A ratiometric threshold for determining presence of cancer during fluorescence-guided surgery.

Academic Article


  • 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 (nā€‰=ā€‰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.
  • Published In


  • fluorescence-guided surgery, head & neck cancer, standardized imaging, surgical oncology, Carcinoma, Squamous Cell, Fluorescence, Head and Neck Neoplasms, Humans, Neoplasm Staging, Prognosis, ROC Curve, Surgery, Computer-Assisted
  • Digital Object Identifier (doi)

    Pubmed Id

  • 7966683
  • Author List

  • Warram JM; de Boer E; Moore LS; Schmalbach CE; Withrow KP; Carroll WR; Richman JS; Morlandt AB; Brandwein-Gensler M; Rosenthal EL
  • Start Page

  • 2
  • End Page

  • 8
  • Volume

  • 112
  • Issue

  • 1