Operative margin control with high‐resolution optical microendoscopy for head and neck squamous cell carcinoma

Miles, Brett A.; Patsias, Alexis; Quang, Timothy; Polydorides, Alexandros; Richards‐Kortum, Rebecca; Sikora, Andrew G.

doi:10.1002/lary.25400

Cited by 27 publications

(34 citation statements)

References 47 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…With the development of new technologies, such as high-resolution microendoscopy, 21 reflectance confocal microscopy, 22 and targeted optical imaging agents, 23 more accurate methods will be available to confirm that no cancer cells remain after the tumor resection. Real-time intraoperative delineation of tumor vs normal tissue will enable complete resection oftumors, with maximal function and aesthetic preservation.…”

Section: Discussionmentioning

confidence: 99%

A Proposal to Redefine Close Surgical Margins in Squamous Cell Carcinoma of the Oral Tongue

Zanoni

Migliacci

et al. 2017

JAMA Otolaryngol Head Neck Surg

128

View full text Add to dashboard Cite

IMPORTANCE Resection of the primary tumor with negative margins is the gold standard treatment for squamous cell carcinoma of the oral tongue (SCCOT). A microscopically positive surgical margin is clearly associated with a higher risk for local recurrence, whereas a negative margin has traditionally been defined as greater than 5.0 mm clearance from the tumor, with lesser margins arbitrarily designated as close. The precise cutoff at which the risk for local recurrence with a close margin approximates that of a microscopically positive margin remains unclear. OBJECTIVE To determine whether the arbitrarily defined close margin (<5.0 mm) would portend as high a risk for local recurrence as a positive margin after resection of SCCOT. DESIGN, SETTING, AND PARTICIPANTS In this retrospective study, head and neck pathologists reviewed archived tumor specimens from 381 patients with SCCOT who underwent primary surgical resection at a tertiary care center from January 1, 2000, through December 31, 2012. Data were analyzed from November 15, 2015, to January 5, 2016. Time-dependent receiver operating characteristic curve analysis was used in patients who did not have a microscopically positive margin to determine an optimal margin cutoff for local recurrence-free survival (LRFS). Pathologic factors were assessed for LRFS in a multivariate Cox proportional hazards regression model. MAIN OUTCOMES AND MEASURES The primary end point was evaluation of the margin distance associated with LRFS. RESULTS Among the 381 patients included in the analysis (222 men [58.3%] and 159 women [41.7%]; mean [SD] age, 58 [14.7] years), the optimal cutoff associated with LRFS was determined to be 2.2 mm. This cutoff was compared with the traditionally accepted cutoff of 5.0 mm. Patients with a margin of 2.3 to 5.0 mm had similar LRFS as patients with a margin of greater than 5.0 mm (hazard ratio [HR], 1.31; 95% CI, 0.58–2.96), and all other comparisons were significantly different (HR for positive margin, 9.03; 95% CI, 3.45–23.67; HR for 0.01-to 2.2-mm margin, 2.83; 95% CI, 1.32–6.07). Based on this result, negative margins were redefined as those with a clearance of greater than 2.2 mm. In a multivariate model adjusting for pathologic factors, positive margins (adjusted HR, 5.73; 95% CI, 2.45–13.41) and margins of 0.01 to 2.2 mm (adjusted HR, 2.00; 95% CI, 1.13–3.55) were the variables most significantly associated with LRFS. CONCLUSIONS AND RELEVANCE In this study, local recurrence-free survival was significantly affected only with surgical margins of less than or equal to 2.2 mm in patients with SCCOT. This new definition of close margins stratifies the risk for local recurrence better than the arbitrary 5.0-mm cutoff that has been used.

show abstract

Section: Discussionmentioning

confidence: 99%

A Proposal to Redefine Close Surgical Margins in Squamous Cell Carcinoma of the Oral Tongue

Zanoni

Migliacci

et al. 2017

JAMA Otolaryngol Head Neck Surg

128

View full text Add to dashboard Cite

show abstract

“…Pilot studies of this technology have demonstrated the potential to discriminate between neoplastic and nonneoplastic tissue in a variety of organ sites, including the esophagus (Pierce et al, 2011;Thekkek et al, 2012;Shin et al, 2015), the oral cavity Pierce et al, 2012b;Miles et al, 2015), the colon (Parikh et al, 2015), and the cervix (Pierce et al, 2012a;Quinn et al, 2012). In this pilot study in Barretos, Brazil, we evaluate the diagnostic accuracy of the HRME imaging system in identifying precancerous lesions of the cervix in vivo.…”

