Abstract
Objective
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.
Methods
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.
Results
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%.
Conclusion
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.
Keywords
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Article info
Publication history
Published online: December 08, 2022
Accepted:
November 25,
2022
Received:
October 2,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 Japanese Society of Otorhinolaryngology-Head and Neck Surgery, Inc. Published by Elsevier B.V. All rights reserved.
