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Determination of Tumor Margins with Surgical Specimen Mapping Using Near-Infrared Fluorescence.
Gao, Rebecca W; Teraphongphom, Nutte T; van den Berg, Nynke S; Martin, Brock A; Oberhelman, Nicholas J; Divi, Vasu; Kaplan, Michael J; Hong, Steven S; Lu, Guolan; Ertsey, Robert; Tummers, Willemieke S F J; Gomez, Adam J; Holsinger, F Christopher; Kong, Christina S; Colevas, Alexander D; Warram, Jason M; Rosenthal, Eben L.
Afiliação
  • Gao RW; Stanford University School of Medicine, Stanford, California.
  • Teraphongphom NT; Department of Otolaryngology - Head and Neck Surgery, Stanford University, Stanford, California.
  • van den Berg NS; Department of Otolaryngology - Head and Neck Surgery, Stanford University, Stanford, California.
  • Martin BA; Department of Pathology, Stanford University, Stanford, California.
  • Oberhelman NJ; Department of Otolaryngology - Head and Neck Surgery, Stanford University, Stanford, California.
  • Divi V; Department of Otolaryngology - Head and Neck Surgery, Stanford University, Stanford, California.
  • Kaplan MJ; Department of Otolaryngology - Head and Neck Surgery, Stanford University, Stanford, California.
  • Hong SS; Department of Otolaryngology - Head and Neck Surgery, Stanford University, Stanford, California.
  • Lu G; Department of Otolaryngology - Head and Neck Surgery, Stanford University, Stanford, California.
  • Ertsey R; Department of Otolaryngology - Head and Neck Surgery, Stanford University, Stanford, California.
  • Tummers WSFJ; Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands.
  • Gomez AJ; Department of Pathology, Stanford University, Stanford, California.
  • Holsinger FC; Department of Otolaryngology - Head and Neck Surgery, Stanford University, Stanford, California.
  • Kong CS; Department of Pathology, Stanford University, Stanford, California.
  • Colevas AD; Department of Medicine, Division of Oncology, Stanford University, Stanford, California.
  • Warram JM; Department of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama.
  • Rosenthal EL; Department of Otolaryngology - Head and Neck Surgery, Stanford University, Stanford, California. elr@stanford.edu.
Cancer Res ; 78(17): 5144-5154, 2018 09 01.
Article em En | MEDLINE | ID: mdl-29967260
For many solid tumors, surgical resection remains the gold standard and tumor-involved margins are associated with poor clinical outcomes. Near-infrared (NIR) fluorescence imaging using molecular agents has shown promise for in situ imaging during resection. However, for cancers with difficult imaging conditions, surgical value may lie in tumor mapping of surgical specimens. We thus evaluated a novel approach for real-time, intraoperative tumor margin assessment. Twenty-one adult patients with biopsy-confirmed squamous cell carcinoma arising from the head and neck (HNSCC) scheduled for standard-of-care surgery were enrolled. Cohort 1 (n = 3) received panitumumab-IRDye800CW at an intravenous microdose of 0.06 mg/kg, cohort 2A (n = 5) received 0.5 mg/kg, cohort 2B (n = 7) received 1 mg/kg, and cohort 3 (n = 6) received 50 mg. Patients were followed 30 days postinfusion and adverse events were recorded. Imaging was performed using several closed- and wide-field devices. Fluorescence was histologically correlated to determine sensitivity and specificity. In situ imaging demonstrated tumor-to-background ratio (TBR) of 2 to 3, compared with ex vivo specimen imaging TBR of 5 to 6. We obtained clear differentiation between tumor and normal tissue, with a 3-fold signal difference between positive and negative specimens (P < 0.05). We achieved high correlation of fluorescence intensity with tumor location with sensitivities and specificities >89%; fluorescence predicted distance of tumor tissue to the cut surface of the specimen. This novel method of detecting tumor-involved margins in surgical specimens using a cancer-specific agent provides highly sensitive and specific, real-time, intraoperative surgical navigation in resections with complex anatomy, which are otherwise less amenable to image guidance.Significance: This study demonstrates that fluorescence can be used as a sensitive and specific method of guiding surgeries for head and neck cancers and potentially other cancers with challenging imaging conditions, increasing the probability of complete resections and improving oncologic outcomes. Cancer Res; 78(17); 5144-54. ©2018 AACR.
Assuntos

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Cirurgia Assistida por Computador / Carcinoma de Células Escamosas de Cabeça e Pescoço Tipo de estudo: Etiology_studies / Guideline / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Ano de publicação: 2018 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Cirurgia Assistida por Computador / Carcinoma de Células Escamosas de Cabeça e Pescoço Tipo de estudo: Etiology_studies / Guideline / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Ano de publicação: 2018 Tipo de documento: Article