• Light guided surgery for primary tumor and lymph node removal

  Precision Surgery: Intraoperative molecular imaging to improve margin detection

  Dr. Eben Rosenthal, Professor of Otolaryngology, Head & Neck Surgery and Radiology, Stanford University
  

Abstract:

Cancer is nearly always a surgically treated disease. Almost 80% of patients with early stage solid tumors undergo surgery at some point within their treatment course. A major gap in quality of care remains the high rate of tumor-positive margins in head and neck cancer (HNC) following surgical resections. Positive margin rates are directly correlated with lower survival but have remained unchanged at 25% for the last two decades! Primary factors that have impeded improving the rate of tumor-positive margins include subjective surgeon assessment as well as the limited amount of the tissue that can be sampled for intraoperative frozen-section analysis. We have demonstrated that use of intraoperative molecular imaging (IMI) can objectively identify the area on the tumor specimen most likely to contain a tumor-positive margin (“sentinel margin”). In a prospective evaluation, a fluorescently-labeled tumor-specific contrast agent is administered intravenously to the patient several days prior to surgery. After the surgical resection, the specimen is evaluated with IMI, in which near infrared imaging is used to identify the location of the sentinel margin on the surgical specimen. This evaluation is compared to subjective assessments of the deep tumor margin by palpation, considered the standard of care. It is expected that IMI imaging will be more accurate in identifying the sentinel margin, and will shorten the time to histological diagnosis while maintaining tissue orientation and high histological image quality. The translation of these new technologies has the potential to double the five-year survival rate of patients with HNC as well offer the potential to improve care for other cancer types as well. 

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