Molecular guided surgery advances

Purpose Despite major advancements in surgical oncology, the positive margin rate for primary head and neck cancer resection remains around 15-30%. Inadequate margins are directly correlated to poor survival, and as such, mitigation of these rates is critical to improve patient outcomes. We have developed an ex vivo imaging strategy that utilizes fluorescence intensity-peaks (relative to background signal) to locate potential close or positive margins on the deep surface of the resected tumor specimen. Experimental Design A clinical trial with over 50 patients with head and neck cancer scheduled for surgery received systemic administration of a tumor-specific contrast agent (panitumumab-IRDye800). After surgical resection, the tumor specimen was imaged in vivo during surgical resection and using a 3D specimen mapping device with optical capability. The three highest fluorescence intensity-peaks on the deep surface of the specimen were isolated and correlated to histology to determine the margin distance at these regions. Results Relative fluorescence peak-intensities identified the closest margin on the deep surface of the specimen within 2.5 minutes. In vivo imaging identified multiple areas that would be considered management changing events. The highest intensity-peak consistently (100%) detected the closest margin to the tumor. Conclusion Fluorescence intensity-peaks can identify the region on the specimen where tumor is closest to specimen’s edge on the deep surface. This technique could have broad applications in obtaining adequate margins in oncological surgery