Intraoperative Molecular Imaging Can Detect Large Nerve Perineural Invasion: A Case Report.
case_report · Level V
Where this comes from
- Record sourced from PubMed, PMID 41498537.
- Also identified by DOI 10.1002/hed.70160 and PMC identifier 13155179.
- Licence recorded as CC BY.
- The licence permits redistribution, so the abstract is shown in full and the full text is available from the publisher.
Abstract
Perineural invasion (PNI) in head and neck squamous cell carcinoma (SCC) results in worse overall survival. Diagnosis requires resection and microscopic evaluation. A 63-year-old male with persistent cT4aN0 p16-positive SCC of the left base of tongue following chemoradiotherapy underwent salvage total glossectomy. Fluorescence-guided imaging of the wound bed was performed with PDE-GEN3 near-infrared (NIR) imaging following infusion of an optically EGFR-targeted antibody, Panitumumab-IRDye800 (pan800). The proximal resected hypoglossal nerve was imaged intraoperatively and demonstrated a strong green fluorescence signal, raising concern for subclinical PNI. Biopsy of the nerve revealed SCC on frozen section analysis. This was re-resected with subsequent proximal margin negative for carcinoma. Postoperatively, ex vivo imaging of the nerve using PDE-GEN3 NIR imaging again demonstrated the presence of pan800 within the initial positive nerve margin, confirming subclinical PNI. This case shows the feasibility of intraoperative fluorescence as a method to help identify subclinical PNI. ClinicalTrials.gov identifier: NCT05945875.
Medical subject headings
- Carcinoma, Squamous Cell
- Molecular Imaging
- Tongue Neoplasms