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Precise Detection of Surgical Margin in Head and Neck Cancer Using Dual Near-Infrared Imaging of the Tumor and Tumor
Kyu Young Choi1,2, Hae Sang Park1,3, Swarali Paranjape1
1Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
Abstract:
The precise determination of resection margins during head and neck cancer surgery remains an unmet clinical challenge, where balancing complete tumor removal with preservation of healthy tissue is critical. To address this, we developed a dual near-infrared (NIR) fluorescence imaging strategy targeting both tumor cells and the tumor microenvironment (TME) in head and neck squamous cell carcinoma (HNSCC). Armed with 2 small-molecule fluorophores, OCTL14 for tumor-specific imaging and cRGD-ZW800-PEG for TME visualization, we performed real-time intraoperative NIR imaging in a FaDu tongue cancer xenograft model. Fluorophores were administered intravenously, and their targeting efficiency was quantified via time-dependent tumor-to-background ratios (TBRs), with surgical margins validated by histopathology. Our results demonstrated robust detection of cancerous tissue (TBR > 2.0) and surrounding TME (TBR > 1.5) within 4 h post-injection. Histopathology confirmed OCTL14 uptake in tumor cells, while cRGD-ZW800-PEG localized to peritumoral regions and vasculature. This dual-imaging approach offers a promising tool for fluorescence-guided surgery, enabling precise margin delineation to reduce locoregional recurrence and perioperative complications, thereby improving patient outcomes and quality of life.
Insights
This study introduces a dual near-infrared fluorescence imaging method for head and neck squamous cell carcinoma (HNSCC) surgery. The technique precisely identifies tumor cells and the tumor microenvironment (TME), improving surgical margin accuracy.
Area of Science:
- Oncology
- Medical Imaging
- Surgical Innovation
Background:
- Accurate resection margin determination is crucial in head and neck cancer surgery.
- Balancing complete tumor removal with healthy tissue preservation is a significant clinical challenge.
Purpose of the Study:
- To develop and evaluate a dual near-infrared (NIR) fluorescence imaging strategy for head and neck squamous cell carcinoma (HNSCC).
- To target both tumor cells and the tumor microenvironment (TME) for improved intraoperative margin delineation.
Main Methods:
- Developed a dual NIR fluorescence imaging strategy using OCTL14 (tumor-specific) and cRGD-ZW800-PEG (TME visualization).
- Conducted real-time intraoperative NIR imaging in a FaDu tongue cancer xenograft model.
- Quantified targeting efficiency using tumor-to-background ratios (TBRs) and validated margins with histopathology.
Main Results:
- Achieved robust detection of cancerous tissue (TBR > 2.0) and TME (TBR > 1.5) within 4 hours post-injection.
- Confirmed OCTL14 uptake in tumor cells and cRGD-ZW800-PEG localization in peritumoral regions and vasculature.
- Histopathology validated the fluorescence imaging findings.
Conclusions:
- The dual-imaging approach provides a promising tool for fluorescence-guided surgery in HNSCC.
- Enables precise margin delineation, potentially reducing locoregional recurrence and perioperative complications.
- Aims to improve patient outcomes and quality of life through enhanced surgical precision.
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