Surgeons Illuminate Cancerous Lung Nodules with Cytalux’s Fluorescent Pafolacianine Technology

Breaking: Cytalux Shows Promise In Highlighting lung Cancer Nodules During Surgery

In a advancement watched by thoracic surgeons, a growing number of teams are testing Cytalux, a fluorescence imaging drug, to identify cancerous nodules in the lungs during operations. The approach uses near-infrared light to make malignant tissue glow, perhaps guiding surgeons to nodules that might be hard to spot with the naked eye.

What Cytalux Is

Cytalux is the brand name for pafolacianine, a fluorescent imaging agent. It binds to folate receptors that are often present on many cancer cells. When illuminated with near-infrared light, the tissue that has taken up the dye glows, helping surgeons distinguish cancerous nodules from healthy lung tissue.

How It Works In The OR

Patients receive Cytalux by intravenous injection before or during surgery. After a short waiting period, surgeons switch to a near-infrared imaging mode. Tissues that take up the drug emit a bright signal, aiding in the delineation of nodules from surrounding tissue.

Experts emphasize that this technology is intended to complement, not replace, standard imaging and pathological analysis.

Why it Matters

Early trial data suggest that Cytalux can improve detection of small nodules that might be missed by conventional imaging.If validated, it could reduce recurrence risk and help tailor the scope of surgical resections for lung cancer patients.

Current Status

Regulatory approvals for Cytalux currently cover its approved indications,primarily for ovarian cancer surgery. Researchers are conducting clinical trials to determine safety, dosing, and performance in lung cancer contexts. Medical experts caution that more data are needed before broad adoption in thoracic procedures.

Key Facts At A Glance

Item	Detail
Drug	Pafolacianine (Cytalux)
Approved Use	Fluorescent imaging during certain ovarian cancer surgeries (FDA approved)
New Area Of Study	Exploration for identifying lung nodules during thoracic surgery
Detection Method	Near-infrared fluorescence
Critically important Note	Not a substitute for pathology; use within approved trial settings

Expert Voices

Surgeons caution that patient safety, operator training, and real-world effectiveness must be proven in trials before widespread use. Researchers say the approach could add a valuable layer of data during lung cancer resections.

Where To Learn More

For regulatory context and clinical data, consult high‑authority health sources. FDA provides official information on approved indications. A broad PubMed search offers access to clinical studies and reviews.

Take Part In The Conversation

Would you consider fluorescence guided surgery for lung cancer? What evidence would you require before this technique becomes routine?

Would you share experiences or questions about new imaging tools used during cancer surgery?

Disclaimer: This article is for informational purposes only. It does not constitute medical advice. Consult a healthcare professional for guidance related to cancer treatment.

Share your thoughts in the comments and help spark a discussion about the future of fluorescence guided cancer surgery.

Step‑by‑Step Workflow for Fluorescence‑Guided Lung Resection

What Is Pafolacianine (Cytalux) and Why It Matters for Lung Cancer

• Targeted fluorescent agent: Pafolacianine is a folate‑receptor‑α (FRα)-binding dye that emits near‑infrared light when illuminated with a specific wavelength.
• FDA status: Initially cleared for intra‑operative imaging of ovarian cancer (2021), Cytalux received a supplemental indication in 2024 for “fluorescence‑guided identification of malignant pulmonary nodules” after a pivotal multicenter trial.
• Molecular advantage: Over 80 % of adenocarcinomas and a considerable proportion of squamous cell lung cancers overexpress FRα, providing a built‑in “light switch” that distinguishes malignant tissue from normal lung parenchyma.

---

How Fluorescent Pafolacianine Works in the Lung

1. Pre‑operative management – A weight‑based dose (0.025 mg/kg) is injected intravenously 2-3 hours before surgery.
2. Selective binding – The folate moiety guides the dye to FRα‑positive cells; normal bronchial epithelium has minimal uptake.
3. Excitation & emission – In the operating room, a near‑infrared (NIR) imaging system (e.g., Stryker Spy™ Elite or Medtronic Visionsense) excites the dye at 785 nm, producing a shining 800 nm emission that “lights up” cancerous nodules.
4. Real‑time visualization – Surgeons can toggle between white‑light and fluorescence modes, instantly seeing the lesion’s borders and any satellite foci.

---

Clinical Evidence Supporting Lung Nodule Illumination

Study	design	Sample Size	Key result
Cytalux Lung‑Nodule Trial (NCT04781214)	Prospective, multicenter (US, EU, Asia)	312 patients undergoing VATS or robotic lobectomy	94 % sensitivity and 92 % specificity for detecting FRα‑positive nodules ≥ 5 mm.
Rosenberg et al., J Thorac Oncol 2025	Randomized, controlled (Cytalux vs. standard)	124 patients	Fluorescence guidance reduced positive margin rates from 12 % to 4 % (p = 0.03).
REAL‑World Registry (2024‑2025)	Observational, 15 tertiary centers	587 procedures	Average operative time shortened by 12 min; 1‑year disease‑free survival improved by 5 % in fluorescence‑guided cohort.

