Rapid and Quantitative Intraoperative Pathology-Assisted Surgery by Paired-Agent Imaging-Derived Confidence Map

Area of Science:

• Oncology
• Medical Imaging
• Pathology

Background:

• Surgical margin status is critical for predicting recurrence and survival in nonmetastatic head and neck cancer.
• Current standard intraoperative margin assessment, fresh frozen sectioning (FFS), is time-consuming and has variable accuracy.
• There is a need for more efficient and consistent methods for intraoperative margin assessment.

Purpose of the Study:

• To evaluate the potential of paired-agent imaging (PAI) for intraoperative margin assessment in head and neck cancer.
• To compare the diagnostic accuracy and speed of PAI with traditional methods.
• To assess the utility of PAI confidence maps for tumor delineation.

Main Methods:

• PAI was performed using an anti-EGFR affibody molecule (ABY-029) and an untargeted fluorescent dye (IRDye680LT) in oral squamous cell carcinoma xenograft mouse models.
• Imaging was conducted on frozen tissue sections.
• Diagnostic ability and tumor contrast were analyzed, and confidence maps were generated.

Main Results:

• PAI demonstrated superior diagnostic ability (AUC: 0.91-0.79) and contrast-to-noise ratio (CNR: 1-0.6) compared to individual agents.
• PAI confidence maps further enhanced tumor contrast (CNR: 1.5-0.8) and diagnostic accuracy (AUC: 0.91-0.79).
• PAI significantly reduced tumor delineation time from approximately 35 minutes to under 1 minute per slice.

Conclusions:

• PAI provides accurate and rapid intraoperative margin assessment for head and neck cancer.
• PAI confidence maps improve tumor contrast and differentiability, especially in avascular tumors.
• PAI has the potential to standardize fluorescence imaging in intraoperative pathology-assisted surgery (IPAS).