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J Surg Oncol. 2015 Jul;112(1):2-8. doi: 10.1002/jso.23946. Epub 2015 Jun 12.

A ratiometric threshold for determining presence of cancer during fluorescence-guided surgery.

Author information

1
Division of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama.
2
Division of General Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
3
Department of Oral & Maxillofacial Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
4
Division of Anatomic Pathology, Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama.

Abstract

BACKGROUND AND OBJECTIVE:

Fluorescence-guided imaging to assist in identification of malignant margins has the potential to dramatically improve oncologic surgery. However, a standardized method for quantitative assessment of disease-specific fluorescence has not been investigated. Introduced here is a ratiometric threshold derived from mean fluorescent tissue intensity that can be used to semi-quantitatively delineate tumor from normal tissue.

METHODS:

Open-field and a closed-field imaging devices were used to quantify fluorescence in punch biopsy tissues sampled from primary tumors collected during a phase 1 trial evaluating the safety of cetuximab-IRDye800 in patients (n = 11) undergoing surgical intervention for head and neck cancer. Fluorescence ratios were calculated using mean fluorescence intensity (MFI) from punch biopsy normalized by MFI of patient-matched tissues. Ratios were compared to pathological assessment and a ratiometric threshold was established to predict presence of cancer.

RESULTS:

During open-field imaging using an intraoperative device, the threshold for muscle normalized tumor fluorescence was found to be 2.7, which produced a sensitivity of 90.5% and specificity of 78.6% for delineating disease tissue. The skin-normalized threshold generated greater sensitivity (92.9%) and specificity (81.0%).

CONCLUSION:

Successful implementation of a semi-quantitative threshold can provide a scientific methodology for delineating disease from normal tissue during fluorescence-guided resection of cancer.

KEYWORDS:

fluorescence-guided surgery; head & neck cancer; standardized imaging; surgical oncology

PMID:
26074273
PMCID:
PMC4510011
DOI:
10.1002/jso.23946
[Indexed for MEDLINE]
Free PMC Article

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