ENTtoday
  • Home
  • COVID-19
  • Practice Focus
    • Allergy
    • Facial Plastic/Reconstructive
    • Head and Neck
    • Laryngology
    • Otology/Neurotology
    • Pediatric
    • Rhinology
    • Sleep Medicine
  • Departments
    • Issue Archive
    • TRIO Best Practices
      • Allergy
      • Facial Plastic/Reconstructive
      • Head and Neck
      • Laryngology
      • Otology/Neurotology
      • Pediatric
      • Rhinology
      • Sleep Medicine
    • Career Development
    • Case of the Month
    • Everyday Ethics
    • Health Policy
    • Legal Matters
    • Letter From the Editor
    • Medical Education
    • Online Exclusives
    • Practice Management
    • Resident Focus
    • Rx: Wellness
    • Special Reports
    • Tech Talk
    • Viewpoint
    • What’s Your O.R. Playlist?
  • Literature Reviews
    • Allergy
    • Facial Plastic/Reconstructive
    • Head and Neck
    • Laryngology
    • Otology/Neurotology
    • Pediatric
    • Rhinology
    • Sleep Medicine
  • Events
    • Featured Events
    • TRIO Meetings
  • Contact Us
    • About Us
    • Editorial Board
    • Triological Society
    • Advertising Staff
    • Subscribe
  • Advertise
    • Place an Ad
    • Classifieds
    • Rate Card
  • Search

Surgeons Describe How They Use Fluorescence to Guide Work on Head and Neck Tumors

by Thomas R. Collins • April 10, 2020

  • Tweet
  • Email
Print-Friendly Version

SAN DIEGO—Eben Rosenthal, MD, medical director of the Stanford Cancer Center, described a case involving a lesion in the oral cavity. It was resected, but there was a surprise: a separate lesion, with a focus of less than 3 mm of tumor. The lesion was discovered only because the Stanford surgeons were using a fluorescent tag attached to an anti-epithelial growth factor antibody that homes in on tumors. The fluorescent dye lit up the satellite lesion, which, after testing, was found to be pathologically positive for tumor.

You Might Also Like

No related posts.

Explore This Issue
March 2020

“We wouldn’t have even known to look for it,” he said.

The use of fluorescent light to see through normal tissues down to head and neck tumors is showing promise as a way of guiding surgeons and improving margins and outcomes—and occasionally discovering other tumors that weren’t even anticipated, Dr. Rosenthal said here during a panel discussion at the Triological Combined Sections Meeting.

How It Works

Detection of tumor close to the surgical margin on resected specimens is a key advantage of fluorescent light technology, Dr. Rosenthal said. The approach is based on the passage of light through normal tissue. The tumor glows bright from the contrast media. The intensity of light that can be seen shining through depends on the depth of the normal tissue on the deep surface of the surgical specimen.

“The deeper the tumor is from the cut surface of the specimen, you see less fluorescent light,” he said.

The approach doesn’t provide exact distances and depths of the tumor, but in a trial of more than 20 patients, researchers found a high correlation between fluorescence intensity and tumor location, with sensitivities and specificities greater than 89% (Cancer Res. 2018;78:5144-5154). The main goal is to find the “sentinel margin,” or margins, the area of the specimen where the tumor is closest to the cut surface (the smallest margin) and, therefore, most likely to be a close or positive margin. Then surgeons assess the depth of that one area of the specimen on frozen section to ensure the margins are clear, he said.

“You can translate that to where you’re going to sample, where you’re going to take your frozen section,” Dr. Rosenthal said.

Reducing Positive Margins

The field could use new ways to reduce the rate of positive margins, which has been flat over the past 20 years. Dr. Rosenthal noted that this is particularly true for oral cavity cancer, which has one of the higher overall positive-margin rates, according to data from the National Cancer Database. Many labs are working on perfecting the technology, but it is still several years from approval, he said.

“The impact of this technology is very high,” Dr. Rosenthal said. “It’s going to be probably another five years before these agents are commercially available—but hopefully sooner.”

Pages: 1 2 3 | Single Page

Filed Under: Features Tagged With: clinical best practices, head and neck cancer, Triological Society Combined Sections MeetingIssue: March 2020

You Might Also Like:

The Triological SocietyENTtoday is a publication of The Triological Society.

The Laryngoscope
Ensure you have all the latest research at your fingertips; Subscribe to The Laryngoscope today!

Laryngoscope Investigative Otolaryngology
Open access journal in otolaryngology – head and neck surgery is currently accepting submissions.

Classifieds

View the classified ads »

TRIO Best Practices

View the TRIO Best Practices »

Top Articles for Residents

  • Do Training Programs Give Otolaryngology Residents the Necessary Tools to Do Productive Research?
  • Why More MDs, Medical Residents Are Choosing to Pursue Additional Academic Degrees
  • What Physicians Need to Know about Investing Before Hiring a Financial Advisor
  • Tips to Help You Regain Your Sense of Self
  • Should USMLE Step 1 Change from Numeric Score to Pass/Fail?
  • Popular this Week
  • Most Popular
  • Most Recent
    • The Dramatic Rise in Tongue Tie and Lip Tie Treatment
    • Vertigo in the Elderly: What Does It Mean?
    • Complications for When Physicians Change a Maiden Name
    • Is Middle Ear Pressure Affected by Continuous Positive Airway Pressure Use?
    • Keeping Watch for Skin Cancers on the Head and Neck
    • The Dramatic Rise in Tongue Tie and Lip Tie Treatment
    • What Happens to Medical Students Who Don’t Match?
    • Rating Laryngopharyngeal Reflux Severity: How Do Two Common Instruments Compare?
    • Vertigo in the Elderly: What Does It Mean?
    • Neurogenic Cough Is Often a Diagnosis of Exclusion
    • Novel Bioabsorbable Plate Associated with Lower Leak Risk in Patients Receiving Endoscopic Skull Base Repair
    • New Findings Support Use of Cemiplimab as Neoadjuvant Therapy in Patients with Resectable Cutaneous Squamous Cell Carcinoma
    • Kinetic Oscillation Stimulation an Effective, Lasting Second-Line Treatment for Patients with Nonallergic Rhinitis
    • Otolaryngologists Vary Significantly in Choice of Injectable Materials for Vocal Fold Injection Augmentation
    • COVID-19 Infection May Be Associated with Unique Manifestation of Facial Nerve Paralysis/Palsy

Polls

Do you believe that having more otolaryngologists appear on mainstream media outlets is a good thing for the field?

View Results

Loading ... Loading ...
  • Polls Archive
  • Home
  • Contact Us
  • Advertise
  • Privacy Policy
  • Terms of Use
  • Cookie Preferences

Visit: The Triological Society • The Laryngoscope • Laryngoscope Investigative Otolaryngology

Wiley
© 2023 The Triological Society. All Rights Reserved.
ISSN 1559-4939