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Indocyanine green fluorescence-guided surgery in head and neck cancer: A systematic review
Emma De Ravin1, Sanjena Venkatesh2, Stefan Harmsen3
1Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, United States of America; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States of America.
Objective:
To assess the feasibility and effectiveness of indocyanine green (ICG) for image-guided resection of head and neck cancer (HNC).
Data Sources:
PubMed, Embase, and Scopus databases.
Review Methods:
Searches were conducted from database inception to February 2022. Patient and study characteristics, imaging parameters, and imaging efficacy data were extracted from each study.
Results:
Nine studies met inclusion criteria, representing 103 head and neck tumors. Weighted mean ICG dose and imaging time were 1.27 mg/kg and 11.77 h, respectively. Among the five studies that provided quantitative metrics of imaging efficacy, average ICG tumor-to-background ratio (TBR) was 1.56 and weighted mean ONM-100 TBR was 3.64. Pooled sensitivity and specificity across the five studies were 91.7 % and 71.9 %, respectively.
Conclusion:
FGS with ICG may facilitate real-time tumor-margin delineation to improve margin clearance rates and progression-free survival. Future studies with validated, quantitative metrics of imaging success are necessary to further evaluate the prognostic benefit of these techniques.
Insights
Indocyanine green (ICG) fluorescence-guided surgery (FGS) shows promise for improving head and neck cancer resection. Real-time tumor delineation with ICG may enhance margin clearance and patient outcomes.
Area of Science:
- Oncology
- Surgical Innovation
- Medical Imaging
Background:
- Head and neck cancer (HNC) resection requires precise tumor margin delineation.
- Current methods for margin assessment can be challenging, potentially leading to incomplete resection or positive margins.
Purpose of the Study:
- To evaluate the feasibility and effectiveness of using indocyanine green (ICG) for image-guided resection in HNC.
- To synthesize existing evidence on ICG's performance in delineating HNC tumors during surgery.
Main Methods:
- Systematic literature search of PubMed, Embase, and Scopus databases up to February 2022.
- Extraction of patient and study characteristics, imaging parameters, and efficacy data from included studies.
- Meta-analysis of pooled sensitivity, specificity, and tumor-to-background ratios (TBR).
Main Results:
- Nine studies involving 103 HNC tumors were included.
- Pooled sensitivity was 91.7% and specificity was 71.9% for ICG-based tumor detection.
- Quantitative imaging metrics showed an average ICG TBR of 1.56 and ONM-100 TBR of 3.64.
Conclusions:
- Fluorescence-guided surgery (FGS) with ICG offers potential for real-time tumor margin delineation in HNC.
- ICG-based FGS may improve margin clearance rates and progression-free survival.
- Further research with validated quantitative metrics is needed to confirm the prognostic benefits.
