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.