title: Narrow band imaging in the intra-operative definition of resection margins in oral cavity and oropharyngeal cancer.
abstract: OBJECTIVE
  In oncological surgery, a three-dimensional resection 1.5-2 cm from the gross tumour edge is currently considered appropriate, and the status of resection margins is the most reliable indicator of radicality. Awareness of "field cancerization" calls for a re-evaluation of the benchmarks of tumour resection; however, its identification is not simple because the dysplastic areas may be far from the main lesion and difficult to recognize macroscopically. New technologies such as narrow band imaging (NBI) could improve the detection of neoplastic and pre-neoplastic areas, ensuring more precise resections. The main purpose of this study was to investigate the value of NBI in detecting pre-cancerous areas and/or cancer around the tumour bulk intra-operatively, to achieve adequate resection of the tumour.
  
  
  METHODS
  The resection margins of 8 oral cavity and 8 oropharyngeal cancers were first drawn by macroscopic evaluation and then re-defined using NBI. Resections were performed following the NBI-drawing if extemporaneous histological examinations of the NBI-defined enlargements were positive for dysplasia or cancer. The number of clear margins was evaluated.
  
  
  RESULTS
  Resections margins were free of tumour or dysplasia at extemporaneous examination; on definitive histology, two patients had a margin positive for cancer and dysplasia, respectively. Among the NBI-defined enlargements, 25% were positive for dysplasia and 75% for cancer. The sensitivity, specificity, positive and negative predictive values were 100%, 88.9%, 100% and 87.5%, respectively.
  
  
  CONCLUSIONS
  The method we propose could be useful for obtaining free surgical margins and reducing the potential development of tumour foci resulting from incomplete resection.
authors.affiliation: ENT Clinic, Head and Neck Department, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Tirelli
authors.affiliation: ENT Clinic, Head and Neck Department, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Piovesana
authors.affiliation: ENT Clinic, Head and Neck Department, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy.
authors.forename: Annalisa
authors.initials: A
authors.lastname: Gatto
authors.affiliation: ENT Clinic, Head and Neck Department, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy.
authors.forename: Margherita
authors.initials: M
authors.lastname: Tofanelli
authors.affiliation: Division of Oral Medicine, Dental Science Department, University of Trieste, Piazza dell'Ospitale 2, 34125 Trieste, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Biasotto
authors.affiliation: ENT Clinic, Head and Neck Department, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy. Electronic address: francesca.boscolonata@gmail.com.
authors.forename: Francesca
authors.initials: F
authors.lastname: Boscolo Nata
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D006801:Humans; D007432:Intraoperative Period; D009062:Mouth Neoplasms / Q000601:surgery*; D009959:Oropharyngeal Neoplasms / Q000601:surgery*; D010865:Pilot Projects; D011446:Prospective Studies
keywords: Field-cancerization; Narrow-band-imaging; Oral-cancer; Oropharynx; Resection-margins; Squamous-cell-carcinoma