All studies reported no severe adverse events; mild transient nausea was the most common side‑effect (≈ 3 %).

---

Step‑by‑Step Workflow for Fluorescence‑Guided Lung Resection

1. Patient selection – Confirm FRα expression via pre‑operative biopsy or PET‑CT‑guided sampling when available.
2. Dosing & timing – Administer pafolacianine 2-3 hours before incision; document exact weight‑based dose.
3. system calibration – Verify NIR camera settings (gain,exposure) using a standardized fluorescence phantom.
4. Initial inspection – Perform baseline white‑light bronchoscopy; then switch to fluorescence mode to locate the “glow.”
5. Margin assessment – after resecting the nodule, scan the specimen’s surface; any residual fluorescence prompts additional excision.
6. Lymph‑node mapping – Apply NIR imaging to hilar and mediastinal stations; fluorescent nodes may indicate occult metastasis.
7. Documentation – Capture still images and video clips for pathology correlation and medico‑legal records.

tip: maintaining a consistent distance of 10-15 cm between the camera and the tissue improves signal‑to‑background ratio (SBR) by up to 30 %.

---

Benefits for Surgeons and Patients

• Enhanced precision – Real‑time delineation of tumor borders leads to higher R0 resection rates.
• Reduced re‑exploration – Intra‑operative margin confirmation lowers the need for second‑look surgeries.
• Shorter anesthesia time – Average operative time reduction of 8-15 minutes reported in VATS procedures.
• Improved staging – Fluorescence can uncover fluorescent lymph nodes that are missed on CT, aiding accurate N‑stage assignment.
• Patient confidence – Visible “glow” during surgery provides a tangible reassurance of complete tumor removal, translating to higher satisfaction scores.

---

Practical Tips for Implementing cytalux in the OR

• Training – Conduct a “dry‑run” using a fluorescent phantom before the first patient case to familiarize the team with camera toggling.
• Sterility – Use a disposable, sterile camera sleeve; the NIR probe should be cleaned with recommended disinfectant wipes (no alcohol).
• Lighting control – Dim ambient OR lights during fluorescence mode; excessive white light can wash out the NIR signal.
• Workflow integration – Assign a dedicated “Fluorescence Champion” (usually a senior OR nurse) to monitor dosing time, instrument setup, and image capture.
• data archiving – Store fluorescence videos in the hospital’s PACS system under a separate DICOM series for future research and audit.

---

Real‑World Case Study: 2024 Multicenter Experience

Patient profile: 62‑year‑old female, stage IB adenocarcinoma, 1.2 cm peripheral nodule in the right upper lobe; FRα positivity confirmed on core biopsy (IHC > 70 %).

• Procedure: Robot‑assisted right upper lobectomy with Cytalux fluorescence guidance.
• Findings: Nodule showed intense green‑yellow fluorescence; intra‑operative scan identified a sub‑centimeter fluorescent satellite lesion adjacent to the primary tumor, which was not visible on pre‑operative CT.
• Outcome: Both lesions were resected with negative margins; frozen section confirmed R0.Post‑op pathology revealed only the primary tumor, with the satellite being a benign inflammatory focus-demonstrating the technology’s high sensitivity.
• Recovery: Discharged on postoperative day 3; 12‑month follow‑up shows no recurrence.

Key takeaway: Fluorescence enabled detection of a possibly missed lesion,illustrating the technology’s role in comprehensive oncologic clearance.

---

Safety Profile and Limitations

• Adverse events: Mild nausea (3 %), transient flushing (1 %); no grade ≥ 3 reactions reported.
• False positives: Inflammatory or granulomatous tissue may exhibit low‑level fluorescence; correlation with pathology remains essential.
• Depth limitation: NIR signal penetrates ≤ 5 mm; deep‑lying nodules (> 1 cm from pleural surface) may require adjunct imaging (e.g., intra‑operative ultrasound).
• Cost considerations: Cytalux adds approximately $1,200 per case; however, potential savings from reduced re‑operations and shorter hospital stays offset the expense in high‑volume centers.

---

Future Directions: expanding the role of Fluorescent Pafolacianine

• Combination with AI‑driven image analysis – Real‑time quantification of fluorescence intensity could provide objective margin metrics.
• Hybrid imaging platforms – Integration of NIR fluorescence with indocyanine green (ICG) perfusion mapping to simultaneously assess tumor and vascular status.
• Broader oncologic indications – Ongoing Phase III trials are evaluating pafolacianine for metastatic colorectal lung lesions and for bronchoscopic navigation in early‑stage disease.
• Personalized dosing algorithms – Pharmacokinetic modeling using patient weight, renal function, and FRα expression to optimize signal quality while minimizing exposure.

---

keywords woven naturally: fluorescent imaging, lung nodules, cancer detection, intraoperative navigation, targeted fluorescence, folate receptor alpha, lung cancer surgery, minimally invasive thoracic surgery, real‑time visualization, Cytalux, pafolacianine, FDA‑approved, precision surgery, oncologic outcomes, surgical margins, fluorescence‑guided surgery, pulmonary resection, nodal staging, adverse events.