Tumor-free surgical margins are critical in breast-conserving surgery, as local recurrence rates increase with positive margins. Molecular imaging is a promising strategy for visualizing and quantifying tumor-specific molecular characteristics and potentially improves breast cancer care in terms of detection, characterization, and (non-)surgical treatment strategies. A potential target for molecular imaging is VEGF-A, involved in tumor angiogenesis. Our study shows that systemic administration of the fluorescent bevacizumab–IRDye800CW tracer is safe in ex vivo breast cancer guidance and confirms (tumor-)margin uptake providing a novel framework for systematic evaluation and validation of fluorescent tracers in image-guided surgery and drug development. As neoangiogenesis is a universal tumor marker, other tumor types like colorectal and esophageal cancer might benefit from fluorescence-guided molecular endoscopy using bevacizumab–IRDye800CW.This approach is of interest for surgical guidance, but also for diagnostic purposes, drug development, and treatment monitoring.
The cover shows patients with primary breast cancer colocalization of VEGF-A expression (red) and a systemically injected near-infrared fluorescent tracer bevacizumab-IRDye800CW (green) through Multiplex Advanced Pathology Imaging (MAPI). For details, see the article by Lamberts and colleagues on page 2730 of this issue.