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Yu Hua Quan



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    P1.16 - Surgery (ID 702)

    • Event: WCLC 2017
    • Type: Poster Session with Presenters Present
    • Track: Surgery
    • Presentations: 2
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      P1.16-012 - Application of Fluorescent and Iodized Dual Marker for Pre-Operative Localization and Image-Guided Surgery of Pulmonary Nodule (ID 9204)

      09:30 - 16:00  |  Author(s): Yu Hua Quan

      • Abstract

      Background:
      This study evaluated the feasibility of pre-operative localization of pulmonary nodule using dual marker composed with indocyanine green (ICG) and lipiodol for minimal and accurate resection in video-assisted thoracoscopic surgery (VATS).

      Method:
      To minimize separation of two materials, we mixed with different frequency and ratio of ICG and lipiodol using a 3-way stopcock, and investigated their distribution with fluorescent microscope. Three rabbits were undergone thoracotomy after computed-tomography (CT) fluoroscopy-guidance injection of each 0.1 ml emulsions into different lobes of rabbit lung at 6, 12 or 24 hours. The localized lesions were evaluated by near-infrared optical imaging and radiograph. The 0.3 ml of emulsion was pre-operatively injected into 22 patients under CT fluoroscpy-guidance, and the localization was then evaluated during surgery by near-infrared imaging and mobile C-arm fluoroscopic x-ray. All freshly excised specimens were diagnosed by pathologic examination.

      Result:
      In in vitro, the separation time of ICG and lipiodol emulsion was delayed proportionally to mixing frequency and ratio. The emulsion mixed with 90 passages and 90% lipiodol was the least separated at 24 hours. On the rabbit lung, the optimal emulsion remained stably on injection site until 24 hours after injection. Pulmonary nodule localization using the optimal emulsion was performed successfully on the 22 patients without complications.

      Conclusion:
      This easy optimal method for pre-operative localization of pulmonary nodule was successfully established. The emulsion can be a useful marker to show the location of lesion to surgeons. However, ICG and lipiodol were not mixed perfectly and evenly. Therefore, there will be needed a future research to stabilize two materials completely.

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      P1.16-018 - Intraoperative Detection of Tumor Resection Margin via Inhalation of Fluorescent Imaging Agents (ID 9755)

      09:30 - 16:00  |  Presenting Author(s): Yu Hua Quan

      • Abstract

      Background:
      Near Infrared (NIR) fluorescent (Indocyanine green, ICG)-based EPR (enhanced permeability and retention) effects on identifying surgical margins are being used in lung cancer surgery. However, as ICG is equally likely to accumulate in tumors and inflamed tissue, this can cause false-positive results. In this study, we developed the novel method of Inhaled fluorescent based detection of intraoperative tumor resection margin by distinguishing cancerous tissue from normal tissue in mouse and rabbit lung cancer models.

      Method:
      ICG (1 mg/kg) was administered to healthy mice and mice with lung cancer via inhalation for 1h, and the lung distribution of ICG was investigated using a fluorescence imaging system. And, we established a computed tomography-guided VX2 lung cancer model in 6 rabbits. ICG was administered to these rabbits and resected tumor from lung cancer patients via nebulizer, and the lung cancer was resected under fluorescence imaging system after 1h. The resected tumor margins were investigated using confocal microscopy.

      Result:
      In normal mice, the inhaled ICG signal was significantly higher in lung compared to other organs (liver, brain, spleen, and kidneys), and this signal decreased over time. In metastatic lung cancer mouse models, the inhaled ICG was distributed only in normal tissues, except cancer. In the rabbit and resected cancer of human, the margin between cancer and normal tissue were distinguished clearly, and the tumor was successfully resected under ICFIS guidance in all 6 rabbits (Fig 3). Additionally, fluorescence and histological microscopy demonstrated that ICG was localized in normal lung tissue. The difference of fluorescent intensity between normal versus cancer tissue showed significantly higher in inhaled ICG Figure 1



      Conclusion:
      Fluorescent signal was dominantly observed in normal lung tissue comparing to cancer area after inhalation of ICG. The aerosolized ICG could provide better image information for intraoperative identification of resection margin during lung cancer surgery than the intravenous ICG injection.

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    P3.02 - Biology/Pathology (ID 620)

    • Event: WCLC 2017
    • Type: Poster Session with Presenters Present
    • Track: Biology/Pathology
    • Presentations: 1
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      P3.02-010 - Significant Increase of Blood Extracellular Vesicles in Pulmonary Vein as Potential Prognostic Biomarker for Lung Cancer Patients (ID 9973)

      09:30 - 16:00  |  Author(s): Yu Hua Quan

      • Abstract

      Background:
      Exracellular vesicles(EVs) are endosome-derived nano-size (30-1000 nm) vesicles released from many cell types including cancer cells. Previous researches have demonstrated that the level of EVs is increased in cancer patients than healthy controls. This study was conducted to evaluate the variation of EVs-count in the proximal tumor-drainage vessel and peripheral vessels during surgery for VX2 rabbit lung cancer model and primary lung cancer patients

      Method:
      A total of 6 rabbits were used in this study (3 in normal group, 31 in lung cancer group). Rabbit VX2 lung cancer model was made by real-time computed tomographic guided inoculation of VX2 cancer. Two weeks after injection, blood was collected from rabbit peripheral vessel and pulmonary vein (proximal tumor-drainage vein). A total of 3 healthy controls and 31 patients with primary lung cancer who had pT2aN0 (stage IB) and underwent lobectomy were selected. For each patient, 3 ml of blood was sampled from the radial artery (peripheral vessel) before surgery and from pulmonary vein of the primary tumor site (proximal tumor-drainage vein) during surgical procedure. Healthy controls blood were collected from peripheral vessels. EVs were isolated by serial centrifugation followed by ExoQuick[TM] and quantitative analysis was performed by NanoSight and western blotting.

      Result:
      EVs-count was not different in normal rabbit model according to blood sampling sites (peripheral vessel: 2.78 x 10[8] particles/ml, pulmonary vessel: 2.64 x 10[8]; p = 0.104). However, in rabbit lung cancer model, EVs were increased by 623.5% in peripheral vessels (1.73 x 10[9 ]particles/ml; p = 0.003) and 787.9% in proximal tumor-drainage vein (2.08 x 10[9] particles/ml; p = 0.001) comparing to those of normal rabbits. Moreover, we confirmed that EVs-count in VX2 lung cancer model was increased by 120.0% (p = 0.05) on the proximal tumor-drainage vein than peripheral vessel. In human blood samples, peripheral blood derived EVs were increased by 181.6% in lung cancer patient in comparison with healthy controls (2.44 x 10[8] particles/ml in healthy control, 4.43 x 10[8] particles/ml in lung cancer patients; p = 0.04). And, EVs were significantly increased by 700.8% in pulmonary vein of the primary tumor site (1.71 x 10[9] particles/ml; p = 0.0001) comparing to peripheral vessels in lung cancer patients

      Conclusion:
      The increase of EVs was more prominent in tumor-drainage veins than peripheral vessels in animal cancer models and lung cancer patients. We suggest that increase of EVs from tumor-drainage veins may provide more relevant prognostic information of the lung cancer patients comparing to those from peripheral vessel after surgery.