Keith Brian A, Marrero-Gonzalez Alejandro R, Chau Isabelle J, Nguyen Shaun A, Albergotti William G, Kejner Alexandra E, Newman Jason G
Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, MSC 550, Charleston, SC, 29425, USA.
School of Osteopathic Medicine, Campbell University, Lillington, NC, USA.
Eur Arch Otorhinolaryngol. 2025 May 17. doi: 10.1007/s00405-025-09442-5.
Obtaining negative margins in primary tumor resection is essential to decreasing recurrence and mortality. Fluorescence imaging may aid in complete tumor removal. As fluorescent agents are still under clinical trial investigation for use in head and neck cancer (HNC), their effectiveness in intraoperative margin assessment (IMA) remains unclear. This scoping review examines the use of fluorescent-guided surgery (FGS) in the treatment of HNC, highlighting significant opportunities in this nascent field.
PubMed, Scopus, CINAHL, and Cochrane Library were searched from inception through March 22, 2024. This study was conducted under PRISMA-ScR guidelines. Data on study characteristics, fluorescence and imaging techniques, imaging efficacy, and diagnostic accuracy were extracted.
Twenty-seven prospective studies from 2013 to 2024 on intraoperative FGS in HNC, involving 455 patients from six countries, were included. Studies ranged from preclinical to phase II trials, applying various fluorescent techniques, predominantly indocyanine green and IRDye800CW, to enhance surgical precision. Imaging assessments were conducted in-vivo, ex-vivo, or both, using a wide range of devices and taking an additional 0 to 30 min intraoperatively. Quantitative measures like signal-to-background ratio and mean fluorescent intensity suggested variable diagnostic accuracy across studies. FGS shows great potential in improving IMA, although standardization in methodologies and reporting is needed.
This scoping review highlights the potential of intraoperative FGS to enhance treatment accuracy in solid HNC, though variability in diagnostic efficacy and a lack of standardized methodologies persist. Advancements in fluorophore technology and uniform procedural protocols are essential to optimize surgical outcomes and move towards personalized HNC interventions.
在原发性肿瘤切除术中获得阴性切缘对于降低复发率和死亡率至关重要。荧光成像可能有助于完整切除肿瘤。由于荧光剂仍处于头颈部癌（HNC）的临床试验研究阶段，其在术中切缘评估（IMA）中的有效性尚不清楚。本综述探讨了荧光引导手术（FGS）在HNC治疗中的应用，突出了这一新兴领域的重大机遇。
检索了从创刊至2024年3月22日的PubMed、Scopus、CINAHL和Cochrane图书馆。本研究按照PRISMA-ScR指南进行。提取了关于研究特征、荧光和成像技术、成像效果及诊断准确性的数据。
纳入了2013年至2024年关于HNC术中FGS的27项前瞻性研究，涉及来自6个国家的455例患者。研究范围从临床前试验到II期试验，应用了各种荧光技术，主要是吲哚菁绿和IRDye800CW，以提高手术精度。使用多种设备在体内、体外或两者进行成像评估，术中额外耗时0至30分钟。诸如信号背景比和平均荧光强度等定量指标表明，不同研究的诊断准确性存在差异。FGS在改善IMA方面显示出巨大潜力，尽管方法学和报告方面需要标准化。
本综述强调了术中FGS在提高实体HNC治疗准确性方面的潜力，尽管诊断效果存在差异且缺乏标准化方法。荧光团技术的进步和统一的程序方案对于优化手术结果和迈向个性化HNC干预至关重要。
