Narrow band imaging in the intra-operative definition of resection margins in oral cavity and oropharyngeal cancer

Tirelli, Gian Carlo; Piovesana, Marco; Gatto, Annalisa; Tofanelli, Margherita; Biasotto, Matteo; Nata, Francesca Boscolo

doi:10.1016/j.oraloncology.2015.07.005

Cited by 57 publications

(71 citation statements)

References 44 publications

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“…Interestingly, estimated tumor thickness was not a major determinant in stage migration. Therefore, in addition to three dimensional evaluation for primary tumors and surrounding structures (extrinsic muscles of the tongue), visualization of microscopic or molecular tumor spread on the mucosal surface should be improved through narrow‐band imaging or fluorescence imaging to minimize the discrepancy between cT and pT classifications.…”

Section: Discussionmentioning

confidence: 99%

Discrepancy between cTNM and pTNM staging of oral cavity cancers and its prognostic significance

Choi

Noh

Lee

et al. 2017

Journal of Surgical Oncology

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Section: Discussionmentioning

confidence: 99%

Discrepancy between cTNM and pTNM staging of oral cavity cancers and its prognostic significance

Choi

Noh

Lee

et al. 2017

Journal of Surgical Oncology

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“…This should allow a better intraoperative evaluation of the depth of invasion . Indeed, deep margins represent a major problem for the surgeon compared to mucosal margins, which are more visible, palpable, and assessable by optical imaging such as NBI . Woolgar and Triantafyllou, in a very detailed appraisal on 301 specimens of oral and oropharyngeal cancers, found 70 cases with positive margins (23.25%), 50 of which (71%) had only deep infiltrated margins.…”

Section: Discussionmentioning

confidence: 99%

“…Considering that inadequate resection margins are reported between 30% and 65%, this represents a difficult task for the clinician. Recently, the intraoperative use of narrow band imaging (NBI) emerged as a promising tool to help the surgeon in the assessment of the real superficial extension of oral, oropharyngeal, and laryngeal cancer . Narrow band imaging is a video endoscopic system with narrow band filters that enhance the microvascular abnormalities, commonly associated with preneoplastic and neoplastic lesions of the upper aerodigestive tract.…”

Section: Introductionmentioning

confidence: 99%

“…In addition, it has been reported that CO2 laser piecemeal resection offers the chance to better characterize tumor extension in depth, which represents a major challenge in head and neck surgery thanks to a different interaction of the laser beam with tumoral and healthy tissue . Thus, on the one hand NBI allows to better define the superficial spread of the tumor, while on the other hand piecemeal resection better assesses deep margins …”

Section: Introductionmentioning

confidence: 99%

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Intraoperative Margin Control in Transoral Approach for Oral and Oropharyngeal Cancer

et al. 2018

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Objectives Piecemeal resection provides an innovative conceptual tool for margins surveillance because it entails the intraoperative evaluation of the whole resection margins and not just sample points, which should result in a better control of deep margins compared to en bloc resection. Although it is recognized that the intraoperative use of narrow band imaging (NBI) results in a better control of superficial margins, in this exploratory study we investigated whether NBI and piecemeal resection could be used in combination to improve margin control at both superficial and deep levels. Because piecemeal resection is based on frozen section analysis, we wanted to verify its reliability compared to definitive histological examination. Methods The status of resection margins in a group of patients with oral and oropharyngeal cancers treated with NBI and laser CO2 piecemeal resection (group 1) was compared with that of an historical group of patients (group 2) treated with NBI and conventional en bloc resection. In group 1, sensitivity, specificity, and positive and negative predictive values were used to verify the rate of concordance between frozen section and definitive histology. Results The difference between deep positive margins in the two groups was statistically significant (P = 0.042). The high sensitivity and specificity (94.6% and 94.7%, respectively) of frozen section analysis also demonstrated its reliability in the examination of larger samples corresponding to the whole margin. Conclusion Even if our findings are limited by the small number of patients, we are confident that the combined use of NBI and piecemeal resection could represent an attractive surgical strategy to improve margin control. Level of Evidence 2b Laryngoscope, 129:1810–1815, 2019

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“…Tirelli et al, reported on the use of NBI margin mapping in 16 patients with head and neck squamous cell carcinoma after traditional macroscopic margin delineation. The authors reported that margins delineated with NBI technology were frequently positive for dysplasia (25%) or malignancy (75%) and that the technology was superior to traditional macroscopic margin delineation [24] . While NBI was reported to be highly sensitive (100%) in this selected group of patients, the author did note that the specificity performance was approximately 88%.…”

Section: Narrow-band Imaging (Nbi)mentioning

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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Narrow band imaging in the intra-operative definition of resection margins in oral cavity and oropharyngeal cancer

Cited by 57 publications

References 44 publications

Discrepancy between cTNM and pTNM staging of oral cavity cancers and its prognostic significance

Discrepancy between cTNM and pTNM staging of oral cavity cancers and its prognostic significance

Intraoperative Margin Control in Transoral Approach for Oral and Oropharyngeal Cancer

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

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