TY - JOUR
T1 - Comparison of narrow band and fluorescence molecular imaging to improve intraoperative tumour margin assessment in oral cancer surgery
AU - de Wit, Jaron G.
AU - van Schaik, Jeroen E.
AU - Voskuil, Floris J.
AU - Vonk, Jasper
AU - de Visscher, Sebastiaan A.H.J.
AU - Schepman, Kees Pieter
AU - van der Laan, Bernard F.A.M.
AU - Doff, Jan J.
AU - van der Vegt, Bert
AU - Plaat, Boudewijn E.C.
AU - Witjes, Max J.H.
N1 - Funding Information:
We thank all patients who participated in this study. Martina Oostenbrug, Karien Kreeft-Polman, Ellen van den Ende-Schaap, Hilde Bouma-Boomsma for the help in recruiting patients. Maaike Barentsen, Erik Bleuel and Lilo Janssens for the assistance in the specimen processing. This study was funded by the Dutch National Cancer Society ( RUG 2015-8084 ).
Publisher Copyright:
© 2022
PY - 2022/11
Y1 - 2022/11
N2 - Objective: New techniques have emerged to aid in preventing inadequate margins in oral squamous cell carcinoma (OSCC) surgery, but studies comparing different techniques are lacking. Here, we compared narrow band imaging (NBI) with fluorescence molecular imaging (FMI), to study which intraoperative technique best assesses the mucosal tumour margins.Materials and Methods: NBI was performed in vivo and borders were marked with three sutures. For FMI, patients received 75 mg of unlabelled cetuximab followed by 15 mg cetuximab-800CW intravenously-two days prior to surgery. The FMI borders were defined on the excised specimen. The NBI borders were correlated with the FMI outline and histopathology.Results: Sixteen patients were included, resulting in 31 NBI and 30 FMI measurements. The mucosal border was delineated within 1 mm of the tumour border in 4/31 (13 %) of NBI and in 16/30 (53 %) FMI cases (p = 0.0008), and within 5 mm in 23/31 (74 %) of NBI and in 29/30 (97 %) of FMI cases (p = 0.0048). The median distance between the tumour border and the imaging border was significantly greater for NBI (3.2 mm, range −6.1 to 12.8 mm) than for FMI (0.9 mm, range −3.0 to 7.4 mm; p = 0.028). Submucosal extension and previous irradiation reduced NBI accuracy.Conclusion: Ex vivo FMI performed more accurately than in vivo NBI in mucosal margin assessment, mainly because NBI cannot detect submucosal extension. NBI adequately identified the mucosal margin especially in early-stage and not previously irradiated tumours, and may therefore be preferable in these tumours for practical and cost-related reasons.
AB - Objective: New techniques have emerged to aid in preventing inadequate margins in oral squamous cell carcinoma (OSCC) surgery, but studies comparing different techniques are lacking. Here, we compared narrow band imaging (NBI) with fluorescence molecular imaging (FMI), to study which intraoperative technique best assesses the mucosal tumour margins.Materials and Methods: NBI was performed in vivo and borders were marked with three sutures. For FMI, patients received 75 mg of unlabelled cetuximab followed by 15 mg cetuximab-800CW intravenously-two days prior to surgery. The FMI borders were defined on the excised specimen. The NBI borders were correlated with the FMI outline and histopathology.Results: Sixteen patients were included, resulting in 31 NBI and 30 FMI measurements. The mucosal border was delineated within 1 mm of the tumour border in 4/31 (13 %) of NBI and in 16/30 (53 %) FMI cases (p = 0.0008), and within 5 mm in 23/31 (74 %) of NBI and in 29/30 (97 %) of FMI cases (p = 0.0048). The median distance between the tumour border and the imaging border was significantly greater for NBI (3.2 mm, range −6.1 to 12.8 mm) than for FMI (0.9 mm, range −3.0 to 7.4 mm; p = 0.028). Submucosal extension and previous irradiation reduced NBI accuracy.Conclusion: Ex vivo FMI performed more accurately than in vivo NBI in mucosal margin assessment, mainly because NBI cannot detect submucosal extension. NBI adequately identified the mucosal margin especially in early-stage and not previously irradiated tumours, and may therefore be preferable in these tumours for practical and cost-related reasons.
KW - Epidermal Growth Factor Receptor
KW - Fluorescence Molecular Imaging
KW - Head and Neck Cancer
KW - Margin assessment
KW - Narrow Band Imaging
U2 - 10.1016/j.oraloncology.2022.106099
DO - 10.1016/j.oraloncology.2022.106099
M3 - Article
AN - SCOPUS:85137621988
SN - 1368-8375
VL - 134
JO - Oral Oncology
JF - Oral Oncology
M1 - 106099
ER -