Fig. 1

Workflow of Fluorescence Imaging-Based LN Preselection. Following panitumumab-IRDye800CW infusion 1–5 days prior to the day of surgery, on the day of surgery, the neck will be operated on after which the neck specimen is collected and imaged with a closed-field imaging device. With the fluorescence guide of the neck specimen, LN grossing is performed as per standard of care. Fluorescence-imaging-based preselection using the fluorescence signal is performed to select LNs at risk of metastasis. Upon showing the feasibility of our approach, we propose that only at-risk LNs, which are characterized by a high mean fluorescence intensity (MFI) and signal-to-background ratio (SBR), have to undergo thorough evaluation at pathology, meaning an hematoxylin and eosin staining, and a closed-field fluorescence image is obtained to correlate fluorescence-imaging-based findings to (histo-) pathology. Low-risk LNs would not require any further evaluation. LN lymph node