Small lung tumors or nodules can be very hard to detect, even with detailed scans. This means that during surgeries to remove larger, known tumors, the hidden tumors may be missed and remain in the lungs. But a fluorescent imaging technology is improving the odds of finding and removing these small growths. Surgeons at The Johns Hopkins Hospital are the first in Maryland to use this imaging agent.

“This technology allows us to increase the number of tools that we have to perform better cancer surgeries for patients, with fewer complications,” says thoracic surgeon Jinny Ha, M.D.

How Fluorescent Imaging Technology Works

Between one to 72 hours before surgery to remove lung tumors, the patient receives an intravenous infusion of the imaging agent. During surgery, this substance specifically targets tumors, even ones that are small or below the surface, and turns them a fluorescent green. This bright color is visible through a specially equipped camera used by surgeons.

Unlike a static image from a CT scan taken before surgery, the fluorescence-guided system gives surgeons dynamic, real-time visual cues that adapt with each breath from the patient. If the system indicates a hidden tumor, the surgeon can remove it along with other, larger tumors during surgery.

During surgery, fluorescent imaging highlights a lung nodule that wasn’t visible by the eye (left). After the procedure, imaging confirms the nodule was successfully removed (right). | ©2025, Johns Hopkins Medicine.

“One of the challenges that we face in thoracic, or chest, surgery is trying to find small lung nodules that are not on the surface,” Ha says. “This imaging technology goes directly to the targeted cells and nothing else, so it is specific and binding to that nodule, lighting it up for us.”

First to Use Fluorescent Imaging in Maryland

Performing surgeries at The Johns Hopkins Hospital, Ha and thoracic surgeon Stephen Yang, M.D., are the first in Maryland to use the tool, which was approved by the Food and Drug Administration in 2021 and has the generic name pafolacianine. The technology is most useful with minimally invasive procedures, says Ha, because larger incisions would allow her to physically feel for malignancies.

The thoracic surgery team reviews each patient’s case to determine if the fluorescent imaging technology is appropriate. The system has the potential to improve the chances of catching and removing smaller tumors while reducing recovery time and complications from surgery. When surgeons can more easily distinguish malignancies from healthy tissue, there is less need to remove tissue for biopsy. Surgeons can use this tool to assess the precise location of tumors and tailor the procedure in real time.

Side Effects and Recovery

Side effects from the intravenous agent are rare, but may include nausea. Most patients remain in the hospital two to three days to recover after minimally invasive surgery.

Patients receive scans several weeks after surgery to see if all tumors were removed. Ha sees several benefits of this new tool in the fight against lung cancer. “It helps find spots that we didn’t identify early on,” she explains. “And it allows us to have a less invasive procedure for the patient, which means they recover faster and experience less pain.”