Background/Objectives: Pancreatic cancer is the fourth leading cause of deaths related to cancer. It is a highly aggressive malignancy and often metastasizes quickly to other parts of the body and organs. The most effective cure is surgical resection, which also is limited by tumor identification and clear tumor margin visualization. Previously, we used MUC4 antibodies labeled with IRDye800CW (anti-MUC4-IR800) to target primary human pancreatic cancer in orthotopic cell line mouse models. Methods: In the present study, we established a pancreatic cancer liver metastasis mouse model by implanting a tumor fragment in the liver and a peritoneal carcinomatosis mouse model by injecting pancreatic cancer cells interperitoneally. Once the tumors were established, anti-MUC4-IR800 was administered to the mice by tail vein injection. Laparotomy was performed and tumors were imaged under white-light and near-infrared (NIR) fluorescence with the Pearl Small Animal Imaging System. Results: NIR imaging after 72 h shows the bright targeting of pancreatic cancer metastasis in both mouse models with high tumor-to-background ratios. Conclusions: Anti-MUC4-IR800 was able to successfully target and brightly label metastatic pancreatic cancer as small as 1 mm. Future clinical applications of the results of the present study are discussed.

Positive surgical margins (PSMs) are a major predictor of recurrence in thyroid cancer; however, their intraoperative detection remains challenging, particularly for microscopic PSMs. This study aimed to demonstrate that a sprayable pH-sensitive near-infrared fluorescent probe (PH10) could specifically and robustly label thyroid tumors in orthotopic mouse models. The pH sensitivity, cytotoxicity, and cellular uptake mechanisms of PH10 were evaluated in papillary thyroid carcinoma (K1) and anaplastic thyroid carcinoma (8505C) cell lines in vitro. Orthotopic thyroid cancer mouse models were then established using both K1 and 8505C cells. In vivo fluorescence following topical spraying of PH10 was quantified after sequential washes to assess tumor-to-background ratios. Fluorescence-guided surgery (FGS) was performed to determine whether PH10 could facilitate complete resection of orthotopically grown thyroid tumors. Complete resection was validated by hematoxylin and eosin histology. PH10 demonstrated low cytotoxicity at clinically relevant concentrations in vitro and showed selective uptake into thyroid cancer cells, predominantly via organic anion transporting polypeptide-mediated transport. Topical spraying of PH10 in orthotopic thyroid cancer mouse models established from K1 and 8505C cell lines generated strong tumor-specific fluorescence. Tumor-to-background ratios were significantly higher than background and remained distinguishable after multiple washes. In both models, PH10 enabled visualization of macroscopic residual tumors and detection of microscopic PSMs, with fluorescence patterns closely corresponding to histologic findings. FGS enabled complete tumor resection, as confirmed by fluorescence and histology. In conclusion, topical application of PH10 provides rapid, tumor-specific fluorescence suitable for identifying PSMs and facilitating complete tumor resection by FGS in thyroid cancer.

Background/Purpose: The only potentially curative procedure for pancreatic cancer is R0 resection, which is difficult to achieve due to poorly defined tumor margins. In the present study, we used an anti-CA19-9 antibody conjugated to a near-infrared fluorophore in orthotopic mouse models to target and visualize pancreatic cancer. Methods: Orthotopic models of the human pancreatic cancer cell lines SW1990 and BxPC3 were established by implanting tumor fragments into the pancreas of athymic nude mice. Anti-CA19-9 and control IgG were conjugated with IRDye800CW. Mice received 50 µg of CA19-9–IRDye800CW or IgG-IRDye800CW via tail-vein injection and were imaged after 72 h. MIA PaCa-2, a CA19-9-negative cell line, was used in subcutaneous models to assess targeting specificity. Results: Using the LI-COR Pearl imaging system in the SW1990 model, the tumor-to-pancreas ratio (TPR) was 4.51 (±0.74), and the tumor to the liver ratio (TLR) was 3.05 (±0.60) with CA19-9-IRDye800CW, while the TPR was 1.67 (±0.16) and the TLR was 0.95 (±0.05) for the non-specific control IgG–IRDye800CW. Using a clinically available fluorescence laparoscope, CA19-9-1RDye800CW demonstrated a TPR of 2.34 (±0.44) and a TLR of 2.23 (±0.49), compared to 1.11 (±0.13) and 0.69 (±0.07), respectively, for IgG-IRDye800CW in the SW1990 orthotopic model. In the BxPC3 models, the TPR was 3.82 (±0.55) and the TLR was 4.13 (±0.77) for CA19-9-IRDye800CW compared to 2.40 (±0.31) and 1.49 (±0.23), respectively, for IgG-IRDye800CW. Conclusions: CA19-9-IRDye800CW provided specific in vivo targeting of two human pancreatic cancer cell lines in orthotopic nude mouse models with superior TPRs and TLRs compared to IgG-IRDye800CW. This tumor-specific fluorescent CA19-9 antibody is a promising clinical tool for improved visualization of pancreatic cancer.

Background/Objectives: Parathyroidectomy is a curative procedure for primary hyperparathyroidism, and multi-phase CT is an integral part of surgical planning. While patients may be referred to centers specializing in endocrine surgery, their imaging may be performed at other facilities without the same high-volume expertise. Methods: A retrospective review was performed of radiologist second reads of outside neck CT imaging in patients with hyperparathyroidism referred for surgical management. Results: The initial outside report was 59% sensitive for localization of parathyroid adenoma in the 74 patients with surgical pathologic confirmation. Second reads of the same CT scans correctly identified the parathyroid adenoma in an additional 24% of patients, for a total sensitivity of 83%. For the 23% of patients with pathologically confirmed multi-gland involvement, the initial outside report was 21% sensitive for lesion detection, and the second read of the same scans was 68% sensitive. Conclusions: Endocrine surgeons should be aware that community-based radiology interpretation of neck CT may be less sensitive than reported series from academic and high-volume practices. In the present study, interpretation via second read of outside CT scans by a neuroradiologist engaged with the endocrine surgery service line increased the sensitivity of detecting candidate lesions, both for single-gland and multi-gland involvement. While it is preferred to have preoperative imaging and interpretation within the same high-volume center as the surgeon for consistency of imaging quality, experience and communication, radiologist second reads deserve financial and service line support when that is not possible given the impact on surgical planning and patient care.