Head and neck cancers represent critical challenges due to the restricted anatomical space in children and the proximity of critical neurovascular structures which can compromise complete tumor resection. Applications of Indocyanine green (ICG) near infrared (NIR) fluorescent image-guided surgery (FGS) have recently expanded into the pediatric population, emphasizing its relevance for tumor delineation and evaluation of tissue perfusion. The objectives of the present study are twofold. First, we aim to assess the role of ICG NIR imagery in identifying neoplastic disease and second, to evaluate its role as an adjunct to identify metastatic deposits in cervical lymph node in children, adolescents, and young adults with head and neck cancers.
Eight patients with head and neck malignancies underwent ICG NIR FGS, between January 2019 and November 2021. ICG NIR findings were compared with preoperative cross-sectional imaging and results of operative tissue pathology analyses.
All primary tumors were identified on preoperative imaging and intraoperatively with ICG NIR; however, for one case, extension of tumor was revealed with ICG NIR and confirmed by histopathological examination but was not otherwise visible on preoperative imaging or with naked eye visual and tactile assessment. ICG NIR assisted the decision process in a difficult case for which curative resection, without significant functional morbidity and potential mortality, was unrealistic. Although ICG NIR evaluation of the surgical bed did not display residual tumor, margins were found positive in two cases. ICG NIR evaluation for local metastases changed the surgical strategy in one patient by prompting conversion to bilateral neck dissections. The sensitivity of preoperative multimodality imaging to identify cervical levels of invasion was 75% with a specificity of 70%, a PPV of 33%, a NPV of 78% and an accuracy of 72%. The ICG NIR sensitivity was 83%, its specificity was 88% with a PPV of 91%, a NPV of 80% and an accuracy of 86%. The combination of preoperative multimodality imaging with ICG NIR findings led to a sensitivity of 83%, specificity of 88% and accuracy of 86%.
This case series provides a proof of concept of the feasibility of ICG NIR, as an adjunct in tumor and local metastases identification in young patients with head and neck tumors. It revealed to be feasible and safe for intra-operative tumor identification, thus guiding and facilitating resection. However, it showed some limitations in precise tumor margin assessment. The combination of preoperative multimodality imaging with ICG NIR findings improved local metastases localization.
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- Pediatric head and neck malignancies: incidence and trends, 1973-2010.Otolaryngol Head Neck Surg. Jun 2015; 152: 1127-1132
- A scoping review of ongoing fluorescence-guided surgery clinical trials in otolaryngology.Laryngoscope. Jan 2022; 132: 36-44
- Fluorescence-guided surgery of cancer: applications, tools and perspectives.Curr Opin Chem Biol. Aug 2018; 45: 64-72
- Stable J-aggregation enabled dual photoacoustic and fluorescence nanoparticles for intraoperative cancer imaging.Nanoscale. Jun 2016; 8: 12618-12625
- Indocyanine green-guided nephron-sparing surgery for pediatric renal tumors.J Pediatr Surg. Aug 2021; (S0022-3468(21)00566-2)
- A review of indocyanine green fluorescent imaging in surgery.Int J Biomed Imaging. 2012; 2012940585
- A narrative review of fluorescence imaging in robotic-assisted surgery.Laparosc Surg. Jul 2021; 5: 31
- <p>NIR fluorescence-guided tumor surgery: new strategies for the use of indocyanine green</p>.IJN. Sep 2019; 14: 7823-7838
- Optimization of the enhanced permeability and retention effect for near-infrared imaging of solid tumors with indocyanine green.Am J Nucl Med Mol Imaging. 2015; 5: 390-400
- Application of indocyanine green in pediatric surgery.Pediatr Surg Int. Oct 2019; 35: 1035-1041
- Indocyanine green-guided pediatric tumor resection: approach, utility, and challenges.Front Pediatr. 2021; 9689612
- The second window ICG technique demonstrates a broad plateau period for near infrared fluorescence tumor contrast in glioblastoma.PLoS One. 2017; 12e0182034
- Sentinel lymph node biopsy for breast cancer patients using fluorescence navigation with indocyanine green.World J Surg Oncol. Dec 2011; 9: 157
- Evaluation of the lateral sentinel node by indocyanine green for rectal cancer based on micrometastasis determined by reverse transcriptase-polymerase chain reaction.Oncol Rep. Oct 2008; 20: 745-750
- Evolving applications of fluorescence guided surgery in pediatric surgical oncology: a practical guide for surgeons.J Pediatr Surg. Feb 2021; 56: 215-223
- Safety and efficacy of indocyanine green in colorectal cancer surgery: a systematic review and meta-analysis of 11,047 patients.Cancers. Feb 2022; 14: 1036
- Endoscopic measurements of free-flap perfusion in the head and neck region using red-excited indocyanine green: preliminary results.J Plast Reconstr Aesthet Surg. Dec 2009; 62: 1602-1608
- Use of indocyanine green angiography for real-time assessment of a sternocleidomastoid muscle flap during complex facial reconstruction.Cureus. Mar 2021; 13: e13970
- Near-Infrared fluorescence imaging using indocyanine green (ICG): emerging applications in pediatric urology.J Pediatr Urol. Oct 2020; 16: 700-707
R: the r project for statistical computing [Internet]. [cited 2022 Apr 13]. Available from: https://www.r-project.org/
- Intraoperative imaging with second window indocyanine green for head and neck lesions and regional metastasis.Otolaryngol Head Neck Surg. Sep 2019; 161: 539-542
- Introduction of VISIONSENSE® for indocyanine green fluorescence-guided parathyroidectomy: Report of a case.Int J Surg Case Rep. 2020; 75: 418-421
- ICG-induced NIR fluorescence mapping in patients with head & neck tumors after the previous radiotherapy.Photodiagnosis Photodyn Ther. Sep 2020; 31101838
- A new concept for macromolecular therapeutics in cancer chemotherapy: mechanism of tumoritropic accumulation of proteins and the antitumor agent smancs.Cancer Res. Dec 1986; 46: 6387-6392
- Introducing fluorescence-guided surgery for pediatric ewing, osteo-, and rhabdomyosarcomas: a literature review.Biomedicines. Oct 2021; 9: 1388
- Fluorescence imaging to localize head and neck squamous cell carcinoma for enhanced pathological assessment.J Pathol Clin Res. Apr 2016; 2: 104-112
Published online: December 08, 2022
Accepted: November 25, 2022
Received: October 2, 2022
Publication stageIn Press Corrected Proof
© 2022 Japanese Society of Otorhinolaryngology-Head and Neck Surgery, Inc. Published by Elsevier B.V. All rights reserved.