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A ratiometric threshold for determining presence of cancer during fluorescence‐guided surgery
Author(s) -
Warram Jason M.,
de Boer Esther,
Moore Lindsay S.,
Schmalbach Cecelia E.,
Withrow Kirk P.,
Carroll William R.,
Richman Joshua S.,
Morlandt Anthony B.,
BrandweinGensler Margaret,
Rosenthal Eben L.
Publication year - 2015
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.23946
Subject(s) - medicine , biopsy , fluorescence , cancer , radiology , head and neck cancer , nuclear medicine , pathology , biomedical engineering , radiation therapy , optics , physics
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. J. Surg. Oncol. 2015 111:2–8 . © 2015 Wiley Periodicals, Inc.