P21: Utility of near infrared autofluorescence detection of small bowel neuroendocrine tumors to guide extent of resection

Thursday, March 23, 2023

3:31 PM – 3:36 PM

Location: SSO HUB: Breast & Endocrine Zone

Poster Presenter(s)

Colleen Kiernan, MD, MPH (she/her/hers)

Assistant Professor of Surgery
Vanderbilt University Medical Center

Disclosure information not submitted.

Author(s)

Colleen Kiernan, MD, MPH (she/her/hers)

Assistant Professor of Surgery
Vanderbilt University Medical Center

Disclosure information not submitted.
GT

Giju Thomas, PhD

Assistant Professor of Biomedical Engineering
Vanderbilt University, United States

Disclosure information not submitted.
PW

Parker Willmon, BS

PhD Student
Vanderbilt University, United States

Disclosure information not submitted.
Christina E. Bailey, MD, MSCI

Associate Professor of Surgery, General Surgery Program Director
Vanderbilt University Medical Center
Nashville, Tennessee, United States

Disclosure information not submitted.
Deepa Magge, MD, FACS

Assistant Professor of Surgery
Vanderbilt University Medical Center
Nashville, Tennessee, United States

Disclosure information not submitted.
MT

Marcus Tan, MBBS

Assistant Professor of Surgery
Vanderbilt University Medical Center, United States

Disclosure information not submitted.
CP

Chandrasekhar Padmanabhan, MD

Assistant Professor of Surgery
Vanderbilt University Medical Center, United States

Disclosure information not submitted.
Kamran Idrees, MD, MSCI, MMHC

Chief, Division of Surgical Oncology and Endocrine Surgery
Vanderbilt University Medical Center
Nashville, Tennessee, United States

Disclosure information not submitted.
AM

Anita Mahadevan-Jansen, PhD

Professor of Biomedical Engineering
Vanderbilt University, United States

Disclosure information not submitted.
Carmen C. Solórzano, MD (she/her/hers)

Professor and Chair, Department of Surgery
Vanderbilt University
Nashville, Tennessee, United States

Disclosure(s): No financial relationships to disclose

Disclosure(s):

Carmen C. Solórzano, MD: No financial relationships to disclose

Introduction: During resection of small bowel neuroendocrine tumors (SBNET), surgeons rely on visual inspection and palpation to determine extent of bowel resection and lymphadenectomy. This may result in incomplete resection of disease. We present a novel label-free approach that utilizes near infrared autofluorescence (NIRAF) detection to localize SBNETs and visualize extent of disease intraoperatively.

Methods: Patients undergoing laparotomy for small bowel neoplasm from March 2021 to August 2022 were enrolled. NIRAF images were captured using a near infrared camera, whereas NIRAF intensities were concurrently recorded using a probe-based near infrared device. NIRAF > 800nm was measured in vivo from small bowel lesion(s) and adjacent uninvolved tissues, and ex vivo in excised specimens. NIRAF intensities were normalized to fat/mesentery. Normalized NIRAF intensities (mean ± standard error) were analyzed and compared. A p-value < 0.05 was considered significant, upon using a 2-tailed Student’s t-test of unequal variance.

Results: Among the 11 patients with SBNET enrolled, normalized NIRAF intensity was significantly elevated for primary SBNETs (4.80 ± 0.32) and lymph node (LN) metastases (6.15 ± 0.77) when compared to surrounding bowel (1.04 ± 0.07, p< 0.01), mesentery (0.66 ± 0.05, p< 0.01), fat (0.68 ± 0.06, p< 0.01) and healthy LNs (1.03 ± 0.03, p< 0.01). In one patient with SBNET metastatic to the liver, the liver metastases however had decreased NIRAF intensity (2.85 ± 0.15), in comparison to the uninvolved liver (19.35 ± 0.15). In comparison, for the 2 patients with non-NET primary small bowel malignancies (adenocarcinoma, clear cell carcinoma), the tumor NIRAF intensity was higher (2.01 ± 0.32) relative to adjacent bowel and mesentery, but yielded substantially lower values compared to primary SBNETs.

Conclusions: Our preliminary findings indicate that NIRAF detection is feasible and could be used intraoperatively to enhance the surgeon’s identification and assessment of the extent of primary and metastatic SBNET. This label-free technology may prove useful in achieving complete resection of the primary tumor and improve nodal staging.

Learning Objectives:

Understand the technologies available to detect tissue autofluorescence
Describe the pattern of tissue autofluorescence in primary and metastatic small bowel neuroendocrine tumors
Evaluate the use of tissue autofluorescence to guide the extent of resection for primary and metastatic small bowel neuroendocrine tumors