Fluorescence-Guided Surgery for Assessing Margins in Head and Neck Cancer: A Review

Area of Science:

• Surgical Oncology
• Medical Imaging
• Cancer Research

Background:

• Head and neck squamous cell cancer (HNSCC) has a persistently high positive margin rate.
• Deep margins are particularly difficult to visualize and are a common source of positive margins in HNSCC surgery.

Purpose of the Study:

• To review a decade of research on fluorescence-guided surgery (FGS) in HNSCC.
• To outline how FGS can improve margin clearance, focusing on deep margin assessment.
• To discuss the application of FGS in oncologic management for HNSCC.

Main Methods:

• Review of existing literature and clinical trial data on FGS in HNSCC.
• Discussion of in vivo and ex vivo fluorescence techniques for margin assessment.
• Analysis of FGS's potential impact on peripheral mucosal and deep margins.

Main Results:

• FGS can highlight residual tumor in the resection bed (in vivo) and assess proximity to the specimen surface (ex vivo).
• The technique is particularly beneficial for improving visualization and clearance of deep margins.
• Multiple fluorescent agents are available or in trials for FGS in various cancer types.

Conclusions:

• FGS offers a promising approach to reduce positive margin rates in HNSCC.
• Understanding FGS applications is crucial for its integration into oncologic management.
• The principles of FGS discussed using HNSCC can be applied to other solid tumor types.