Intraoperative navigation in complex head and neck resections: indications and limits

Catanzaro, S.; Copelli, Chiara; Manfuso, Alfonso; Tewfik, Karim; Pederneschi, N.; Cassano, Lazzaro; Cocchi, R

doi:10.1007/s11548-016-1486-0

Cited by 29 publications

(27 citation statements)

References 23 publications

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“…The main limitation of the present study is its preclinical nature, which makes the results potentially biased by the "ideal" conditions of the laboratory setting. However, the preliminary clinical data published in the literature so far align with the observations of the present study [21][22][23]. This makes the translation of such technology into clinical practice a step forward, however there must be adequate research in the clinical setting to ensure that there is measurable clinical benefit to the patient from an oncological point of view.…”

Section: Limitations Of the Studysupporting

confidence: 75%

“…Likewise, Catanzaro et al and Tarsitano et al recently demonstrated that navigation provided a significant improvement in terms of deep margin status when added to the standard procedure for advanced maxillary, oral, or orbital cancers (i.e. ablation followed by mapping of the surgical bed with frozen-section biopsies) [21,22]. While these studies included only a limited number of patients (18), they were the first advocates for margin improvement using surgical navigation.…”

Section: Surgical Navigationmentioning

confidence: 99%

“…However, the potential for navigation to maximize precision and avoid major complications during the ablation was considered when this technology was first described for head and neck surgical oncology [17][18][19]. Navigation has clearly demonstrated improved accuracy and reproducibility of craniomaxillofacial osteotomies [20], thus translating clinically into improved outcomes [21][22][23][24].…”

Section: Introductionmentioning

confidence: 99%

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Navigation-guided osteotomies improve margin delineation in tumors involving the sinonasal area: A preclinical study

et al. 2019

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To demonstrate and quantify, in a preclinical setting, the benefit of three-dimensional (3D) navigation guidance for margin delineation during ablative open surgery for advanced sinonasal cancer. Materials and methods: Seven tumor models were created. 3D images were acquired with cone beam computed tomography, and 3D tumor segmentations were contoured. Eight surgeons with variable experience were recruited for the simulation of osteotomies. Three simulations were performed: 1) Unguided, 2) Guided using realtime tool tracking with 3D tumor segmentation (tumor-guided), and 3) Guided by 3D visualization of both the tumor and 1-cm margin segmentations (margin-guided). Analysis of cutting planes was performed and distance from the tumor surface was classified as follows: "intratumoral" when 0 mm or negative, "close" when greater than 0 mm and less than or equal to 5 mm, "adequate" when greater than 5 mm and less than or equal to 15 mm, and "excessive" over 15 mm. The three techniques (unguided, tumor-guided, margin-guided) were statistically compared. Results: The use of 3D navigation for margin delineation significantly improved control of margins: unguided cuts had 18.1% intratumoral cuts compared to 0% intratumoral cuts with 3D navigation (p < 0.0001). Conclusion: This preclinical study has demonstrated the significant benefit of navigation-guided osteotomies for sinonasal tumors. Translation into the clinical setting-with rigorous assessment of oncological outcomeswould be the proposed next step.

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Section: Limitations Of the Studysupporting

confidence: 75%

Section: Surgical Navigationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Navigation-guided osteotomies improve margin delineation in tumors involving the sinonasal area: A preclinical study

et al. 2019

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“…Unfortunately, the highest overall inadequate margins rates (15%-30%) in all of surgical oncology are found in head and neck cancer (6). Despite the introduction of many novel technologies, inadequate margin rates have not changed over the past 30 years as surgeons cannot successfully differentiate healthy from diseased tissue (6,7). The most commonly used method for intraoperative margin control is frozen section analysis (FSA); however, this technique suffers from sampling errors as surgeons often struggle to identify which suspicious regions should be sent for histopathologic assessment (8).…”

Section: Introductionmentioning

confidence: 99%

The Sentinel Margin: Intraoperative Ex Vivo Specimen Mapping Using Relative Fluorescence Intensity

