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Background Tissue with Native Target Expression Can Determine Presence of Nodal Metastasis in Head and Neck Squamous
Nicole Meeks1, Sherin James2, Giri Krishnan3
1Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
Purpose:
Survival and treatment intensity in patients with head and neck squamous cell carcinoma (HNSCC) is determined by the presence of lymph node (LN) metastasis, and as a result surgical removal of potentially affected LN remains a mainstay practice. Fluorescence guided surgery (FGS) using targeted optical agents is an expanding field that shows great potential for aiding diagnosis of metastatic LN. Given variations in fluorescence background, a reference standard for regions of interest is necessary for cross patient comparison. The present study aims to determine whether tissue with native target expression can be used as a background to determine metastatic LN in patients with HNSCC infused with anti-epidermal growth factor receptor (EGFR) targeted imaging agents.
Procedures:
Twenty-two patients infused with panitumumab-IRDye800 or cetuximab-IRDye800 prior to surgery were included. Fluorescence imaging and analysis was performed on resected LNs (N = 843) using the submandibular glands (SMG) and skin as reference standard tissue with known EGFR antigen expression.
Results:
Sixteen patients (72.7%) had at least one positive LN on final pathology. The LN to SMG (LN/SMG) and LN to skin (LN/skin) ratios were significantly higher in metastatic LN compared to benign LN (p < 0.0001 for both). Using patient-specific ratios to determine an optimal LN/skin cutoff was the most sensitive (95.2%) and directly comparing the LN/skin ratio of all patients to determine a cutoff was the most specific (86.3%).
Conclusions:
In HNSCC patients infused with a molecularly targeted fluorescent tracer, endogenous expression of the target antigen can be used as a reference standard to detect LN metastasis. Additionally, the performance of the background in determining metastatic LN can be improved by utilizing patient-specific reference standards.
Insights
Native tissue expression can serve as a reference standard for detecting lymph node metastasis in head and neck cancer using fluorescence guided surgery. Patient-specific ratios improve diagnostic accuracy for identifying metastatic lymph nodes.
Area of Science:
- Oncology
- Surgical Innovation
- Medical Imaging
Background:
- Lymph node metastasis significantly impacts head and neck squamous cell carcinoma (HNSCC) patient outcomes.
- Surgical lymph node (LN) removal is standard, but accurate detection of metastasis is crucial.
- Fluorescence-guided surgery (FGS) with targeted agents shows promise for intraoperative LN assessment.
Purpose of the Study:
- To evaluate endogenous tissue expression as a reference standard for detecting metastatic LNs in HNSCC patients.
- To determine if native target expression can provide a reliable background for fluorescence imaging analysis.
- To assess the utility of anti-epidermal growth factor receptor (EGFR) targeted imaging agents in conjunction with a reference standard.
Main Methods:
- Twenty-two HNSCC patients received panitumumab-IRDye800 or cetuximab-IRDye800.
- Resected LNs (N=843) underwent fluorescence imaging.
- Submandibular glands (SMG) and skin, with known EGFR expression, served as reference standards.
Main Results:
- Metastatic LNs showed significantly higher LN/SMG and LN/skin fluorescence ratios than benign LNs (p<0.0001).
- Patient-specific LN/skin ratios achieved 95.2% sensitivity for detecting metastasis.
- Comparing all patient LN/skin ratios yielded 86.3% specificity.
Conclusions:
- Endogenous EGFR expression in native tissues can serve as a reference standard for detecting LN metastasis in HNSCC patients undergoing FGS.
- Utilizing patient-specific reference standards enhances the performance of fluorescence-guided detection of metastatic LNs.
- This approach aids in more accurate surgical assessment of nodal involvement in HNSCC.
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