Related Experiment Video
Updated: Mar 12, 2026
Author Spotlight: 3D Scanning and Augmented Reality for Enhanced Cancer Surgery Communication
Published on: December 15, 2023
Intraoperative fluorescence-guided fresh frozen sectioning for margin control in head and neck cancer: phase 2
Thomas S Nijboer1, Bas Keizers2,3, Koos Boeve1
1Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.
Abstract:
Tumour-free margins ( >5 mm) in head and neck malignancies improve prognosis, possibly impacting the need for adjuvant treatment. In this phase II prospective, non-randomised trial (NCT05499065), we investigate the use of fluorescence imaging using the tumour targeting fluorescent tracer cetuximab-IRDye800CW combined with fresh frozen sectioning to identify inadequate margins intraoperatively in patients with oral squamous cell carcinoma. Primary objectives of our study are intraoperative detection of inadequate margins and additional resections, and feasibility of implementing fluorescence-guided fresh frozen sectioning (FG-FFS) into the clinical workflow. In this study, 10 out of 20 patients show inadequate margins after initial surgery; FG-FFS correctly classifies margin in 19 patients. Additional resections increase tumour-free margin rates from 50% to 85%, where anatomical boundaries limit further improvement in one patient. Intraoperative margin adjustment reduces the need for adjuvant treatment in seven patients. These findings demonstrate that FG-FFS is a reliable and feasible method for intraoperative margin assessment without delaying surgery.
Insights
Fluorescence-guided fresh frozen sectioning (FG-FFS) accurately identifies inadequate tumour margins in head and neck cancer surgery. This method improves tumour-free margin rates and reduces the need for adjuvant treatments.
Area of Science:
- Oncology
- Surgical Oncology
- Medical Imaging
Background:
- Achieving tumour-free margins (>5 mm) in head and neck cancers is crucial for patient prognosis and may reduce the need for adjuvant therapy.
- Intraoperative assessment of surgical margins is challenging, often leading to positive margins and subsequent complications or treatments.
Purpose of the Study:
- To investigate the efficacy of fluorescence imaging with cetuximab-IRDye800CW combined with fresh frozen sectioning (FG-FFS) for intraoperative margin assessment in oral squamous cell carcinoma.
- To evaluate the feasibility of integrating FG-FFS into the clinical workflow and its impact on surgical outcomes.
Main Methods:
- A prospective, non-randomised phase II clinical trial (NCT05499065) involving patients with oral squamous cell carcinoma.
- Utilisation of fluorescence imaging with a tumour-targeting tracer (cetuximab-IRDye800CW) alongside intraoperative fresh frozen sectioning.
Main Results:
- FG-FFS correctly identified margins in 19 out of 20 patients.
- Initial surgery revealed inadequate margins in 10 patients; FG-FFS guided additional resections, increasing tumour-free margin rates from 50% to 85%.
- Intraoperative margin adjustments enabled by FG-FFS reduced the need for adjuvant treatment in seven patients.
Conclusions:
- Fluorescence-guided fresh frozen sectioning is a reliable and feasible method for intraoperative margin assessment in oral squamous cell carcinoma.
- FG-FFS can significantly improve tumour-free margin rates and potentially decrease the requirement for adjuvant therapies without delaying surgical procedures.
