Intraoperative Tumor Assessment Using Real-Time Molecular Imaging in Head and Neck Cancer Patients

J Am Coll Surg. 2019 Dec;229(6):560-567.e1. doi: 10.1016/j.jamcollsurg.2019.09.007. Epub 2019 Sep 27.


Background: In head and neck cancer, surgical resection using primarily visual and tactile feedback is considered the gold standard for solid tumors. Due to high numbers of tumor-involved surgical margins, which are directly correlated to poor clinical outcomes, intraoperative optical imaging trials have rapidly proliferated over the past 5 years. However, few studies report on intraoperative in situ imaging data that could support surgical resection. To demonstrate the clinical application of in situ surgical imaging, we report on the imaging data that are directly (ie in real-time) available to the surgeon.

Study design: Fluorescence intensities and tumor-to-background ratios (TBRs) were determined from the intraoperative imaging data-the view as seen by the surgeon during tumor resection-of 20 patients, and correlated to patient and tumor characteristics including age, sex, tumor site, tumor size, histologic differentiation, and epidermal growth factor receptor (EGFR) expression. Furthermore, different lighting conditions in regard to surgical workflow were evaluated.

Results: Under these circumstances, intraoperative TBRs of the primary tumors averaged 2.2 ± 0.4 (range 1.5 to 2.9). Age, sex, tumor site, and tumor size did not have a significant effect on open-field intraoperative molecular imaging of the primary tumors (p > 0.05). In addition, variation in EGFR expression levels or the presence of ambient light did not seem to alter TBRs.

Conclusions: We present the results of successful in situ intraoperative imaging of primary tumors alongside the optimal conditions with respect to both molecular image acquisition and surgical workflow. This study illuminates the potentials of open-field molecular imaging to assist the surgeon in achieving successful cancer removal.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Biomarkers, Tumor / metabolism
  • ErbB Receptors / metabolism
  • Female
  • Head and Neck Neoplasms / diagnosis*
  • Head and Neck Neoplasms / metabolism
  • Head and Neck Neoplasms / surgery
  • Humans
  • Immunohistochemistry
  • Intraoperative Period
  • Male
  • Middle Aged
  • Molecular Imaging / methods*
  • Reproducibility of Results
  • Squamous Cell Carcinoma of Head and Neck / diagnosis*
  • Squamous Cell Carcinoma of Head and Neck / metabolism
  • Squamous Cell Carcinoma of Head and Neck / surgery
  • Surgery, Computer-Assisted / methods*
  • Surgical Procedures, Operative / methods*


  • Biomarkers, Tumor
  • EGFR protein, human
  • ErbB Receptors