An Imaging Agent (Pafolacianine) for Identifying Lesions in Pediatric Patients With Primary or Metastatic Solid Tumors

• Biospecimen Collection (Procedure), also known as Biological Sample Collection, Biospecimen Collected, Specimen Collection: Undergo tissue sample collection
• Near Infrared Imaging (Procedure), also known as Near-Infrared Imaging, NIR Imaging: Undergo NIR fluorescent imaging
• Pafolacianine Sodium (Drug), also known as Cytalux: Given IV
• Surgical Procedure (Procedure), also known as Operation, Surgery, Surgery Type, Surgery, Not Otherwise Specified (NOS), Surgical, Surgical Intervention, Surgical Interventions, Surgical Procedures, Type of Surgery, Surgery, NOS: Undergo SOC surgery

Primary outcomes

• Accuracy of Cytalux™ (pafolacianine) injection used with NIR fluorescent imaging for detecting lesions [Up to 30 days after surgery]: Each excised specimen will be analyzed for histologic findings to determine accuracy of Cytalux™ (pafolacianine) injection used with near infrared (NIR) fluorescent imaging for detecting lesions. Accuracy will be assessed using sensitivity and specificity.

Secondary outcomes

• Time between Cytalux™ administration and NIR imaging detection intraoperatively [Day 0 to 1]: Descriptive statistics will be performed and descriptive summaries such as mean (standard deviation) or median (minimum, maximum) for continuous variables and frequencies and percentages for categorical variables will be reported.
• Reasons for not excising NIR avid lesions [Day 0 to 1]: Descriptive statistics will be performed and descriptive summaries such as mean (standard deviation) or median (minimum, maximum) for continuous variables and frequencies and percentages for categorical variables will be reported. All tests will be two sided and p-values less than 0.05 will be considered statistically significant.
• Incidence of Adverse Events surgery [From study enrollment up to 30 days after surgery]: Cytalux™ (pafolacianine) will be assessed for safety in children and adolescent patients undergoing by the number and severity of adverse events (AEs), defined as events (serious or non-serious) of scientific and medical concern specific to the investigational product and/or the combination of products being used in a study. AEs will be assessed using National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) Version 5.

Sex: All, ages: 6 Months to 17 Years

Inclusion Criteria:

* Willingness of research participant or legal guardian/representative to give written informed consent
* Age 6 months to 17 years
* Have a diagnosis, or a high clinical suspicion, of a solid tumor in the neck, chest, abdomen, pelvis, or extremities with a plan for surgical resection including embryonal tumors, sarcomas, neurogenic tumors, carcinomas, mesenchymal tumors, germ cell tumors. Children may undergo surgical resection or biopsy of a solid tumor that is suspected to be malignant without a separate preoperative biopsy; therefore, the tumor type may not be definitively known preoperatively

Exclusion Criteria:

* Previous exposure to Cytalux™ (pafolacianine) injection
* Any medical condition that in the judgement of the investigators could potentially jeopardize the safety of the participant
* History of anaphylactic reactions to products containing indocyanine green for near infrared imaging. Participants with a medical history of 'idiopathic anaphylaxis' will require evaluation
* History of allergy to any of the components of Cytalux™ (pafolacianine) injection
* Presence of any psychological, familial, sociological condition or geographical challenges potentially hampering compliance with the study protocol or follow-up schedule
* Received an investigational agent in another investigational drug or vaccine trial within 30 days prior to the administration of the study drug. Investigational trials involving administration of drugs or vaccines which are already Food and Drug Administration (FDA)-approved, such as Children's Oncology Group cooperative trials, are okay
* Known sensitivity to fluorescent light
* Pregnancy
* Unable or unwilling to discontinue folic acid, folate supplements, and multi-vitamins containing folate 48 hours prior to drug administration
* Renal failure on dialysis or estimated glomerular filtration rate (eGFR) < 30 mL/min/1.72m\^2 as measured by the U25 eGFR equation for patients ≥1 year(s) of age. For patients < 1 year of age, creatinine > 2x the upper limit of normal will serve as an exclusion criteria. Creatinine will be measured by enzymatic assay with calibration traceable to the international standard reference materials and minimal bias compared to isotope-dilution mass spectrometry (IDMS) reference methodology.
* Undergoing workup for liver failure or listed for liver transplant. Patients with Gilbert's syndrome will be excluded if impaired liver function defined as values > 3x the upper limit of normal (ULN) for alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), or total bilirubin
* Unable or unwilling to use adequate birth control/contraceptive measures or abstain from sexual activity for 30 days following the study intervention
* Anticipated need to donate ova or sperm within 30 days following study intervention

• Stephanie F. Polites, MD, MPH, Principal investigator, Mayo Clinic