PT  - JOURNAL ARTICLE
AU  - Giri Krishnan
AU  - Nynke S. van den Berg
AU  - Naoki Nishio
AU  - Shrey Kapoor
AU  - Jaqueline Pei
AU  - Laura Freeman
AU  - Yu-Jin Lee
AU  - Quan Zhou
AU  - Stan van Keulen
AU  - Shayan Farkurnejad
AU  - James Condon
AU  - Fred M. Baik
AU  - Brock A. Martin
AU  - Eben L. Rosenthal
TI  - Fluorescent Molecular Imaging Can Improve Intraoperative Sentinel Margin Detection in Oral Squamous Cell Carcinoma
AID  - 10.2967/jnumed.121.262235
DP  - 2022 Aug 01
TA  - Journal of Nuclear Medicine
PG  - 1162--1168
VI  - 63
IP  - 8
4099  - http://jnm.snmjournals.org/content/63/8/1162.short
4100  - http://jnm.snmjournals.org/content/63/8/1162.full
SO  - J Nucl Med2022 Aug 01; 63
AB  - In head and neck cancer, a major limitation of current intraoperative margin analysis is the ability to detect areas most likely to be positive based on specimen palpation, especially for larger specimens where sampling error limits detection of positive margins. This study aims to prospectively examine the clinical value of fluorescent molecular imaging to accurately identify “the sentinel margin,” the point on a specimen at which the tumor lies closest to the resected edge in real-time during frozen section analysis. Methods: Eighteen patients with oral squamous cell carcinoma were enrolled into a prospective clinical trial and infused intravenously with 50 mg of panitumumab-IRDye800CW 1–5 d before surgery. Resected specimens were imaged in a closed-field near-infrared optical imaging system in near real-time, and custom-designed software was used to identify locations of highest fluorescence on deep and peripheral margins. The surgeon identified the sentinel margin masked to optical specimen mapping, and then the regions of highest fluorescence were identified and marked for frozen analysis. Final pathology based on specimen reconstruction was used as reference standard. Results: Resected specimens were imaged in the operating room, and fluorescence had a higher interobserver agreement with pathology (Cohen κ value 0.96) than the surgeon (Cohen κ value of 0.82) for the location of the closest margin. Plotting margin distance at the predicted sentinel margin location of each observer versus the actual closest margin distance at pathology demonstrated best correlation between fluorescence and pathology (R2 = 0.98) with surgeon (R2 = 0.75). Conclusion: Fluorescence imaging can improve identification of the sentinel margin in head and neck cancer resections, holding promise for rapid identification of positive margins and improved oncologic outcomes.