{"entity":{"id":"idea-moon-image-guided-surgery-everywhere","kind":"idea","name":"Real-time margin assessment and image-guided surgery as the global standard","aka":[],"tldr":"Surgeons often cannot see where a tumour ends. Fluorescent dyes and AI-read imaging in the operating theatre can show them, cutting repeat operations. Make this routine everywhere.","summary":"Positive margins lead to re-operation or recurrence in breast, head and neck, prostate and gastrointestinal surgery. Tumour-targeted fluorescent agents (pegulicianine approved for breast lumpectomy, PSMA- and folate-targeted agents), intraoperative mass spectrometry and rapid AI histology can assess margins during surgery. The proposal is a programme to standardise and validate these tools across common operations, integrate them into low-cost surgical imaging platforms suitable for district hospitals, and make margin status with intraoperative assessment a quality indicator.","asOf":"2026-09-08","links":[{"label":"Bottleneck evidence (Surgery and radiotherapy cure most, get least): Sullivan et al., Global cancer surgery (Lancet Oncology Commission 2015)","url":"https://doi.org/10.1016/S1470-2045(15)00223-5"}],"tags":[],"related":[],"cancers":["head-and-neck","breast-hr-positive","prostate"],"sections":[],"technologies":["fluorescence-guided-surgery","optical-imaging","digital-pathology-ai"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["b-surgery-radiation-innovation","b-global-access"],"keyPapers":["paper-sullivan-lancet-oncol"],"journals":[],"dependsOn":[],"notes":[],"hypothesis":"Routine intraoperative margin assessment halves positive margin rates and re-operations in breast and head and neck surgery, and low-cost versions perform equivalently in resource-limited hospitals.","rationale":"Surgery remains the most curative treatment for most solid tumours and its main technical failure is invisible margins; the imaging agents and readers now exist.","test":"Randomised trials of image-guided versus standard surgery in breast and oral cancer with positive margin rate as primary endpoint, plus a validation of low-cost imaging systems in two middle-income countries.","maturity":"early-clinical","actor":"engineering","cost":"large","horizonYears":6},"route":"/ideas/idea-moon-image-guided-surgery-everywhere/","neighbours":{"cancer":[{"id":"head-and-neck","kind":"cancer","name":"Head and neck squamous cell carcinoma","route":"/cancers/head-and-neck/"},{"id":"breast-hr-positive","kind":"cancer","name":"HR-positive / HER2-negative breast cancer","route":"/cancers/breast-hr-positive/"},{"id":"prostate","kind":"cancer","name":"Prostate cancer","route":"/cancers/prostate/"}],"technology":[{"id":"digital-pathology-ai","kind":"technology","name":"Digital pathology & AI","route":"/technologies/digital-pathology-ai/"},{"id":"fluorescence-guided-surgery","kind":"technology","name":"Fluorescence-guided surgery","route":"/technologies/fluorescence-guided-surgery/"},{"id":"optical-imaging","kind":"technology","name":"Optical & fluorescence imaging","route":"/technologies/optical-imaging/"}],"bottleneck":[{"id":"b-global-access","kind":"bottleneck","name":"Most of the world has almost no cancer care","route":"/bottlenecks/b-global-access/"},{"id":"b-surgery-radiation-innovation","kind":"bottleneck","name":"Surgery and radiotherapy cure most, get least","route":"/bottlenecks/b-surgery-radiation-innovation/"}],"paper":[{"id":"paper-sullivan-lancet-oncol","kind":"paper","name":"Global cancer surgery: delivering safe, affordable, and timely cancer surgery","route":"/key-papers/paper-sullivan-lancet-oncol/"}]}}