• van KeulenStanSDepartment of Otolaryngology, Division of Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA; Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center/Academic Centre for Dentistry A, Naoki Nishio, Shayan Fakurnejad, Nynke S van den Berg, Guolan Lu, Andrew Birkeland, Brock A Martin, Tymour Forouzanfar, A Dimitrios Colevas, and Eben L Rosenthal.
• Department of Otolaryngology, Division of Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA; Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center/Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands.
• J. Am. Coll. Surg. 2019 Dec 1; 229 (6): 560567.e1560-567.e1.

BackgroundIn head and neck cancer, surgical resection using primarily visual and tactile feedback is considered the gold standard for solid tumors. Due to high numbers of tumor-involved surgical margins, which are directly correlated to poor clinical outcomes, intraoperative optical imaging trials have rapidly proliferated over the past 5 years. However, few studies report on intraoperative in situ imaging data that could support surgical resection. To demonstrate the clinical application of in situ surgical imaging, we report on the imaging data that are directly (ie in real-time) available to the surgeon.Study DesignFluorescence intensities and tumor-to-background ratios (TBRs) were determined from the intraoperative imaging data-the view as seen by the surgeon during tumor resection-of 20 patients, and correlated to patient and tumor characteristics including age, sex, tumor site, tumor size, histologic differentiation, and epidermal growth factor receptor (EGFR) expression. Furthermore, different lighting conditions in regard to surgical workflow were evaluated.ResultsUnder these circumstances, intraoperative TBRs of the primary tumors averaged 2.2 ± 0.4 (range 1.5 to 2.9). Age, sex, tumor site, and tumor size did not have a significant effect on open-field intraoperative molecular imaging of the primary tumors (p > 0.05). In addition, variation in EGFR expression levels or the presence of ambient light did not seem to alter TBRs.ConclusionsWe present the results of successful in situ intraoperative imaging of primary tumors alongside the optimal conditions with respect to both molecular image acquisition and surgical workflow. This study illuminates the potentials of open-field molecular imaging to assist the surgeon in achieving successful cancer removal.Copyright © 2019 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

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