In head and neck cancer, a major limitation of current intraoperative margin analysis is the ability to detect areas most likely to be positive based on specimen palpation, especially for larger specimens where sampling error limits detection of positive margins. This study aims to prospectively examine the clinical value of fluorescent molecular imaging to accurately identify "the sentinel margin," the point on a specimen at which the tumor lies closest to the resected edge in real-time during frozen section analysis. Methods: Eighteen patients with oral squamous cell carcinoma were enrolled into a prospective clinical trial and infused intravenously with 50 mg of panitumumab-IRDye800CW 1–5 d before surgery. Resected specimens were imaged in a closed-field near-infrared optical imaging system in near real-time, and custom-designed software was used to identify locations of highest fluorescence on deep and peripheral margins. The surgeon identified the sentinel margin masked to optical specimen mapping, and then the regions of highest fluorescence were identified and marked for frozen analysis. Final pathology based on specimen reconstruction was used as reference standard. Results: Resected specimens were imaged in the operating room, and fluorescence had a higher interobserver agreement with pathology (Cohen value 0.96) than the surgeon (Cohen value of 0.82) for the location of the closest margin. Plotting margin distance at the predicted sentinel margin location of each observer versus the actual closest margin distance at pathology demonstrated best correlation between fluorescence and pathology (R² = 0.98) with surgeon (R² = 0.75). Conclusion: Fluorescence imaging can improve identification of the sentinel margin in head and neck cancer resections, holding promise for rapid identification of positive margins and improved oncologic outcomes.

在头颈癌中，当前术中切缘分析的一个主要局限性是无法根据标本触诊检测最有可能呈阳性的区域，尤其是对于较大的标本，其中抽样误差限制了阳性切缘的检测。本研究旨在前瞻性地检查荧光分子成像的临床价值，以准确识别“前哨边缘”，即在冷冻切片分析期间实时标本上肿瘤最接近切除边缘的点。方法：18 名口腔鳞状细胞癌患者被纳入一项前瞻性临床试验，并在手术前 1-5 天静脉输注 50 mg panitumumab-IRDye800CW。切除的标本在近实时的闭场近红外光学成像系统中成像，并使用定制设计的软件来识别深部和周边边缘上荧光最高的位置。外科医生识别出被光学标本映射掩盖的前哨边缘，然后识别并标记荧光最高的区域以进​​行冷冻分析。基于标本重建的最终病理学被用作参考标准。结果：在手术室对切除的标本进行成像，对于最近边缘的位置，荧光与病理学（Cohen 值为 0.96）的观察者间一致性高于外科医生（Cohen 值为 0.82）。绘制每个观察者预测的前哨边缘位置的边缘距离与病理学上实际最近的边缘距离，证明了荧光与病理学 ( R ² = 0.98) 与外科医生 ( R ² = 0.75) 之间的最佳相关性。结论：荧光成像可以改善头颈癌切除术中前哨边缘的识别，有望快速识别阳性边缘并改善肿瘤学结果。