Joaquin Austerlitz

Background: Neoadjuvant immunotherapy is an emerging treatment for patients with head and neck cancer. Given the heterogeneity of response, novel methods of intraoperative tumor and margin assessment warrant investigation. Methods: A 55‐year‐old male presented with a cT3N2c supraglottic squamous cell carcinoma with a combined positive score of 5. The patient received 2 cycles of neoadjuvant pembrolizumab prior to laryngectomy. The specimen underwent intraoperative micro‐positron emission tomography/computed tomography (micro‐PET/CT) imaging. Results: Final pathology demonstrated a pathologic complete response (pCR). On pre‐treatment whole body PET/CT, maximum standardized uptake value (SUV _max ) was 21.8 in the tumor and 10.7 (~50%) at the tracheostomy site. Intraoperative micro‐PET/CT showed residual uptake in the tumor region (SUV _max 16.1) and tracheostomy site (SUV _max 16.9). Conclusion: In this case report of pCR, intraoperative micro‐PET/CT demonstrated similar avidity at the primary tumor site compared to the tracheostomy site, highlighting the potential utility of this novel imaging approach in patients receiving neoadjuvant immunotherapy.

Background: Text‐based pathology reports inadequately communicate complex three‐dimensional (3D) relationships in musculoskeletal oncology, potentially contributing to errors in re‐resection and adjuvant treatment planning. While our prior 7‐case pilot study established technical feasibility, the scalability of this workflow and its utility as a platform for further innovation have not been demonstrated. Methods: We conducted a prospective implementation study of 36 musculoskeletal oncology specimens at a tertiary sarcoma center between April 2023 and November 2025. Specimens underwent ex vivo 3D scanning using a structured light scanner, followed by virtual annotation using computer‐aided design software to mirror the standard‐of‐care grossing process and create visual pathology reports (VPRs). The primary outcome was systematic implementation without disrupting standard processing. Secondary outcomes included platform‐derived applications: augmented reality (AR)‐guided re‐resection, 3D margin heat maps, and 3D wound‐bed scans. Results: All 36 specimens were scanned and mapped (21 soft tissue, 13 bone, 2 metastatic; median greatest specimen dimension 12.7 cm). Positive margins occurred in 13.9% ( N = 5) of cases. VPRs were presented in multidisciplinary tumor boards in three of these five cases. AR guidance was implemented in eight staged‐resection cases ( N = 4 for positive margin re‐resection, N = 4 for pre‐reconstruction planning), 3D heat maps were created for eight cases, and intraoperative wound bed scanning was piloted once. Discussion/Conclusion: 3D specimen scanning and virtual mapping are scalable workflows providing a permanent visual record of resected specimens and functioning as a foundational platform for novel interventions. AR‐guided surgery and 3D heat mapping demonstrate potential paradigm shifts from static reporting to dynamic, visual pathologic reporting and surgical guidance.

Background: Delays in postoperative radiotherapy (PORT) beyond 6 weeks are associated with worse outcomes in head and neck cancer (HNC). This study evaluated whether a discharge summary prompt could reduce PORT delay. Methods: A retrospective review of patients from 2018 to 2023 was used as a pre‐intervention baseline. An EHR‐based discharge summary intervention was implemented in May 2023. Delayed PORT was defined as initiation > 42 days from surgery. Time to PORT was evaluated with Kaplan–Meier and log‐rank testing. Logistic regression identified predictors of delay; Cox modeling evaluated factors associated with time to PORT initiation. Results: Among 391 patients (260 pre‐intervention, 131 post‐intervention), PORT delay decreased from 74.2% to 46.6% after implementation ( p < 0.001). The discharge summary prompt was independently associated with lower odds of delay (OR 0.28, 95% CI 0.14–0.56; p < 0.001) and faster PORT initiation (HR 2.05, 95% CI 1.43–2.93; p < 0.001). Conclusions: A simple discharge summary prompt may reduce PORT delay in HNC.

Background: Intraoperative ¹⁸ F‐fluorodeoxyglucose ( ¹⁸ F‐FDG) micro‐positron emission tomography/computed tomography (micro‐PET/CT) is an emerging modality for margin assessment. Prior to clinical use, micro‐PET/CT margin distances must be correlated with gold‐standard histopathology. Methods: Micro‐PET/CT uptake was co‐registered to 3D specimen models annotated with margin sampling sites using principal component analysis and iterative closest point surface registration. Margin distances were measured on the fused models using Gaussian Mixed Modeling and compared with histopathology. Results: Fused micro‐PET/CT and 3D specimen models were successfully generated for five patients with head and neck cancer. Among the 16 measured margins, the margin distance on the fused models was within 1 mm of histopathology in 15/16 cases. The Bland–Altman plot demonstrated excellent agreement (±1.25 mm). Conclusion: We report a novel technique to register micro‐PET/CT data to annotated 3D specimen models. Margin distance measured on the micro‐PET/CT scans correlated closely with histopathology. Intraoperative micro‐PET/CT warrants further investigation in head and neck margin assessment.

Background: Neoadjuvant chemoimmunotherapy is being explored in locally advanced head and neck squamous cell carcinoma (HNSCC), yet the spatial patterns of pathologic response and clinical implications remain poorly characterized. Methods: A 79‐year‐old female with recurrent left oral tongue SCC (PD‐L122C3 Combined Positive Score 90) who underwent prior resection and free flap reconstruction received neoadjuvant pembrolizumab, paclitaxel, and carboplatin followed by definitive surgical resection with intraoperative positron emission tomography/computed tomography (PET/CT) imaging. Results: Final histopathology revealed two discrete foci of residual poorly differentiated SCC, measuring 1.8 and 0.5 cm, separated by an 8 mm intervening bridge of inflammation without viable tumor. Intraoperative PET/CT with 3D specimen mapping confirmed the spatial relationship between residual foci and intervening treatment effect. Conclusions: Pathologic response to neoadjuvant chemoimmunotherapy in HNSCC can manifest as a multifocal regression pattern. Intraoperative real‐time approaches to assessing treatment response warrant further investigation. Trial Registration: ClinicalTrials.gov identifier: NCT06915454