P176. Intraoperative molecular imaging with pafolacianine as an adjunct for localization and surgical management of semi-solid and ground glass opacities
Presented During: Thoracic Poster Session II
University of Pittsburgh Medical Center
Allison Park, PA
United States - Contact Me
Dr. Ajabshir obtained his medical degree from Florida International University Wertheim College of Medicine in Miami, Florida. He completed his General Surgery Residency at Mount Sinai Medical Center in Miami Beach and went on to pursue a Fellowship in Cardiothoracic Surgery at the University of Pittsburgh Medical Center. He is currently an Assistant Professor of Cardiothoracic Surgery, where he practices at UPMC Passavant. Dr. Ajabshir's surgical focus areas include minimally invasive and robotic surgery for benign and malignant diseases of the chest and foregut, diagnostic and interventional bronchoscopy and esophagoscopy, and airway management and treatment of tracheobronchial disease.
Sunday, May 4, 2025: 9:00 AM - 4:00 PM
Seattle Convention Center | Summit
Room: Poster Area, Exhibit Hall
Description
Objectives: Intraoperative molecular imaging (IMI) can improve the localization of semi solid and ground glass opacities and enhance the ability to perform sublobar resection. This report encompasses our experience following the integration of a folate receptor (FR)-targeted fluorescent agent into a minimally invasive thoracic surgery practice for purposes of the management of ground glass and semi solid lesions.
Methods: Cases from June 2023 through October 2024 were reviewed to identify all patients with one or more semi solid or ground glass opacity with plans for sublobar pulmonary resection. Pafolacianine infusion was performed within 24 hours of surgery. Pre-operative CT scans were used to determine lesion size and depth. The lung was inspected for fluorescence using a proprietary imaging system.
Results: There were 42 patients (28 females, 14 males, mean age 69 years) encompassing 53 separate lesions. Multiple lesions were targeted in 16.7% of patients (7/42). The median lesion size was 14 mm (range 6-32 mm), and median depth was 3 mm (range 1-27 mm). Minimally invasive (robotic n=20 VATS n=22) resection was performed in all patients (segmentectomy n=13, wedge resection n=19, segmentectomy and wedge resection n=3, lobectomy n=4). The overall rate of sublobar resection was 90.4% (38/42). In 40.4% (17/42) of patients, the target lesions were not detectable under visual inspection with white light but were visualized with IMI. Lesion depth was higher in lesions not visualized with IMI compared to those that were visualized (11.6 mm vs. 5.2 mm, p=0.008). Final histology demonstrated malignancy in 86.7% (46/53). Benign lesions included granuloma and parenchymal scar. All final margins were negative.
Conclusions: This is the first report of experience with pafolacianine for cancer in the lung with a specific focus on localization of semi solid and ground glass opacities. These data reflect a meaningful practice change for the surgical management of these often hard to localize, small and multifocal lesions. Moreover, the use of IMI during resection of these early stage lung cancers enhances the ability to perform sublobar, parenchymal sparing resections.
Authors
Ryan Levy (1), Nicholas Baker (2), Navid Ajabshir (3), Tadeusz Witek (4), Omar Awais (5), Evan Alicuben (6)
Institutions
(1) University of Pittsburgh School of Medicine, Pittsburgh, PA, (2) West Virginia University School of Medicine, Morgantown, WV, (3) University of Pittsburgh Medical Center, Pittsburgh, PA, (4) UPMC Presbyterian, Pittsburgh, PA, (5) UPMC Mercy Hospital, Pittsburgh, PA, (6) University of Pittsburgh Medical Center, Oakmont, PA
Methods: Cases from June 2023 through October 2024 were reviewed to identify all patients with one or more semi solid or ground glass opacity with plans for sublobar pulmonary resection. Pafolacianine infusion was performed within 24 hours of surgery. Pre-operative CT scans were used to determine lesion size and depth. The lung was inspected for fluorescence using a proprietary imaging system.
Results: There were 42 patients (28 females, 14 males, mean age 69 years) encompassing 53 separate lesions. Multiple lesions were targeted in 16.7% of patients (7/42). The median lesion size was 14 mm (range 6-32 mm), and median depth was 3 mm (range 1-27 mm). Minimally invasive (robotic n=20 VATS n=22) resection was performed in all patients (segmentectomy n=13, wedge resection n=19, segmentectomy and wedge resection n=3, lobectomy n=4). The overall rate of sublobar resection was 90.4% (38/42). In 40.4% (17/42) of patients, the target lesions were not detectable under visual inspection with white light but were visualized with IMI. Lesion depth was higher in lesions not visualized with IMI compared to those that were visualized (11.6 mm vs. 5.2 mm, p=0.008). Final histology demonstrated malignancy in 86.7% (46/53). Benign lesions included granuloma and parenchymal scar. All final margins were negative.
Conclusions: This is the first report of experience with pafolacianine for cancer in the lung with a specific focus on localization of semi solid and ground glass opacities. These data reflect a meaningful practice change for the surgical management of these often hard to localize, small and multifocal lesions. Moreover, the use of IMI during resection of these early stage lung cancers enhances the ability to perform sublobar, parenchymal sparing resections.
Authors
Ryan Levy (1), Nicholas Baker (2), Navid Ajabshir (3), Tadeusz Witek (4), Omar Awais (5), Evan Alicuben (6)
Institutions
(1) University of Pittsburgh School of Medicine, Pittsburgh, PA, (2) West Virginia University School of Medicine, Morgantown, WV, (3) University of Pittsburgh Medical Center, Pittsburgh, PA, (4) UPMC Presbyterian, Pittsburgh, PA, (5) UPMC Mercy Hospital, Pittsburgh, PA, (6) University of Pittsburgh Medical Center, Oakmont, PA