Utilization of Cytalux (Pafolacianine) in Identification of Metastatic Sarcoma post VATs Metastasectomy

Abstract Background Intraoperative molecular imaging using intravenous Pafolacianine (Cytalux) has been reported to improve tumor detection in malignant pulmonary and ovarian lesions. Pafolacianine’s affinity for oncological processes in these specific tissues has aided in the elucidation of adequate margins for diagnostic and therapeutic resections when administered shortly prior to surgical intervention [1]. The role for Pafolacianine for malignant lesions in other organ systems as well as the time in which Pafolacianine remains bound and fluoroscopically detectable, is unknown. Case Presentation : Presented here is a case of a 27-year-old man found with recurrent malignant Peripheral Nerve Sheath Tumor (MPNST) of the right upper extremity who developed new bilateral lung nodules concerning for metastatic disease. Initially, we performed a laparoscopic left-sided video assisted thoracoscopy (VATS) with perioperative Pafolacianine administration and intra-operative Stryker thoracoscopy. These techniques allowed us to successfully remove his metastatic pulmonary disease with wedge metastasectomy. Incidentally, using the thoracoscopy enabled us to identify his primary tumor within the left antecubital fossa. He was then able to undergo excision of his primary disease on postoperative day six. Since the primary tumor continued to emit a fluoroscopic signal that aided us in resection the cancerous lesion in a heavily scarred field. Conclusion To date, there have been no reported cases of Pafolacianine retention within extra-pulmonary and ovarian tumor cells after an extended period of time. We believe our case demonstrates the prospective application and effectiveness of Pafolacianine in targeting cancer cells by fluorescence-guided scopy. In summary, we theorize that there is a role for Pafolacianine, in tandem with fluorescence-guided thoracoscopy, in identifying malignant lesions regardless of tumor location and timing of drug administration.