Fluorescence molecular imaging for identification of high-grade dysplasia in patients with head and neck cancer

Shayan Fakurnejad, Stan van Keulen, N. Nishio, Myrthe Engelen, Nynke S. van den Berg, Guolan Lu, Andrew Birkeland, Fred Baik, A. Dimitrios Colevas, Eben L. Rosenthal, Brock A. Martin

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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.

Original languageEnglish (US)
Pages (from-to)50-55
Number of pages6
JournalOral Oncology
Volume97
DOIs
StatePublished - Oct 2019
Externally publishedYes

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Keywords

  • Antibody
  • Dysplasia
  • Fluorescence imaging
  • Head and neck cancer
  • Molecular imaging
  • Near-infrared
  • Oral cavity

ASJC Scopus subject areas

  • Oral Surgery
  • Oncology
  • Cancer Research

Cite this

Fakurnejad, S., van Keulen, S., Nishio, N., Engelen, M., van den Berg, N. S., Lu, G., Birkeland, A., Baik, F., Colevas, A. D., Rosenthal, E. L., & Martin, B. A. (2019). Fluorescence molecular imaging for identification of high-grade dysplasia in patients with head and neck cancer. Oral Oncology, 97, 50-55. https://doi.org/10.1016/j.oraloncology.2019.08.008