Section: Introductionmentioning

confidence: 97%

High-resolution microendoscopy: a point-of-care diagnostic for cervical dysplasia in low-resource settings

Grant

Fregnani²,

Possati-Resende³

et al. 2017

European Journal of Cancer Prevention

Self Cite

View full text Add to dashboard Cite

Cervical cancer is the third leading cause of cancer-related death among women in low-to-middle income countries. Pap testing and pathological services are difficult to implement under these settings. Alternative techniques for the diagnosis of cervical precancer in these settings are needed to reduce the burden of the disease. The objective of this study was to evaluate the diagnostic accuracy of a low-cost, high-resolution microendoscope imaging system in identifying precancerous lesions of the cervix in vivo. A retrospective study of 59 patients undergoing colposcopy for an abnormal Pap test was performed at Hospital de Câncer de Barretos in Brazil. All patients underwent colposcopy as per standard of care, and acetowhite lesions were recorded. High-resolution microendoscopy (HRME) images were obtained from one colposcopically normal region and from all lesions observed on colposcopy. Biopsies of abnormal areas were obtained and reviewed by three independent, blinded pathologists and compared with HRME findings. The mean nuclear area and the median nuclear eccentricity were calculated from HRME images acquired from each site. A diagnostic algorithm to distinguish histopathologically diagnosed cervical intraepithelial neoplasias of grade 2 or more severe lesions (high grade) from less severe lesions (low grade) was developed using these parameters. A test of trend was used to analyze the relationship between HRME positivity and severity of histopathogical diagnosis. Fisher's exact test was used to analyze differences in HRME positivity between high-grade and low-grade lesions. Evaluable images were obtained from 108 of 143 discrete sites. Of these, 71 sites were colposcopically normal or low grade according to histopathology and 37 were diagnosed as high grade on the basis of histopathology. Using the mean nuclear area and the median nuclear eccentricity, HRME images from 59 colposcopically abnormal sites were classified as high grade or low grade with 92% sensitivity and 77% specificity compared with histopathological findings. Increasing HRME positivity showed a significant trend with increasing severity of diagnosis (Ptrend<0.001). We found a strong association (P<0.001) between HRME positivity and a histopathological diagnosis of cervical intraepithelial neoplasia of grade 2 or higher. HRME demonstrated an accurate in-situ diagnosis of high-grade dysplasia. In low-resource settings in which colposcopy and histopathology services are severely limited or unavailable, HRME may provide a low-cost, accurate method for diagnosis of cervical precancer without the need for biopsy, allowing for a single 'screen-and-treat' approach.

show abstract

“…The authors concluded that HRME may offer promise in the intraoperative evaluation of surgical margins if more specific targeted contrast agents (i.e. fluorescent targeted contrast) were coupled with the device (Figure 2) [27] .…”

Section: Figure 1 High Resolution Microendoscopy (Hrme) Images From mentioning

confidence: 99%

“…The authors concluded that HRME had a reliability of high-to distinguish benign versus malignant mucosa in these selected images (Figure 1. ) [27] . The investigators did note that issues with image acquisition were problematic including severe inflammation, keratin debris, contrast artifact, bleeding, and the significant limitation of the technology that at the current time is limited to surface imaging (50µm).…”

Section: Figure 1 High Resolution Microendoscopy (Hrme) Images From mentioning

confidence: 99%

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

Miles

2016

Cancer Cell Microenviron

View full text Add to dashboard Cite

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.

show abstract

Operative margin control with high‐resolution optical microendoscopy for head and neck squamous cell carcinoma

Abstract: 3b.

Cited by 27 publications

References 47 publications

A Proposal to Redefine Close Surgical Margins in Squamous Cell Carcinoma of the Oral Tongue

A Proposal to Redefine Close Surgical Margins in Squamous Cell Carcinoma of the Oral Tongue

High-resolution microendoscopy: a point-of-care diagnostic for cervical dysplasia in low-resource settings

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

Contact Info

Product

Resources

About