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Intraoperative Molecular Imaging Provides Rapid and Accurate Diagnosis of Primary Pulmonary Adenocarcinoma
Gregory T Kennedy*1, Olugbenga T Okusanya*1, Daniel F Heitjan*1, Charuhas Deshpande*1, Leslie A Litzky*1, Jane J Keating*1, Steven M Albelda*1, Shuming Nie*2, Philip S Low*3, Jeffrey A Drebin1, Sunil Singhal*1
1University of Pennsylvania School of Medicine, Philadelphia, PA;2Emory University, Atlanta, GA;3Purdue University, West Lafayette, IN

OBJECTIVE: To compare molecular imaging to frozen section analysis for intraoperative diagnosis of solitary pulmonary nodules (SPNs).
BACKGROUND: Intraoperative frozen section analysis of indeterminate SPNs guides the extent of pulmonary resection. Frozen sectioning is time consuming and susceptible to error, and alternative diagnostic modalities have been unsuccessfully pursued for decades. We report a novel molecular imaging technology that rapidly and accurately diagnoses primary pulmonary adenocarcinomas, which are the most common SPNs.
METHODS: Thirty consecutive patients with an indeterminate SPN were preoperatively administered a contrast agent specific for primary pulmonary adenocarcinomas. During surgery, SPNs were removed and molecular imaging was used to identify primary adenocarcinomas. Frozen section analysis was performed, and immunohistochemical diagnosis served as the gold standard to compare the diagnostic techniques.
RESULTS: Molecular imaging identified 19 of 19 primary adenocarcinomas and correctly predicted those patients that should undergo a lobectomy. There were no false positive diagnoses despite two metastatic adenocarcinomas. Frozen section identified 13 (68%) primary adenocarcinomas, and a false negative diagnosis incorrectly altered the management in one patient. Molecular imaging required 2.4 minutes compared to 26.5 minutes for frozen section (p<0.001).
CONCLUSIONS: This proof-of-principle study demonstrates that molecular imaging has superior positive predictive value for primary adenocarcinomas and is significantly faster than frozen section. Targeted contrast agents can be developed for other tumors, and this technology can be broadly applied in surgical oncology.


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