Clinical challenges in image-guided surgery in cancer

The field of image guided surgery (IGS) has gained much interest due to the introduction of targeted fluorescent tracers. IGS trials in cancer are aimed at detection of unknown pathology or the assessment of a surgical margin after excision. Next to developing fluorescent tracers and imaging devices, a successful introduction into cancer care requires adaptation of clinical workflows. Adapting the strategy to answer the right clinical question is becomes more relevant now first experiences with fluorescent tracers have shown the potential of image guided surgery. At UMCG we have used several targeted tracers for intra operative use. Cetuximab-800CW tracer for the detection of EGFr, bevazicumab-800CW for VEGF and others such as ONM100 as a pH sensitive probe. Our studies show that targeted tracers can provide valuable information during surgery and that IGS can serve as a decision making tool. Although, the focus of the IGS community currently lies on the choice of tracers, we think that the design of the workflow should gain as much attention as well. When this is organised in a clinical setting the choice of a tracer can easily be adapted.