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Intraoperative Molecular Imaging Is Superior to Positron Emission Tomography for Identifying Malignant Pulmonary Nodules
Jarrod D Predina1, Andrew Newton1, Jane Keating1, Olugbenga Okusanya2, Jeffrey Drebin1, Sunil Singhal1
1University of Pennsylvania School of Medicine, Philadelphia, PA;2University of Pittsburgh Medical Center, Pittsburgh, PA

OBJECTIVE(S): PET is commonly utilized in preoperative assessment of patients with pulmonary nodules; however, sensitivity can be limited. We hypothesize that intraoperative molecular imaging (IMI) with the folate receptor targeted near-infrared agent (OTL0038) is more sensitive than PET for identifying malignant pulmonary nodules.
METHODS: Fifty patients with CT confirmed pulmonary nodules underwent preoperative PET. Patients then received OTL0038 prior to pulmonary resection. During resection, IMI was utilized to image known lung nodules and identify synchronous lesions. Mean size, standardized uptake value (SUV), and tumor-to-background fluorescence ratio (TBR) were compared for known and synchronous nodules by paired t-tests.
RESULTS: IMI identified 49/50 (98%) known pulmonary nodules. In 10 patients, IMI identified 11 additional lesions not described by PET. Nodules detected only by IMI were smaller than preoperatively identified nodules (0.5cm vs 2.4cm; p=0.022) and had lower SUVs (1.0 vs 4.3; p=0.013). TBR was similar among nodules only identified by IMI versus those identified preoperatively (3.1 and 3.2;p>0.05). Sensitivity of IMI versus PET was 98.2% versus 69.5% (p<0.001); positive-predictive values were 90.1% versus 89.6%(p>0.05).

CONCLUSIONS: These data suggest that intraoperative molecular imaging is more sensitive than PET in identifying malignant pulmonary nodules. Utilizing intraoperative imaging as an adjunct to standard imaging may provide superior oncologic outcomes. These data are the basis of the first phase II clinical trial of intraoperative tumor imaging in the United States.

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