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Updated: Feb 18, 2026
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Published on: August 15, 2025
Tailored resections in oral and oropharyngeal cancer using narrow band imaging
Giancarlo Tirelli1, Marco Piovesana1, Alberto Vito Marcuzzo1
1ENT Clinic, Head and Neck Department, Azienda Sanitaria Universitaria Integrata di Trieste, Strada di Fiume 447, 34149 Trieste, Italy.
Purpose:
In a previous pilot study we observed that intra-operative narrow-band imaging (NBI) helps achieve clear superficial resection margins. The aim of this study was to verify if the use of intra-operative NBI can help to obtain tailored resections and if it is influenced by the lesion site, aspects not investigated in our previous study.
Materials And Methods:
The resection margins of 39 oral and 22 oropharyngeal squamous cell carcinomas were first set at 1.5cm from the macroscopic lesion boundary (white light, WL, tattoo). Then, the superficial tumor extension was more precisely defined with NBI, giving rise to three possible situations: NBI tattoo larger than the WL tattoo, NBI tattoo coinciding with the WL tattoo, or NBI tattoo smaller than the WL tattoo. For each of these situations the space comprised between the NBI and WL tattoos was defined "NBI positive", "NBI null", and "NBI negative", respectively. Resections were performed following the outer tattoo. The number of clear superficial resection margins, and the pathological response on the "NBI-positive" and the "NBI-negative" areas were recorded.
Results:
We obtained 80.3% negative superficial resection margins. NBI provided a more precise definition of superficial tumor extension in 43 patients. Sensitivity, specificity, positive and negative predictive values were 94.4%, 64%, 79.1% and 88.9%, respectively; a test of proportions demonstrated they were not influenced by tumor site.
Conclusions:
NBI could allow for real-time definition of superficial tumor extension with possible tailored resections and fewer positive superficial resection margins; it is not influenced by tumor site.
Insights
Intra-operative narrow-band imaging (NBI) improves tumor margin definition for oral cancers, leading to more tailored resections and fewer positive margins. This technique
Area of Science:
- Oncology
- Surgical Oncology
- Medical Imaging
Background:
- Previous pilot studies suggested narrow-band imaging (NBI) aids in achieving clear superficial resection margins.
- The precise impact of NBI on tailored resections and its variability based on lesion site remained uninvestigated.
Purpose of the Study:
- To verify if intra-operative NBI facilitates tailored tumor resections.
- To determine if the effectiveness of NBI in defining resection margins is influenced by the tumor's anatomical location (oral vs. oropharyngeal).
Main Methods:
- Resection margins were initially set at 1.5cm from the macroscopic boundary using white light (WL).
- Narrow-band imaging (NBI) was then used to refine superficial tumor extension, creating NBI tattoos relative to WL tattoos.
- Resections were performed based on the outer tattoo, and outcomes regarding margin status and pathological response in NBI-defined areas were analyzed.
Main Results:
- 80.3% of superficial resection margins were clear (negative).
- NBI accurately redefined superficial tumor extension in 43 patients.
- NBI demonstrated high sensitivity (94.4%) and negative predictive value (88.9%), with specificity of 64% and positive predictive value of 79.1%, irrespective of tumor site.
Conclusions:
- Intra-operative NBI enables real-time definition of superficial tumor spread.
- NBI facilitates tailored surgical resections, potentially reducing positive superficial margins.
- The utility of NBI in this context is not affected by the tumor's location within the oral cavity or oropharynx.
