# Intraoperative fluorescence in solid head and neck cancer: A scoping review

## TL;DR

This review explores how fluorescence imaging during surgery could improve accuracy in removing head and neck cancers, though more standardization is needed.

## Contribution

The study provides a comprehensive scoping review of fluorescent-guided surgery in head and neck cancer, identifying current gaps and opportunities.

## Key findings

- Fluorescent-guided surgery shows potential to improve intraoperative margin assessment in head and neck cancer.
- Variability in diagnostic accuracy and lack of standardized methodologies were observed across studies.
- Indocyanine green and IRDye800CW are the most commonly used fluorescent agents in the reviewed studies.

## Abstract

Obtaining negative margins in primary tumor resection is essential to decreasing recurrence and mortality. Fluorescence imaging may aid in complete tumor removal. As fluorescent agents are still under clinical trial investigation for use in head and neck cancer (HNC), their effectiveness in intraoperative margin assessment (IMA) remains unclear. This scoping review examines the use of fluorescent-guided surgery (FGS) in the treatment of HNC, highlighting significant opportunities in this nascent field.

PubMed, Scopus, CINAHL, and Cochrane Library were searched from inception through March 22, 2024. This study was conducted under PRISMA-ScR guidelines. Data on study characteristics, fluorescence and imaging techniques, imaging efficacy, and diagnostic accuracy were extracted.

Twenty-seven prospective studies from 2013 to 2024 on intraoperative FGS in HNC, involving 455 patients from six countries, were included. Studies ranged from preclinical to phase II trials, applying various fluorescent techniques, predominantly indocyanine green and IRDye800CW, to enhance surgical precision. Imaging assessments were conducted in-vivo, ex-vivo, or both, using a wide range of devices and taking an additional 0 to 30 min intraoperatively. Quantitative measures like signal-to-background ratio and mean fluorescent intensity suggested variable diagnostic accuracy across studies. FGS shows great potential in improving IMA, although standardization in methodologies and reporting is needed.

This scoping review highlights the potential of intraoperative FGS to enhance treatment accuracy in solid HNC, though variability in diagnostic efficacy and a lack of standardized methodologies persist. Advancements in fluorophore technology and uniform procedural protocols are essential to optimize surgical outcomes and move towards personalized HNC interventions.

The online version contains supplementary material available at 10.1007/s00405-025-09442-5.