Keulen

Nishio

Birkeland

et al. 2019

Clinical Cancer Research

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Purpose: Despite major advancements in surgical oncology, the positive margin rate for primary head and neck cancer resection remains around 15%-30%. In particular, the deep surface margin is the most challenging to adequately assess. Inadequate margins are directly correlated to poor survival, and as such, mitigation of these rates is critical to improve patient outcomes. We have developed an ex vivo imaging strategy that utilizes fluorescence intensity peaks (relative to background signal) of an injected anti-EGFR antibody conjugated to a fluorescent probe to locate potential close or positive margins on the deep surface of the resected tumor specimen. Experimental Design: Twelve patients with head and neck cancer scheduled for surgery received systemic administration of a tumor-specific contrast-agent (panitumumab-IRDye800CW). After surgical resection, the tumor specimen was imaged using a fluorescence imager. The three highest fluorescence intensity-peaks on the deep surface of the specimen were isolated and correlated to histology to determine the margin distance at these regions. Results: Relative fluorescence peak intensities identified the closest margin on the deep surface of the specimen within 2.5 minutes. The highest intensity peak consistently (100%) detected the closest margin to the tumor. The difference in tumor margin distance between the first and second highest fluorescence intensity peak averaged 2.1 AE 1.4 mm. The tumor-margin difference between the second and third highest peak averaged 1.6 AE 0.6 mm. Conclusions: Fluorescence intensity peaks can identify the region on the specimen where tumor is closest to specimen's edge on the deep surface. This technique could have broad applications in obtaining adequate margins in oncological surgery.

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“…Surgical resection remains the gold standard for the majority of solid tumors [1]. Despite improved medical technologies for preoperative surgical planning [2,3] and intraoperative guidance, including radio-guided and fluorescence imaging-based approaches [4,5], head and neck surgeons still primarily rely on their vision and palpation to determine surgical margins. Not surprisingly, tumor-positive margins are still found in 15–30% of all head and neck cancer resections [6–8].…”

Section: Introductionmentioning

confidence: 99%

Rapid, non-invasive fluorescence margin assessment: Optical specimen mapping in oral squamous cell carcinoma

et al. 2019

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Objective Surgical resection remains the primary treatment for the majority of solid tumors. Despite efforts to obtain wide margins, close or positive surgical margins (<5mm) are found in 15–30% of head and neck cancer patients. Obtaining negative margins requires immediate, intraoperative feedback of margin status. To this end, we propose optical specimen mapping of resected tumor specimens immediately after removal. Materials and Methods A first-in-human pilot study was performed in patients (n=8) after infusion of fluorescently labeled antibody, panitumumab-IRDye800 to allow surgical mapping of the tumor specimen. Patients underwent standard of care surgical resection for head and neck squamous cell carcinoma (HNSCC). Optical specimen mapping was performed on the primary tumor specimen and correlated with pathological findings after tissue processing. Results Optical mapping of the specimen had a 95% sensitivity and 89% specificity to detect cancer within 5mm (n=160) of the cut surface. To detect tumor within 2mm of the specimen surface, the sensitivity of optical specimen mapping was 100%. The maximal observed penetration depth of panitumumab-IRDye800 through human tissue in our study was 6.3mm. Conclusion Optical specimen mapping is a highly sensitive and specific method for evaluation of margins within <5mm of the tumor mass in HNSCC specimens. This technology has potentially broad applications for ensuring adequate tumor resection and negative margins in head and neck cancers.

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Intraoperative navigation in complex head and neck resections: indications and limits

Abstract: Intraoperative navigation resulted to be a reliable method to improve oncological safety in a selected group of patients.

Cited by 29 publications

References 23 publications

Navigation-guided osteotomies improve margin delineation in tumors involving the sinonasal area: A preclinical study

Navigation-guided osteotomies improve margin delineation in tumors involving the sinonasal area: A preclinical study

The Sentinel Margin: Intraoperative Ex Vivo Specimen Mapping Using Relative Fluorescence Intensity

Rapid, non-invasive fluorescence margin assessment: Optical specimen mapping in oral squamous cell carcinoma

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