Comparison of narrow band and fluorescence molecular imaging to improve intraoperative tumour margin assessment in oral cancer surgery

Jaron G de Wit; Jeroen E van Schaik; Floris J Voskuil; Jasper Vonk; Sebastiaan A H J de Visscher; Kees-Pieter Schepman; Bernard F A M van der Laan; Jan J Doff; Bert van der Vegt; Boudewijn E C Plaat; Max J H Witjes

doi:10.1016/j.oraloncology.2022.106099

Comparison of narrow band and fluorescence molecular imaging to improve intraoperative tumour margin assessment in oral cancer surgery

Oral Oncol. 2022 Nov:134:106099. doi: 10.1016/j.oraloncology.2022.106099. Epub 2022 Sep 12.

Affiliations

¹ Department of Oral & Maxillofacial Surgery, University of Groningen, University Medical Centre Groningen, the Netherlands.
² Department of Otorhinolaryngology, Head and Neck Surgery, University of Groningen, University Medical Centre Groningen, the Netherlands.
³ Department of Oral & Maxillofacial Surgery, University of Groningen, University Medical Centre Groningen, the Netherlands; Department of Pathology & Medical Biology, University of Groningen, University Medical Centre Groningen, the Netherlands.
⁴ Department of Otorhinolaryngology, Head and Neck Surgery, University of Groningen, University Medical Centre Groningen, the Netherlands; Department of Otorhinolaryngology, Head and Neck Surgery, Haaglanden Medical Centre, The Hague, the Netherlands.
⁵ Department of Pathology & Medical Biology, University of Groningen, University Medical Centre Groningen, the Netherlands.
⁶ Department of Oral & Maxillofacial Surgery, University of Groningen, University Medical Centre Groningen, the Netherlands. Electronic address: m.j.h.witjes@umcg.nl.

PMID: 36096045
DOI: 10.1016/j.oraloncology.2022.106099

Abstract

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.

Keywords: Epidermal Growth Factor Receptor; Fluorescence Molecular Imaging; Head and Neck Cancer; Margin assessment; Narrow Band Imaging.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Carcinoma, Squamous Cell* / diagnostic imaging
Carcinoma, Squamous Cell* / pathology
Carcinoma, Squamous Cell* / surgery
Cetuximab / therapeutic use
Head and Neck Neoplasms*
Humans
Margins of Excision
Molecular Imaging
Mouth Neoplasms* / diagnostic imaging
Mouth Neoplasms* / pathology
Mouth Neoplasms* / surgery
Narrow Band Imaging
Prospective Studies

Substances

Cetuximab