Improved intraoperative identification of close margins in oral squamous cell carcinoma resections using a dual aperture fluorescence ratio approach: first in-human results

Cody C. Rounds; Jaron G. de Wit; Jasper Vonk; Jennifer Vorjohan; Sophia Nelson; Allyson Trang; Brooke Villinski; Kimberley S. Samkoe; Jovan G. Brankov; Floris J. Voskuil; Max J. H. Witjes; Kenneth M. Tichauer

doi:10.1117/1.JBO.29.1.016003

17 January 2024 Improved intraoperative identification of close margins in oral squamous cell carcinoma resections using a dual aperture fluorescence ratio approach: first in-human results

Cody C. Rounds, Jaron G. de Wit, Jasper Vonk, Jennifer Vorjohan, Sophia Nelson, Allyson Trang, Brooke Villinski, Kimberley S. Samkoe, Jovan G. Brankov, Floris J. Voskuil, Max J. H. Witjes, Kenneth M. Tichauer

Author Affiliations +

Journal of Biomedical Optics, Vol. 29, Issue 1, 016003 (January 2024). https://doi.org/10.1117/1.JBO.29.1.016003

Abstract

Significance

Surgical excision is the main treatment for solid tumors in oral squamous cell carcinomas, where wide local excision (achieving a healthy tissue margin of >5 mm around the excised tumor) is the goal as it results in reduced local recurrence rates and improved overall survival.

Aim

No clinical methods are available to assess the complete surgical margin intraoperatively while the patient is still on the operating table; and while recent intraoperative back-bench fluorescence-guided surgery approaches have shown promise for detecting “positive” inadequate margins (<1 mm), they have had limited success in the detection of “close” inadequate margins (1 to 5 mm). Here, a dual aperture fluorescence ratio (dAFR) approach was evaluated as a means of improving detection of close margins.

Approach

The approach was evaluated on surgical specimens from patients who were administered a tumor-specific fluorescent imaging agent (cetuximab-800CW) prior to surgery. The dAFR approach was compared directly against standard wide-field fluorescence imaging and pathology measurements of margin thickness in specimens from three patients and a total of 12 margin locations (1 positive, 5 close, and 6 clear margins).

Results

The area under the receiver operating characteristic curve, representing the ability to detect close compared to clear margins (>5 mm) was found to be 1.0 and 0.57 for dAFR and sAF, respectively. Improvements in dAFR were found to be statistically significant (p<0.02).

Conclusions

These results provide evidence that the dAFR approach potentially improves detection of close surgical margins.

CC BY: © The Authors. Published by SPIE under a Creative Commons Attribution 4.0 International License. Distribution or reproduction of this work in whole or in part requires full attribution of the original publication, including its DOI.

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Cody C. Rounds, Jaron G. de Wit, Jasper Vonk, Jennifer Vorjohan, Sophia Nelson, Allyson Trang, Brooke Villinski, Kimberley S. Samkoe, Jovan G. Brankov, Floris J. Voskuil, Max J. H. Witjes, and Kenneth M. Tichauer "Improved intraoperative identification of close margins in oral squamous cell carcinoma resections using a dual aperture fluorescence ratio approach: first in-human results," Journal of Biomedical Optics 29(1), 016003 (17 January 2024). https://doi.org/10.1117/1.JBO.29.1.016003

Received: 19 October 2023; Accepted: 21 December 2023; Published: 17 January 2024

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KEYWORDS

Fluorescence

Resection

Tumors

Imaging systems

Surgery

Cancer detection

Pathology

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