# Multimodal Fluorescence- and Imaging-Guided Surgical Navigation: Developing Methods for Subsurface, Indirect Visualization of Cancers Requiring Wide Local Excision

> **NIH NIH K23** · DARTMOUTH-HITCHCOCK CLINIC · 2020 · $169,555

## Abstract

Project Summary
The primary goal of cancer surgery is to cure patients of their tumors. One of the oncological surgeon’s
greatest challenges is to successfully distinguish cancer tissue from non-cancer tissue. Fluorescence-
guided surgery has radically changed the surgeon’s ability to make this determination, with demonstrably
better outcomes; however, fluorescence guidance is currently only applicable in the setting of tumors that
are near their parent organ’s surface, such as the throat or bladder, or cancers that are removed
piecemeal, such as brain tumors. In both of these scenarios, the tumor is visualized directly with surface-
based fluorescence guidance. Many cancers, such as the sarcomas that I treat in clinical practice, are
removed ideally with a zone of normal tissue surrounding the tumor; this zone is referred to as the
margin. This type of surgery is called a wide local excision and the success or failure of the surgery is
determined by the presence or absence of cancer cells at the cut surface of the removed specimen,
which is reviewed by a pathologist. The pathologist will classify the margin as positive, where cancer
cells are present at the specimen’s surface—a failed wide local excision, or negative, where only normal
tissue is present at the specimen’s surface—a successful wide local excision. Based on published
reports, failed wide local excisions occur about 20-25% of the time, which have negative effects on
patient outcomes. Applying fluorescence guidance to wide local excision surgeries holds the promise of
providing real-time feedback to surgeons regarding the distance from their instruments to the tumor’s
surface, thereby instructing the surgeon as to the thickness of the margin and helping avoid a failed
surgery—such a change in practice would be revolutionary. Fluorescence-guided surgery for cancers
requiring wide local excision is possible in theory; however, it would require that the cancer’s location be
monitored via indirect, subsurface fluorescence guidance, which is not possible with current technology. I
am a fellowship-trained musculoskeletal oncology surgeon, a subspecialty of orthopaedics dedicated to
the surgical treatment of patients with bone and soft-tissue sarcomas that generally require radical, limb-
sparing operations. I believe that fluorescence-guided surgery holds tremendous promise for treating
patients with sarcomas and other cancers requiring wide local excision. I have completed seminal work
to address knowledge gaps that must be filled in order to translate this concept into practice, however, I
realize the limits of my knowledge and skills and understand that in order to pursue my career goals I
require additional training. Through this award I will pursue mentored research and didactics in
biomedical optics, advanced imaging technology, and clinical research design that will enable me to
transition from a junior clinical researcher into an independent clinician-scientist and achieve my prima...

## Key facts

- **NIH application ID:** 9975158
- **Project number:** 5K23EB026507-04
- **Recipient organization:** DARTMOUTH-HITCHCOCK CLINIC
- **Principal Investigator:** Eric R Henderson
- **Activity code:** K23 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $169,555
- **Award type:** 5
- **Project period:** 2018-08-01 → 2022-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9975158

## Citation

> US National Institutes of Health, RePORTER application 9975158, Multimodal Fluorescence- and Imaging-Guided Surgical Navigation: Developing Methods for Subsurface, Indirect Visualization of Cancers Requiring Wide Local Excision (5K23EB026507-04). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/9975158. Licensed CC0.

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