecular imaging was able to locate 15 of 18 (83%) nonpalpable lesions and measure margins in 39 of 40 patients (95%) that were nearly identical to final pathologic margins with median difference of only 1.3 mm (IQR 0.7-2.0 mm).

TBL: Intraoperative molecular imaging is a nifty technique to identify occult disease and minimize risk of involved margins in real time. | Kennedy, JAMA Surg 2021

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