TY - JOUR T1 - Precision Surgery Guided by Intraoperative Molecular Imaging JF - Journal of Nuclear Medicine JO - J Nucl Med SP - 1620 LP - 1627 DO - 10.2967/jnumed.121.263409 VL - 63 IS - 11 AU - Feredun Azari AU - Kevin Zhang AU - Gregory T. Kennedy AU - Ashley Chang AU - Bilal Nadeem AU - Edward J. Delikatny AU - Sunil Singhal Y1 - 2022/11/01 UR - http://jnm.snmjournals.org/content/63/11/1620.abstract N2 - Intraoperative molecular imaging (IMI) has recently emerged as an important tool in the armamentarium of surgical oncologists. IMI allows real-time assessment of oncologic resection quality, margin assessment, and occult disease detection during real-time surgery. Numerous tracers have now been developed for use in IMI-guided tissue sampling. Fluorochromes localize to the tumor by taking advantage of their disorganized capillary milieu, overexpressed receptors, or upregulated enzymes. Although fluorescent tracers can suffer from issues of autofluorescence and lack of depth penetration, these challenges are being addressed through hybrid radioactive/fluorescent tracers and new tracers that fluoresce in the near-infrared (NIR-II [wavelength > 1,000 nm]) range. IMI is already being used to treat numerous cancers, with demonstrated improvement in cancer recurrence and patient outcomes without incurring significant burden on either clinicians or patients. In this comprehensive review, we discuss history, mechanism, current oncologic applications, and future directions of IMI-guided optical biopsy. ER -