Discussion
Negative margins are associated with improved survival and
progression-free survival in surgically-treated
OPSCC.1FMI with NIR fluorophores has added to surgeons’ armamentarium to
achieve negative margins and has been successfully implemented in
glioma, breast cancer, and ovarian
cancer.2,8,9Prior studies demonstrated that ICG failed to localize head and neck
neoplasms and their margins during
TORS.4However, our group demonstrated that SWIG imaging with the VisionSense
IridiumTM can be used for intraoperative visualization
of head and neck tumors and identification of regional metastasis to aid
surgical
resection.5The present study is the first evaluation and comparison of SWIG imaging
with the VisionSense IridiumTM to the da
Vinci-integrated FireflyTM NIR platform during TORS
resection of OPSCC.
While the robot-integrated platform (System 1) only demonstrated NIR
fluorescence in 2 of 6 (33%) lesions, the dedicated NIR exoscope system
(System 2) visualized 5 of 6 (83%) lesions, and identified 2 additional
tumors that had not been visible under white light alone. These results
suggest that System 2 outperforms System 1, which may be explained by
differences in imaging processing software or detector sensitivity
between the two
systems.6System 1 requires additional refinement to improve its efficacy in
aiding TORS resection. Additionally, given that some cases were better
visualized with ICG than white light, this technology could be
beneficial in evaluation of head and neck carcinoma of an unknown
primary.
Limitations to this study include its small sample size and homogenous
sample population, which included only male, Caucasian patients. For
further evaluation, larger sample sizes with more diverse patient
characteristics should be utilized.