Objective:

To demonstrate the effectiveness of fluorescence-guided surgery (FGS) using panitumumab-IRDye800 in identifying perineural invasion (PNI) and bone involvement in gingival squamous cell carcinoma (SCC).

Approach:

• Case Presentation: A 64-year-old male with invasive SCC underwent fluorescence imaging during surgery, revealing localized signals indicating tumor involvement in the mandible and inferior alveolar nerve.
• Fluorescence Imaging: Intraoperative open-field fluorescence imaging was performed using a portable detection device, leading to targeted biopsies that confirmed PNI and tumor invasion.
• Histopathological Correlation: Fluorescence microscopy was used to correlate fluorescence signals with histologically confirmed tumor involvement, demonstrating accurate identification of tumor cells.

Key Findings:

• Fluorescence imaging localized to the mandibular body and inferior alveolar canal corresponded with frozen-section confirmation of PNI.
• Final pathology revealed advanced disease with bony invasion and positive margins, confirming fluorescence-identified tumor involvement.
• Fluorescence-guided surgery improved intraoperative decision-making by identifying tumor spread beyond mucosal surfaces.

Interpretation:

The study supports the use of fluorescence guidance to enhance the detection of tumor margins and perineural invasion in head and neck cancer surgeries.

Limitations:

• Frozen section analysis has inherent sampling constraints, particularly at deep or irregular margins.
• The study is based on a single case, limiting generalizability.

Conclusion:

Fluorescence-guided surgery combined with frozen section analysis may improve the identification of tumor involvement in complex anatomical regions.

Sources:

• ClinicalTrials.gov