Image-guided surgery in oral cancer: toward improved margin control

Area of Science:

• Oncology
• Surgical Oncology
• Medical Imaging

Background:

• Oral cancer surgery often results in inadequate resection margins, particularly deep ones.
• Traditional methods like intraoperative frozen section have limitations in improving margin control.
• Current techniques for superficial margin assessment include mucosal staining, optical coherence tomography, and narrow band imaging.

Purpose of the Study:

• To review recent intraoperative techniques for assessing tumor extension and resection margins in oral cancer.
• To evaluate image-guided surgery approaches for improving margin control.
• To identify techniques closest to clinical implementation for oral cancer resection.

Main Methods:

• Review of recent studies on intraoperative techniques for oral cancer margin assessment.
• Analysis of in-vivo and ex-vivo imaging modalities.
• Evaluation of techniques like intraoperative ultrasound and fluorescence-guided resection.

Main Results:

• Intraoperative ultrasound and targeted fluorescence-guided resections demonstrate high clinical potential for margin control.
• Specimen-based gross analysis significantly reduces positive resection margins but requires further improvement.
• Advanced imaging like MRI and PET/CT for ex-vivo assessment need more research; spectroscopy data is scarce.

Conclusions:

• Intraoperative ultrasound and fluorescence imaging are the most promising techniques for improving oral cancer resection margins.
• These methods are nearing clinical implementation and offer significant potential for image-guided oral cancer surgery.
• Further research is needed for ex-vivo imaging techniques to enhance margin assessment.