Fluorescence-Guided Detection of Perineural and Bony Invasion With Margin Correlation in Gingival Squamous Cell Carcinoma Using Panitumumab-IRDye800.

Abstract

Near-infrared (NIR) fluorescence-guided surgery using EGFR-targeted tracers (e.g., panitumumab-IRDye800CW) can provide real-time visualization of tumors and margins in Head and Neck Squamous Cell Carcinoma. Prior studies have demonstrated its safety and potential to improve intraoperative decision-making and margin assessment. A patient with biopsy-proven oral cavity squamous cell carcinoma (SCC) was enrolled in an imaging-based clinical trial and received intravenous panitumumab and panitumumab-IRDye800CW prior to surgical resection. Intraoperative wide-field NIR fluorescence imaging was performed during marginal mandibulectomy to assess tumor extent, and regions of increased fluorescence signal prompted targeted frozen section biopsy. Intraoperative fluorescence imaging revealed focal signal within the left mandible and along the inferior alveolar canal that was not grossly apparent. Targeted biopsy of these regions confirmed invasive SCC with mandibular bone invasion and perineural invasion of the inferior alveolar nerve. Fluorescence findings correlated with frozen section analysis, specimen-level imaging, histopathology, and final surgical staging, ultimately prompting a recommendation for definitive re-resection. This case demonstrates that EGFR-targeted NIR fluorescence can detect subclinical bony and perineural tumor extension beyond mucosal surfaces, guiding targeted frozen section sampling and intraoperative management. Fluorescence-guided surgery may serve as a valuable adjunct for evaluating deep and anatomically complex margins in head and neck oncologic surgery. NCT06819228.