ArticleOperative neurosurgery (Hagerstown, Md.)2019
Folate Receptor Near-Infrared Optical Imaging Provides Sensitive and Specific Intraoperative Visualization of Nonfunctional Pituitary Adenomas.
Article in Operative neurosurgery (Hagerstown, Md.), 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 1 of them a synthesis that pooled it.
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Who cites it
15 citing papers in PubMed, 1 synthesis or guideline pooled it, 41 citations in OpenAlex.
- Use of optical fluorescence agents during surgery for pituitary adenomas: current state of the field.Journal of neuro-oncology · 2019Pooled it
- Surface-Registration Frameless Stereotactic Navigation Is Less Accurate During Prone Surgeries: Intraoperative Near-Infrared Visualization Using Second Window Indocyanine Green Offers an Adjunct.Molecular imaging and biology · 2020Trial
- Systematic review of fluorescence-guided surgery in pituitary neuroendocrine tumours.Endocrine oncology (Bristol, England) · 2025Review
- Fluorescence detection of pituitary neuroendocrine tumour during endoscopic transsphenoidal surgery using bevacizumab-800CW: a non-randomised, non-blinded, single centre feasibility and dose finding trial [DEPARTURE trial].European journal of nuclear medicine and molecular imaging · 2025Article
- Enlightening the invisible: Applications, limits and perspectives of intraoperative fluorescence in neurosurgery.Brain & spine · 2024Review
- Dual probe difference specimen imaging for prostate cancer margin assessment.Journal of biomedical optics · 2023Article
- Intraoperative Tumor Detection Using Pafolacianine.International journal of molecular sciences · 2022Review
- Forging the Frontiers of Image-Guided Neurosurgery-The Emerging Uses of Theranostics in Neurosurgical Oncology.Frontiers in bioengineering and biotechnology · 2022Article
- Fluorescence guided surgery for pituitary adenomas.Journal of neuro-oncology · 2021Review
- Diagnosis of Pituitary Adenoma Biopsies by Ultrahigh Resolution Optical Coherence Tomography Using Neuronal Networks.Frontiers in endocrinology · 2021Article
- Receptor-Targeted Fluorescence-Guided Surgery With Low Molecular Weight Agents.Frontiers in oncology · 2021Review
- Confocal Laser Endomicroscopy Assessment of Pituitary Tumor Microstructure: A Feasibility Study.Journal of clinical medicine · 2020Article
- Intraoperative near-infrared imaging with receptor-specific versus passive delivery of fluorescent agents in pituitary adenomas.Journal of neurosurgery · 2019Article
- Near-Infrared Optical Contrast of Skull Base Tumors During Endoscopic Endonasal Surgery.Operative neurosurgery (Hagerstown, Md.) · 2019Article
- Indocyanine-Green for Fluorescence-Guided Surgery of Brain Tumors: Evidence, Techniques, and Practical Experience.Frontiers in surgery · 2019Article
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Authors and funding
15 authors at 3 institutions in 1 country.
Funding
Abstract
backgroundSurgical resection is the primary treatment for nonfunctional (NF) pituitary adenomas, but gross-total resection is difficult to achieve in all cases. NF adenomas overexpress folate receptor alpha (FRα).
objectiveTo test the hypothesis that we could target FRα for highly sensitive and specific intraoperative detection of NF adenomas using near-infrared (NIR) imaging.
methodsFourteen patients with NF pituitary adenoma were infused with the folate analog NIR dye OTL38 preoperatively. NIR fluorescence signal-to-background ratio (SBR) was recorded for each tumor during resection of the adenomas. Extent of surgery was not modified based on the presence or absence of fluorescence. Immunohistochemistry was performed to assess FRα expression in all specimens. Magnetic resonance imaging (MRI) was performed postoperatively to assess residual neoplasm.
resultsNine adenomas overexpressed FRα and fluoresced with a NIR SBR of 3.2 ± 0.52, whereas the 5 non-FRα-overexpressing adenomas fluoresced with an SBR of 1.5 ± 0.21. Linear regression demonstrated a significant correlation between intraoperative SBR and the FRα expression (P-value < .001). Analysis of 14 margin samples revealed that the surgeon's impression of the tissue had 83% sensitivity, 100% specificity, 100% positive predictive value, and 89% negative predictive value, while NIR fluorescence had 100% for all values. NIR fluorescence accurately predicted postoperative MRI results in 78% of FRα-overexpressing patients.
conclusionPreoperative injection of folate-tagged NIR dye provides strong signal and visualization of NF pituitary adenomas. It is 100% sensitive and specific for detecting margin neoplasm and can predict postoperative MRI findings. Our results suggest that NIR fluorescence may be superior to white-light visualization alone and may improve resection rates in NF pituitary adenomas.
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