Fluorescence molecular imaging for identification of high-grade dysplasia in patients with head and neck cancer. (October 2019)

• Record Type: Journal Article
• Authors: Fakurnejad, Shayan; van Keulen, Stan; Nishio, Naoki; Engelen, Myrthe; van den Berg, Nynke S.; Lu, Guolan; Birkeland, Andrew; Baik, Fred; Colevas, A. Dimitrios; Rosenthal, Eben L.; Martin, Brock A.
• Is Part Of: Oral oncology. Volume 97(2019)
• Page Start: 50
• Page End: 55
• Publication Date: 2019-10
• Subjects: Near-infrared -- Fluorescence imaging -- Molecular imaging -- Dysplasia -- Head and neck cancer -- Oral cavity -- Antibody; Mouth -- Cancer -- Periodicals; Mouth -- Tumors -- Periodicals; Mouth Diseases -- Periodicals; Mouth Neoplasms -- Periodicals; Bouche -- Cancer -- Périodiques; Bouche -- Tumeurs -- Périodiques; Tumeurs -- Périodiques; Electronic journals; 616.9943105
• DOI: 10.1016/j.oraloncology.2019.08.008
• Languages: English
• ISSNs: 1368-8375

Abstract

Highlights: Increasing degree of squamous dysplasia is associated with increasing EGFR expression. Near-infrared labeled anti-EGFR antibody that can help detect dysplasia. HGD demonstrates greater fluorescence signal compared to LGD or normal epithelium. Abstract: Objective: High-grade dysplasia is associated with a risk of malignant transformation, and it is necessary to distinguish from normal epithelium or low-grade dysplasia, especially in the intraoperative setting. We hypothesize that an anti-epidermal growth factor receptor (EGFR) contrast agent can be used to differentiate high-grade dysplasia from low-grade dysplasia and normal epithelium. Materials and methods: Patients with biopsy proven head and neck squamous cell carcinoma (HNSCC) were enrolled in a clinical trial using systemically injected fluorescently labeled anti-EGFR antibody (panitumumab-IRDye800CW) (NCT02415881). Paraffin embedded tumor specimens from 11 patients were evaluated by fluorescence histopathology. Hematoxylin and eosin (H&E) slides were reviewed by a board-certified pathologist, and regions of invasive squamous cell carcinoma, high-grade dysplasia and low-grade dysplasia were delineated. EGFR expression was assessed for each patient by way of immunohistochemistry. Results: 11 patients were included in the study with a total of 219 areas on tissue sections analyzed; 68 normal epithelium, 53 low-grade dysplasia, 48 high-grade dysplasia, and 50 malignant regions. The signal-to-background ratio (SBR) increased proportionally with increasing grade of dysplasia; normal epithelium (1.5 ± 0.1), low-grade dysplasia (1.8 ± 0.1), high-grade dysplasia: (2.3 ± 0.2). High-grade dysplasia had a significantly higher SBR when compared to normal or low-grade dysplasia (p < 0.05). Fluorescence histopathology positively correlated with EGFR expression by immunohistochemistry, which also increased proportionally with increasing degree of dysplasia. Conclusion: Molecular imaging with an anti-EGFR agent can successfully discriminate high-grade dysplastic lesions from low-grade dysplasia and normal epithelium.