Epidermal Growth Factor Receptor–Targeted Fluorescence Molecular Imaging for Postoperative Lymph Node Assessment in Patients with Oral Cancer

The Journal of Nuclear Medicine

article

Jasper Vonk¹  Jaron G. de Wit¹  Floris J. Voskuil¹  Yang Hang Tang¹  Wouter T.R. Hooghiemstra²  Matthijs D. Linssen²  Evert van den Broek³  Jan J. Doff³  Sebastiaan A.H.J. de Visscher¹  Kees-Pieter Schepman¹  Bert van der Vegt³  Gooitzen M. van Dam⁴  Max J.H. Witjes¹ 

[1] Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen;Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen;Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen;Department of Nuclear Medicine and Molecular Imaging and Medical Imaging Center, University Medical Center Groningen, University of Groningen;TRACER BV

关键词: fluorescence molecular imaging;    lymph node metastasis;    cetuximab-800CW;    epidermal growth factor receptor;    head and neck cancer;   

DOI  :  10.2967/jnumed.121.262530

学科分类：医学（综合）

来源: Society of Nuclear Medicine

【 摘 要 】

In most oral cancer patients, surgical treatment includes resection of the primary tumor combined with excision of lymph nodes (LNs), either for staging or for treatment. All LNs harvested during surgery require tissue processing and subsequent microscopic histopathologic assessment to determine the nodal stage. In this study, we investigated the use of the fluorescent tracer cetuximab-800CW to discriminate between tumor-positive and tumor-negative LNs before histopathologic examination. Here, we report a retrospective ad hoc analysis of a clinical trial designed to evaluate the resection margin in patients with oral squamous cell carcinoma (NCT02415881). Methods: Two days before surgery, patients were intravenously administered 75 mg of cetuximab followed by 15 mg of cetuximab-800CW, an epidermal growth factor receptor–targeting fluorescent tracer. Fluorescence images of excised, formalin-fixed LNs were obtained and correlated with histopathologic assessment. Results: Fluorescence molecular imaging of 514 LNs (61 pathologically positive nodes) could detect tumor-positive LNs ex vivo with 100% sensitivity and 86.8% specificity (area under the curve, 0.98). In this cohort, the number of LNs that required microscopic assessment was decreased by 77.4%, without missing any metastases. Additionally, in 7.5% of the LNs false-positive on fluorescence imaging, we identified metastases missed by standard histopathologic analysis. Conclusion: Our findings suggest that epidermal growth factor receptor–targeted fluorescence molecular imaging can aid in the detection of LN metastases in the ex vivo setting in oral cancer patients. This image-guided concept can improve the efficacy of postoperative LN examination and identify additional metastases, thus safeguarding appropriate postoperative therapy and potentially improving prognosis.

【 授权许可】

CC BY