Diagnostic Accuracy of Fluorescence-guided Surgery for Head and Neck Cancer Margin Assessment: A Systematic Review

Saturday, October 17, 2026

9:36 AM - 9:42 AM PT

Location: West Exhibit Hall A, Learning Zone 3

Presenting Author(s)

Dylan K. Thompson, BS

Medical Student
Vanderbilt University School of Medicine
Nashville, Tennessee, United States

Co-Author(s)

SL

Samuel Le, BS

Medical Student
Vanderbilt University School of Medicine, United States
SH

Shahar Hartman, BA

Medical Student
Vanderbilt University School of Medicine, United States
FC

Finnegan Clark

Co-Author(s)

HT

Hidenori Tanaka, MD

Visiting assistant professor
Vanderbilt University Medical Center
Nashville, Tennessee, United States
SG

Shravan Gowrishankar, MA, MD

Research Fellow
Vanderbilt Department of Otolaryngology–Head and Neck Surgery, United States

Senior Author(s)

ER

Eben Rosenthal, MD

Vanderbilt University Medical Center, United States

Disclosure(s):

Eben "L Rosenthal, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Head and Neck Squamous Cell Carcinoma (HNSCC) has among the highest positive margin rates in surgical oncology using traditional tools of direct visualization and palpation. Advances in fluorescence-guided surgery (FGS) provide new opportunities to better define tumor margins and improve clearance and survival. The objective of this review is to summarize the diagnostic accuracy of FGS in patients with HNSCC receiving a systemically infused fluorescent agent.

Methods: This systematic review collected studies from PubMed, EMBASE, and Cochrane Library following PRISMA guidelines. Studies presenting diagnostic data (sensitivity, specificity) of a systemically infused agent used in FGS for HNSCC were included. Studies involving non-squamous cell head and neck cancer, topical fluorescent agents, non-human subjects, case reports, and non-English language studies were excluded. Bias risk and quality of studies were evaluated using Quality Assessment of Diagnostic Accuracy Studies-2 checklist.

Results: A total of 12/2,902 studies were included. Collectively, these studies examined FGS performed on 205 HNSCC patients. Several agents, including Cetuximab-800CW, FG001, Indocyanine Green, ONM-100, and panitumumab-IRDye800CW, were injected 15 to 72 hours prior to resection. In vivo imaging was performed in 10/12 included studies. 4/12 studies demonstrated the sensitivity of in vivo imaging to range from 86% to 100%. 2/12 studies reported in vivo imaging specificity to range from 87% to 96%. Ex vivo imaging was performed in all included studies. 8/12 studies described the sensitivity of ex vivo imaging to range from 91% to 100%. 5/12 studies presented ex vivo imaging specificity to range from 74.5% to 91%.

Conclusions: FGS is a sensitive and specific diagnostic tool for in vivo and ex vivo determination of tumor margins during HNSCC resection. Compared to current methods, FGS offers both higher sensitivity and specificity of tumor margin identification. Through this improvement, FGS harbors the potential to decrease HNSCC recurrence and improve patient outcomes.