Background: Residual tumor detection in advanced stage ovarian cancer  OC  represents a critical challenge in the treatment of the disease. Optimal abdominal cytoreduction until no evidence of macroscopic disease is the primary surgical endpoint, ith demonstrated survivaladvantages, hoever current imaging modalities have shon lo detection sensitivity belo 10 mm diameter. Novel targeted molecule-based imaging systems offer higher detection rate and are likely to extend the aim of complete resection to the microscopic scale. We applied a custom designed imaging system to a preclinical OC model and observed higher microscopic tumor detection and survival advantage compared to non-image guided debulking surgery. Methods: A to component imaging system as developed. The contrast agent is an intra-peritoneal injectable nanomolecular probe, composed of a single alled carbon nanotube  SWNT  coupled ith an engineered M13-bacteriophage carrying a modified peptide targeting secreted protein, acidic and rich in cysteine  SPARC , extracellular protein overexpressed in OC. The imaging device system is capable of detecting SWNT inherent fluorescence in near-infrared second indo  NIR2  and of displaying real-time images to guide intraoperative tumor debulking. Results: In an orthotopic OC animal model, the imaging system detected microscopic tumors in the millimeter and sub-millimeter scale resolution ith a mean tumor diameter of Mean and SD 1.36 1.01 and 3.27 2.10 mm  p: 0.0005  compared to eye detected tumors. The imaging system demonstrated sensitivity of 97.2 percent and specificity of 70.9 percent, and a Receiver Operator Area under the Curve  ROC SE  of 0.86 0.04. In a survival surgery animal model, the imaging guided resection surgery compared to non guided surgery shoed a survival advantage for the experimental arm, ith median survival time of 40.5 and 28.0 days, respectively  HR 0.26, 95 percent CI 0.07 to 0.93, p: 0.039 . Conclusions: The accuracy of the imaging system and its survival advantage in this OC preclinical model are promising to support the translation to first-in-human investigation, and suggest further exploitation in targeted delivery therapies.,J Clin Oncol 34, 2016  suppl; abstr 5530 00:00.0,Gynecologic Cancer