Intraoperative In Vivo Imaging Modalities in Head and Neck Cancer Surgical Margin Delineation: A Systematic Review

Abstract

Surgical margin status is one of the strongest prognosticators in predicting patient outcomes in head and neck cancer, yet head and neck surgeons continue to face challenges in the accurate detection of these margins with the current standard of care. Novel intraoperative imaging modalities have demonstrated great promise for potentially increasing the accuracy and efficiency in surgical margin delineation. In this current study, we collated and analyzed various intraoperative imaging modalities utilized in head and neck cancer to evaluate their use in discriminating malignant from healthy tissues. The authors conducted a systematic database search through PubMed/Medline, Web of Science, and EBSCOhost (CINAHL). Study screening and data extraction were performed and verified by the authors, and more studies were added through handsearching. Here, intraoperative imaging modalities are described, including optical coherence tomography, narrow band imaging, autofluorescence, and fluorescent-tagged probe techniques. Available sensitivities and specificities in delineating cancerous from healthy tissues ranged from 83.0% to 100.0% and 79.2% to 100.0%, respectively, across the different imaging modalities. Many of these initial studies are in small sample sizes, with methodological differences that preclude more extensive quantitative comparison. Thus, there is impetus for future larger studies examining and comparing the efficacy of these intraoperative imaging technologies.

Multispectral optoacoustic tomography of benign parotid tumors in vivo: a prospective observational pilot study

“…In the same way, identical MSOT parameters allowed a differentiation of different benign and malignant thyroid disorders 16 . There are several biophotonic procedures are explored for diagnostic use in head and neck surgery 22 . In literature, there are so far only isolated few investigations on salivary glands using other biophotonic methods such as optical coherence tomography (OCT) or Raman spectroscopy 23 , 24 .…”

Surgical Extent for Oral Cancer: Emphasis on a Cut-Off Value for the Resection Margin Status: A Narrative Literature Review

“…The limitations of deep resection frequently result in a suboptimal margin status. Some researchers have attempted real-time imaging, such as ultrasonography during surgery [ 18 , 19 ] or in vivo imaging [ 20 , 21 , 22 , 23 ]; however, a common and broad application of real-time imaging to a practice requires further development and clinical research. In short, a surgical strategy for complete tumor removal can be accomplished under the current surgical approach only with a tumor resection that includes safety margins from the boundaries of presumed gross tumors.…”

Intraoperative Techniques That Define the Mucosal Margins of Oral Cancer In-Vivo: A Systematic Review

“…There are several systematic reviews evaluating margin visualization techniques that may contribute to a higher number of adequate resection margins [ 25 , 26 , 27 , 28 ]. However, these reviews discuss only deep margins [ 28 , 29 ] or a combination of deep and superficial margins [ 26 ].…”

“…However, these reviews discuss only deep margins [ 28 , 29 ] or a combination of deep and superficial margins [ 26 ]. Some also include pre-clinical research, research that includes technologies that require sampling of the resection specimen and/or wound bed, or ex-vivo examination of the resection specimen [ 26 , 27 , 29 ].…”