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Endoscopic Fluorescence-Guided Surgery for Sinonasal Cancer Using an Antibody-Dye Conjugate
Zachary P Hart1, Naoki Nishio1,2, Giri Krishnan1,3
1Department of Otolaryngology, Stanford University School of Medicine, Stanford, California, U.S.A.
Objective:
Endoscopic resection of sinonasal squamous cell carcinoma has become the standard of care, but challenges remain in obtaining clear resection margins. The current study evaluated the feasibility of endoscopic fluorescence-guided surgery (FGS) to improve surgical resection in a human sinus surgical model.
Methods:
A fluorescence endoscope optimized for near-infrared (NIR) fluorescence detection was evaluated in a phantom study. Various endoscope diameters (4 and 10 mm) and viewing angles (0, 30, and 45 degrees) were evaluated to determine the sensitivity of the system for IRDye800CW detection at various working distances (1-5 cm). Endoscopic FGS was then validated in a three-dimensional human sinus surgical model to which squamous cell tumors derived from mice were inserted. Mice had received intravenous panitumumab-IRDye800CW and upon fluorescence-guided tumor resection, mean fluorescence intensity (MFI) and tumor-to-background ratio (TBR) were calculated in in situ and ex vivo settings.
Results:
A significantly higher fluorescence intensity was found when using the 10-mm diameter endoscope compared to the 4mm diameter endoscope (P < .001). No significant difference in MFI was found among the viewing angles of the 4-mm diameter endoscope. Using the human sinus model, the highest MFI and TBR were obtained at a 1-cm working distance compared to longer working distances.
Conclusion:
We demonstrate that clinically acceptable TBRs were obtained with several working distances to discriminate tumor tissue from adjacent normal tissue in a human sinus model, and that endoscopic FGS may have great potential in identifying residual tumor tissue regions during surgery. Laryngoscope, 2019.
Insights
Endoscopic fluorescence-guided surgery (FGS) shows promise for improving sinonasal squamous cell carcinoma resection. This technique effectively identified tumor tissue in a human sinus model, aiding in achieving clear surgical margins.
Area of Science:
- Otolaryngology
- Surgical Oncology
- Medical Imaging
Background:
- Endoscopic resection is standard for sinonasal squamous cell carcinoma.
- Achieving clear resection margins remains a surgical challenge.
Purpose of the Study:
- To evaluate the feasibility of endoscopic fluorescence-guided surgery (FGS) for improving surgical resection in a human sinus model.
- To assess the effectiveness of near-infrared (NIR) fluorescence detection in identifying tumor tissue.
Main Methods:
- A fluorescence endoscope for NIR detection was tested in phantom and human sinus models.
- Tumor models were created using mouse-derived squamous cell carcinoma.
- Panitumumab-IRDye800CW was administered intravenously, and fluorescence metrics (MFI, TBR) were analyzed.
Main Results:
- A 10-mm diameter endoscope yielded significantly higher fluorescence intensity than a 4-mm scope.
- Optimal tumor detection was achieved at a 1-cm working distance in the human sinus model.
- Clinically acceptable tumor-to-background ratios (TBRs) were obtained, discriminating tumor from normal tissue.
Conclusions:
- Endoscopic FGS demonstrates potential for identifying residual tumor during surgery.
- This technique may enhance the precision of sinonasal cancer resection.
- Further validation in clinical settings is warranted.
