The visualization/distinction of diseased and healthy tissues represents a critical problem, both in the case of surgery (the problem of precision) and in the case of therapy with drug delivery systems (the problem of drug targeting). In these situations, the goal is to avoid iatrogenic injuries. These issues involve the treatment of different diseases, and cancer is one of the most important (but not the only) examples among them as the most pervasive and feared disease of humankind. Through centuries of research, scientists have obtained significant results manifested in the development of new drugs, new surgical techniques, and new diagnostic tools. Today, we have the opportunity to transform it from an infamous disease into a truly curable condition. While the war is far from a complete success in terms of remission, most patients experience prolonged survival and good quality of life. Among the discoveries, we now understand that intraoperative staging is a pivotal route to eradicating a tumor through surgery. We also know that chemotherapy is most effective when the tumorous burden is as close as possible to zero remaining cells. It is clear that intraoperative imaging is a tool aimed at guiding the surgeon, and in response, intraoperative ultrasound has arisen as a solution to the task. However, there is a limit to its resolution.
Theranostic systems based on polymeric nanoparticles represent another important weapon to be used, in addition to, or as an alternative to surgery.
Recently, fluorescent tracers of different kinds have demonstrated a prospective path to enhance diagnostic approaches. Several pioneering studies have shown that indocyanine green can detect a cancer and guide the surgeon. There has been increasing interest in such studies on liver cancers, breast tumors, gynecologic neoplasms as well as those in several other disease sites. Interestingly, fluorescent dyes can diffuse through the lymphatic system so the lymphnodes can be easily observed. In parallel, there has been a flourishing of new instruments, aiming to test fluorescence in emerging fields, such as laparoscopic and robotic surgery. Minimally invasive procedures present unique challenges for intraoperative detection because the instruments (and probes) have to be smaller and equally accurate. Research efforts from academia and industry are trying to stabilize florescent dies by coupling them with polymers, micro and nanoparticles, to obtain a precision bullet to target and uncover any residual cancer. The time has come to bring together such efforts to give a large visibility to a potential breakthroughs that are flourishing in the clinical setting. And most importantly, the time has come for a united venture among basic science, biotechnology, medicine and engineering to explore what seems possible and feasible in this field.
Caption of the Figure:
Intraoperative detection of intrahepatic biliary tree to guide precision surgery (experimental).
The visualization/distinction of diseased and healthy tissues represents a critical problem, both in the case of surgery (the problem of precision) and in the case of therapy with drug delivery systems (the problem of drug targeting). In these situations, the goal is to avoid iatrogenic injuries. These issues involve the treatment of different diseases, and cancer is one of the most important (but not the only) examples among them as the most pervasive and feared disease of humankind. Through centuries of research, scientists have obtained significant results manifested in the development of new drugs, new surgical techniques, and new diagnostic tools. Today, we have the opportunity to transform it from an infamous disease into a truly curable condition. While the war is far from a complete success in terms of remission, most patients experience prolonged survival and good quality of life. Among the discoveries, we now understand that intraoperative staging is a pivotal route to eradicating a tumor through surgery. We also know that chemotherapy is most effective when the tumorous burden is as close as possible to zero remaining cells. It is clear that intraoperative imaging is a tool aimed at guiding the surgeon, and in response, intraoperative ultrasound has arisen as a solution to the task. However, there is a limit to its resolution.
Theranostic systems based on polymeric nanoparticles represent another important weapon to be used, in addition to, or as an alternative to surgery.
Recently, fluorescent tracers of different kinds have demonstrated a prospective path to enhance diagnostic approaches. Several pioneering studies have shown that indocyanine green can detect a cancer and guide the surgeon. There has been increasing interest in such studies on liver cancers, breast tumors, gynecologic neoplasms as well as those in several other disease sites. Interestingly, fluorescent dyes can diffuse through the lymphatic system so the lymphnodes can be easily observed. In parallel, there has been a flourishing of new instruments, aiming to test fluorescence in emerging fields, such as laparoscopic and robotic surgery. Minimally invasive procedures present unique challenges for intraoperative detection because the instruments (and probes) have to be smaller and equally accurate. Research efforts from academia and industry are trying to stabilize florescent dies by coupling them with polymers, micro and nanoparticles, to obtain a precision bullet to target and uncover any residual cancer. The time has come to bring together such efforts to give a large visibility to a potential breakthroughs that are flourishing in the clinical setting. And most importantly, the time has come for a united venture among basic science, biotechnology, medicine and engineering to explore what seems possible and feasible in this field.
Caption of the Figure:
Intraoperative detection of intrahepatic biliary tree to guide precision surgery (experimental).
