Indocyanine Green Fluorescence-Guided Surgery for Margin Assessment in Oral Cancer : A Feasibility Study

Achieving clear surgical margins in oral cancer surgery is crucial for reducing recurrence rate and improving patient survival. However, intraoperative margin assessment remains challenging due to limitations in visual and tactile evaluation. Indocyanine green (ICG) fluorescence imaging has emerged as a potential adjunct for real-time surgical guidance, though its intraoperative utility in oral cancer is not yet fully established. This prospective, non-randomized feasibility study included 75 patients undergoing surgery for oral cancer. Untagged ICG was administered prior to anesthesia induction. Intraoperative near-infrared imaging was used to delineate tumor margins, which were compared with gross clinical assessment and histopathologic evaluation. The need for intraoperative margin revision, final margin status, and the predictive performance of ICG-derived margins were analyzed. Margin revision was performed in 28% of cases. Final histopathology revealed clear margins in 57.3%, close margins in 30.7%, and involved margins in 12% of patients. ICG-delineated margins differed significantly from both gross and histologic margins (p < 0.01). A deep ICG margin > 4.5 mm predicted the absence of revision with 98.1% sensitivity and 75.5% overall accuracy. ICG fluorescence imaging is not recommended as a standalone modality for intraoperative margin assessment in oral cancer surgery but may be a valuable adjunct to conventional evaluation methods. Standardized protocols and larger validation studies are warranted to confirm its role in surgical oncology practice.