Fluorescence Visualization–Guided Surgery for Early-Stage Oral Cancer

Poh, Catherine F.; Anderson, Donald W.; Durham, J.S.; Chen, Jiahua; Berean, Ken; MacAulay, Calum; Rosin, Miriam P.

doi:10.1001/jamaoto.2015.3211

Cited by 59 publications

(56 citation statements)

References 44 publications

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“…Local recurrence, however, continues to be a common cause of treatment failure in these patients. This is due to presence of clinically invisible and histologically undetectable genetically altered cells, 27 or ‘‘satellite’’ tumor cells within a reactive zone surrounding the solid neoplasm. 47 Furthermore, frozen margin assessment in the OR is constrained by time and susceptible to sampling error, which has led to false-negative results in up to 23% of lumpectomy cases.…”

Section: Discussionmentioning

confidence: 99%

“…Wide local excision: autofluorescence improving tumor margin delineation versus white light. 27 Whole-organ resection: intraoperative fluorescence images of the parathyroid gland with (A) bright-field of parathyroid and thyroid from patient undergoing thyroidectomy, (B) NIR fluorescence showing parathyroid in red, and (C) bright-field and fluorescence images superimposed to show parathyroid fluorescence. 28 …”

Section: Figurementioning

confidence: 99%

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Oncologic Procedures Amenable to Fluorescence-guided Surgery

et al. 2017

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Objective: Although fluorescence imaging is being applied to a wide range of cancers, it remains unclear which disease populations will benefit greatest. Therefore, we review the potential of this technology to improve outcomes in surgical oncology with attention to the various surgical procedures while exploring trial endpoints that may be optimal for each tumor type. Background: For many tumors, primary treatment is surgical resection with negative margins, which corresponds to improved survival and a reduction in subsequent adjuvant therapies. Despite unfavorable effect on patient outcomes, margin positivity rate has not changed significantly over the years. Thus, patients often experience high rates of re-excision, radical resections, and overtreatment. However, fluorescence-guided surgery (FGS) has brought forth new light by allowing detection of subclinical disease not readily visible with the naked eye. Methods: We performed a systematic review of clinicatrials.gov using search terms ‘‘fluorescence,’’ ‘‘image-guided surgery,’’ and ‘‘near-infrared imaging’’ to identify trials utilizing FGS for those received on or before May 2016. Inclusion criteria: fluorescence surgery for tumor debulking, wide local excision, whole-organ resection, and peritoneal metastases. Exclusion criteria: fluorescence in situ hybridization, fluorescence imaging for lymph node mapping, nonmalignant lesions, nonsurgical purposes, or image guidance without fluorescence. Results: Initial search produced 844 entries, which was narrowed down to 68 trials. Review of literature and clinical trials identified 3 primary resection methods for utilizing FGS: (1) debulking, (2) wide local excision, and (3) whole organ excision. Conclusions: The use of FGS as a surgical guide enhancement has the potential to improve survival and quality of life outcomes for patients. And, as the number of clinical trials rise each year, it is apparent that FGS has great potential for a broad range of clinical applications.

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Section: Discussionmentioning

confidence: 99%

Section: Figurementioning

confidence: 99%

Oncologic Procedures Amenable to Fluorescence-guided Surgery

et al. 2017

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“…The fluorescent system was the VELscope system (VELscope; LED Medical Diagnostics, Inc.) Patients were followed for after surgery and patients who underwent surgery with fluorescence visualization had a dramatic reduction in the 3-year local recurrence rate. This publication has validated the concept that image guided margin delineation can result in improved oncologic outcomes [28] . While this investigation is an excellent example of the concept of fluorescent-guided imaging to guide surgical resection, the VELscope system relies on tissue autofluorescence with the associated issues of specificity as noted previously.…”

Section: Tissue Auto Fluorescencementioning

confidence: 61%

“…However in the setting of known dysplastic lesion, or frank malignancy, which has been biopsied, tissue autofluorescence may provide sufficient specificity to improve outcomes as reported in the noted study. Currently the group is currently finalizing data from a multicenter, phase 3 trial to validate their results [28] . While the laboratory results of examining tissue autofluorescence have shown significant promise in the discrimination of malignant tissues, actual application in clinical trials has been extremely variable in terms of specificity [29,72] .…”

Section: Tissue Auto Fluorescencementioning

confidence: 99%

How Close Are We to Real Time Optical Margin Control in Head and Neck Oncologic Surgery?

Miles

2016

Cancer Cell Microenviron

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The quest for negative margins during head and neck oncologic surgery continues to challenge surgeons worldwide. Current technological advances offer significant promise to advance the field and improve operative margin detection. This review focuses on current optical technology, which has been evaluated for intraoperative margin control in head and neck oncologic surgery. Many of the current systems have technical limitations and there is no current standard technology being applied in the field of head and neck oncology to enhance intraoperative margin control. Surgeons continue to rely on intraoperative frozen section analysis, however many optical systems have shown high rates of sensitivity and specificity when discriminating benign from malignant tissue. These technologies shows significant promise for intraoperative margin control and may be enhanced by targeted molecular imaging, or spectral analysis, in the future. Translational trials are rare and are the key to the path of independence from frozen section analysis.

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“…In our research, we saw a reduced local recurrence rate from two digits to one. The data were published recently in JAMA Otolaryngology [1]. …”

Section: Q Can You Tell Us About Your Work With the Cools Trial Usinmentioning

confidence: 99%

Improving Public Awareness and Outcomes for Oral Cancer

Poh

2016

Future Sci. OA

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Catherine Poh speaks to G Westcott, Commissioning Editor: Dr. C Poh gained a dental degree from the National Taiwan University in Taipei, Taiwan and went on to gain her PhD from the University of British Columbia in 1997, looking into molecular biology in oral cancer. In addition to her current role an associate professor in the Faculty of Dentistry at the University of British Columbia, she is a senior clinician scientist at the Integrative Oncology Department of the BC Cancer Agency's Research Centre. She has various other roles, including being active within the Oral Oncology Department at BC Cancer Agency and the Oral Mucosal Disease Program at Vancouver General Hospital. Her research focuses on the application of molecular and imaging tools for screening, detection and management of at-risk oral lesions. She is currently the principal investigator of a Terry Fox Research Institute-funded ($5 million), pan-Canadian multicenter randomized controlled surgical trial.

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Fluorescence Visualization–Guided Surgery for Early-Stage Oral Cancer

Cited by 59 publications

References 44 publications

Oncologic Procedures Amenable to Fluorescence-guided Surgery

Oncologic Procedures Amenable to Fluorescence-guided Surgery

How Close Are We to Real Time Optical Margin Control in Head and Neck Oncologic Surgery?

Improving Public Awareness and Outcomes for Oral Cancer

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