Srinivasan Akash, Kaminskaite Viktorija, Winter Stuart C
Medical Sciences Division, University of Oxford, Oxford, UK.
Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.
Clin Otolaryngol. 2025 Mar;50(2):220-240. doi: 10.1111/coa.14263. Epub 2024 Dec 4.
The aim of surgery for head and neck squamous cell carcinoma (HNSCC) is to achieve clear resection margins, whilst preserving function and cosmesis. Fluorescent markers have demonstrated potential in the intraoperative visualisation and delineation of tumours, such as glioma, with consequent improvements in resection. The purpose of this scoping review was to identify and compare the fluorescent markers that have been used to detect and delineate HNSCC to date.
A literature search was performed using the Ovid MEDLINE, Ovid Embase, Cochrane CENTRAL, ClinicalTrials.gov and ICTRP databases. Primary human studies published through September 2023 demonstrating the use of fluorescent markers to visualise HNSCC were selected and reviewed independently by two authors.
The search strategy identified 5776 records. Two hundred and forty-four full texts were reviewed, and sixty-five eligible reports were included. The most used fluorescent markers in the included studies were indocyanine green (ICG) (n = 14), toluidine blue (n = 11), antibodies labelled with IRDye800CW (n = 10) and 5-aminolevulinic acid (5-ALA) (n = 8). Toluidine blue and ICG both have limited specificity, although novel targeted options derived from ICG may be more effective. 5-ALA has been demonstrated as a topical marker and, recently, via enteral administration but it is associated with photosensitivity reactions. The fluorescently labelled antibodies cetuximab-IRDye800CW and panitumumab-IRDye800CW are promising options being investigated by ongoing trials.
Multiple safe fluorescent markers have emerged which may aid the surgical resection of HNSCC. Further research in larger cohorts is required to identify which marker should be considered gold standard.
头颈部鳞状细胞癌（HNSCC）手术的目的是实现切缘阴性，同时保留功能和美观。荧光标记物已在术中可视化和勾勒肿瘤（如胶质瘤）方面显示出潜力，从而改善了切除术效果。本综述的目的是识别和比较迄今为止用于检测和勾勒HNSCC的荧光标记物。
使用Ovid MEDLINE、Ovid Embase、Cochrane CENTRAL、ClinicalTrials.gov和ICTRP数据库进行文献检索。选择截至2023年9月发表的关于使用荧光标记物可视化HNSCC的原发性人体研究，并由两位作者独立进行综述。
检索策略共识别出5776条记录。对244篇全文进行了综述，纳入了65篇符合条件的报告。纳入研究中使用最多的荧光标记物是吲哚菁绿（ICG）（n = 14）、甲苯胺蓝（n = 11）、IRDye800CW标记的抗体（n = 10）和5-氨基乙酰丙酸（5-ALA）（n = 8）。甲苯胺蓝和ICG的特异性都有限，尽管ICG衍生的新型靶向制剂可能更有效。5-ALA已被证明是一种局部标记物，最近也可通过肠内给药，但它与光敏反应有关。荧光标记的抗体西妥昔单抗-IRDye800CW和帕尼单抗-IRDye800CW是正在进行的试验中正在研究的有前景的选择。
已经出现了多种安全的荧光标记物，可能有助于HNSCC的手术切除。需要在更大的队列中进行进一步研究，以确定哪种标记物应被视为金标准。
