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Intraoperative Imaging with Second Window Indocyanine Green for Head and Neck Lesions and Regional Metastasis

Vanessa C Stubbs1, Samantha Jaffe1, Karthik Rajasekaran1

  • 11 Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.

Otolaryngology--Head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery
|May 1, 2019
PubMed

Insights

Near-infrared (NIR) imaging with indocyanine green (ICG) dye shows promise for visualizing head and neck tumors and metastases. This pilot study found NIR imaging feasible for identifying primary lesions and assessing regional lymph nodes during surgery.

Area of Science:

  • Oncologic Surgery
  • Medical Imaging
  • Head and Neck Malignancy

Background:

  • Optical imaging with near-infrared (NIR) fluorescent dye is established in oncologic surgery.
  • Its application in head and neck cancer surgery remains to be fully established.
  • Accurate visualization of primary tumors and metastatic lymph nodes is crucial for effective treatment.

Purpose of the Study:

  • To evaluate the feasibility of using NIR imaging with indocyanine green (ICG) dye.
  • To visualize primary tumors and regional metastases in head and neck malignancies.
  • To assess the utility of NIR imaging for intraoperative guidance in head and neck cancer surgery.

Main Methods:

  • A pilot study involving patients undergoing resection of primary head and neck tumors.
  • Patients received indocyanine green (ICG) dye injection the day before surgery.
  • Intraoperative visualization of primary lesions, margins, and neck dissection specimens was performed using the VisionSense Iridium camera system.

Main Results:

  • Eighty-six percent of primary head and neck tumors exhibited fluorescence compared to surrounding tissues.
  • ICG positivity demonstrated 100% sensitivity for identifying pathologic lymph nodes in 7 neck dissection specimens.
  • Nonpathologic lymph nodes showed ICG positivity in 3 patients, indicating a need for careful interpretation.

Conclusions:

  • Near-infrared (NIR) imaging utilizing indocyanine green (ICG) dye is a feasible technique for intraoperative imaging in head and neck cancer.
  • NIR imaging can aid in visualizing primary tumor extent and identifying potentially metastatic lymph nodes.
  • Further research is warranted to optimize the use of ICG dye in head and neck oncologic surgery.
Keywords:
head and neck cancerindocyanine green dyeintraoperative imagingnear-infrared imagingoptical imagingprecision surgery

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