Fluorescence image-guided tumour surgery

Intraoperative fluorescent imaging can provide real-time identification of tumours, lymph nodes, nerves and other healthy and malignant tissues during oncological surgery, contributing to better surgical outcomes. Various fluorescent probes have been clinically approved for surgical applications, improving tumour resection precision and preventing iatrogenic injury. In this Review, we discuss the development and application of fluorescent probes for image-guided surgery, including systemically and locally applied probes that are either non-targeted or targeted to specific tumours and tissues. We discuss the optimization and clinical potential of these probes, and highlight their current and future applications in oncological surgery. In addition, we examine the hardware of fluorescence imaging equipment, and discuss how artificial intelligence can enable real-time quantification to guide surgical decision-making. Finally, we highlight the remaining challenges in the field of image-guided surgery, including the need for standardization to achieve regulatory approval of new probes, and the required team effort for new probe development. Fluorescence imaging-guided surgery enables tumour resection with high precision, while preventing injury of healthy tissues. This Review discusses the clinical application and preclinical development of intraoperative fluorescence imaging probes and imaging equipment, including artificial intelligence algorithms.