Near-Infrared Intraoperative Imaging Can Successfully Identify Malignant Pleural Mesothelioma After Neoadjuvant Chemotherapy

Our plain-English summary of Near-Infrared Intraoperative Imaging Can Successfully Identify Malignant Pleural Mesothelioma After Neoadjuvant Chemotherapy, by J.D. Predina, A. Newton, G. Kennedy, et al (Molecular Imaging, 2017).

The study

• Authors: J.D. Predina, A. Newton, G. Kennedy, M.K. Lee, S. Singhal
• Journal: Molecular Imaging
• Published: 2017;16:1536012117723785
• Cited by: 13 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant pleural mesothelioma is a deadly disease. Complete surgical resection provides patients with the best opportunity for long-term survival. Unfortunately, identification of disease during resection can be challenging. In this report, we describe successful intraoperative utilization of the near-infrared imaging agent, indocyanine green, to help the surgeon identify malignant disease in a patient with malignant pleural mesothelioma who had previously received neoadjuvant chemotherapy. This technology may ultimately enhance the thoracic surgeon's ability to identify small disease deposits at the time of resection.

In plain English

This brief report described a single patient: a 67-year-old man treated at the University of Pennsylvania for a left-sided pleural tumor. A needle biopsy was suggestive of epithelioid malignant pleural mesothelioma. In a clinical trial he first received six cycles of cisplatin/pemetrexed with a study drug, LY3023414, and then about five weeks of LY3023414 alone. Twenty-four hours before a left-sided pleurectomy and decortication, he was given intravenous indocyanine green (5 mg/kg), a dye that glows under near-infrared light. During surgery the imaging helped the surgeon tell benign inflammation apart from tumor on the pleural surface, and it clearly showed a nodule on the diaphragm. A pathologist confirmed mesothelioma in 91% of the glowing nodules; the report does not give the number of nodules. No mesothelioma was found in non-glowing areas of the specimen. The imaging added 5 minutes to the operation, and the patient recovered without signs of study drug toxicity. The authors called these initial results encouraging and said more data are being collected. The report does not discuss asbestos exposure.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Case report (brief report) of one patient
• Who was studied: One 67-year-old male patient with a left-sided pleural tumor, biopsy suggestive of epithelioid malignant pleural mesothelioma, seen at a pleural disease clinic at the University of Pennsylvania
• Exposure: No asbestos exposure is reported. The intervention studied was intravenous indocyanine green (5 mg/kg) given 24 hours before surgery for near-infrared imaging during the operation. This followed prior chemotherapy with cisplatin/pemetrexed and LY3023414.
• Main results:
  • In this patient, imaging during surgery helped the surgeon distinguish benign inflammation from malignant spots on the pleural surface. Inflammation and pleural studding were present, all under 1 cm.
  • The diaphragmatic nodule was clearly outlined by the fluorescence and was removed.
  • Of the fluorescent nodules examined by a pulmonary pathologist, 91% were confirmed as mesothelioma. The total number of nodules is not stated.
  • No mesothelioma deposits were found in non-fluorescent areas of the specimen. The authors reported this as a negative predictive value of 100%.
  • The imaging added 5 minutes to the operation, and the patient recovered without signs of study drug toxicity.
• The authors' conclusion: The authors concluded that this case showed the safety and feasibility of the imaging, called the initial results encouraging, and said it was effective after neoadjuvant chemotherapy. They suggested it may improve mesothelioma resection.
• Limitations the authors state:
  • The authors described the results as initial and said additional data are still being collected.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Neoadjuvant Chemotherapy, Surgical Resection.

Related studies

• Types of surgery post-neoadjuvant chemotherapy for pleural mesothelioma — K. Kuribayashi, H. Doi, et al. (2019)
• Complete pathological response to neoadjuvant pemetrexed/cisplatin in combination with regional hyperthermia in a patient with sarcomatoid peritoneal mesothelioma — S. Kruger, M.K. Angele, et al. (2014)
• Intraoperative fluorescence imaging in thoracic surgery — A.D. Newton, J.D. Predina, et al. (2018)
• An overview of neoadjuvant chemotherapy in the multimodality treatment of malignant pleural mesothelioma — G. Pasello, G.L. Ceresoli, et al. (2013)
• Prognostic significance of metabolic response by positron emission tomography after neoadjuvant chemotherapy for resectable malignant pleural mesothelioma — Y. Tsutani, T. Takuwa, et al. (2013)
• Tertiary lymphoid structures in epithelioid malignant peritoneal mesothelioma are associated with neoadjuvant chemotherapy, but not with prognosis — N. Benzerdjeb, P. Dartigues, et al. (2021)

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