Fluorescence Identification of Head and Neck Squamous Cell Carcinoma and High-Risk Oral Dysplasia With BLZ-100, a Chlorotoxin-Indocyanine Green Conjugate

Abstract

Importance Surgical cure of head and neck squamous cell carcinoma (HNSCC) remains hampered by inadequately resected tumors and poor recognition of lesions with malignant potential. BLZ-100 is chlorotoxin-based tumor targeting agent which has not yet been studied in HNSCC. Objective To evaluate BLZ-100 uptake in models of HNSCC and oral dysplasia. Design Observational study (including sensitivity/specificity analysis) of BLZ-100 uptake in an orthotopic xenograft mouse model of HNSCC and a carcinogen-induced dysplasia model of hamster cheek pouches. Setting Research laboratory Participants NSG mice, Golden Syrian hamsters Interventions Various HNSCC xenografts were established in the tongues of NSG mice. BLZ-100 was intravenously injected and fluorescence uptake was measured. To induce dysplasia, the carcinogen DMBA was applied to the cheek pouch of Golden Syrian hamsters for 9–16 weeks. BLZ-100 was subcutaneously injected and fluorescence uptake was measured. Main Outcomes and Measures The signal-to-background ratio (SBR) of BLZ-100 was measured in tumor xenografts. To calculate the sensitivity and specificity of BLZ-100 uptake, a digital grid was placed over tissue sections and correlative histologic sections to discretely measure fluorescence intensity and presence of tumor; a receiver operating characteristic (ROC) curve was then plotted. In the hamster dysplasia model, cheeks were graded according to dysplasia severity. The SBR of BLZ-100 was compared among dysplasia grades. Results In HNSCC xenografts, BLZ-100 demonstrated an overall signal-to-background ratio (SBR) of 2.51 +/− 0.47 SD. The ROC curve demonstrated an area under the curve (AUC) of 0.889; a SBR of 2.5 corresponded to 92% sensitivity and 74% specificity. When this analysis was focused on the tumor and non-tumor interface, the AUC increased to 0.971; a SBR of 2.5 corresponded to 95% sensitivity and 91% specificity. DMBA treatment of hamster cheek pouches generated lesions representing all grades of dysplasia. The SBR of high-grade dysplasia was significantly greater than that of mild-to-moderate dysplasia (2.31 +/− 0.71 SD versus 1.51 +/− 0.34 SD, p=0.006). Conclusions and Relevance BLZ-100 is a sensitive and specific marker of HNSCC, and can distinguish high-risk from low-risk dysplasia. BLZ-100 has the potential to serve as an intraoperative guide for tumor margin excision and identification of pre-malignant lesions.

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