A Ratiometric Threshold for Determining Presence of Cancer During Fluorescence-guided Surgery

Overview

Journal J Surg Oncol

Specialties General Surgery
Oncology

Date 2015 Jun 16

PMID 26074273

Citations 17

Authors

Jason M Warram

Esther de Boer

Lindsay S Moore

Cecelia E Schmalbach

Kirk P Withrow

William R Carroll

Joshua S Richman

Anthony B Morlandt

Margaret Brandwein-Gensler

Eben L Rosenthal

Affiliations

Soon will be listed here.

Abstract

Background And Objective: Fluorescence-guided imaging to assist in identification of malignant margins has the potential to dramatically improve oncologic surgery. However, a standardized method for quantitative assessment of disease-specific fluorescence has not been investigated. Introduced here is a ratiometric threshold derived from mean fluorescent tissue intensity that can be used to semi-quantitatively delineate tumor from normal tissue.

Methods: Open-field and a closed-field imaging devices were used to quantify fluorescence in punch biopsy tissues sampled from primary tumors collected during a phase 1 trial evaluating the safety of cetuximab-IRDye800 in patients (n = 11) undergoing surgical intervention for head and neck cancer. Fluorescence ratios were calculated using mean fluorescence intensity (MFI) from punch biopsy normalized by MFI of patient-matched tissues. Ratios were compared to pathological assessment and a ratiometric threshold was established to predict presence of cancer.

Results: During open-field imaging using an intraoperative device, the threshold for muscle normalized tumor fluorescence was found to be 2.7, which produced a sensitivity of 90.5% and specificity of 78.6% for delineating disease tissue. The skin-normalized threshold generated greater sensitivity (92.9%) and specificity (81.0%).

Conclusion: Successful implementation of a semi-quantitative threshold can provide a scientific methodology for delineating disease from normal tissue during fluorescence-guided resection of cancer.

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