Linda Martin, MD, an associate professor in the Department of Surgery, presented research as a late-breaking abstract at the 2022 American Association for Thoracic Surgeons about a phase 3 trial to test the use of pafolacianine for introperative molecular imaging of cancer in the lung. Dr. Martin was one of only 12 investigators nationwide to lead the study, which was accepted for publication in February in the Journal of Thoracic and Cardiovascular Surgery.
Pafolacianine is a folate receptor-target fluorescent agent, that allows the identification and localization of cancers in the lung so that they can be accurately identified and resected with minimally invasive surgery. The dye is given intravenously 4-24 hours before surgery, through a regular IV. The dye binds tumors expressing folate receptors. While looking at the lungs with a camera, we switch to near-infrared light and the tumor “glows”. In 10% of cases, a second, unsuspected cancer was found; in over 1/3 of cases surgeons could tell immediately that their margin was too close and they could adjust the extent of surgery; and in almost 20%, it allowed for the identification of the nodule where it was otherwise undetectable using our standard tools.
This is especially helpful now that more and more early-stage cancers are being identified from lung cancer screening and CT imaging performed for unrelated reasons. These small nodules can be hard to find, like a ‘needle in a haystack.’ In some cases, it requires a CT-guided dye injection, or bronchoscopic injection, or to do open thoracotomy to palpate the lung to find the nodule. This new technique greatly simplifies the localization process and saves, time, resources, and the risks inherent with additional invasive procedures.