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Tumor identification accuracy, operating time, and tumor\u2010free survival were compared.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>RACPP guidance aided tumor detection (positive histology in 90% [27\/30] vs 48% [15\/31] for WL; <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001). An approximate 25% ratiometric signal increase as the threshold to distinguish between tumor and adjacent tissue, yielded &gt;90% detection sensitivity and specificity. Operating time was reduced by 54% (<jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001), and tumor\u2010free survival was increased with RACPP guidance (<jats:italic>p<\/jats:italic>\u2009=\u2009.025).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>RACPP provides real\u2010time intraoperative guidance leading to improved survival. Ratiometric signal thresholds can be set according to desired detection accuracy levels for future RACPP applications. \u00a9 2015 Wiley Periodicals, Inc. Head Neck 38: 715\u2013723, 2016<\/jats:p><\/jats:sec>","DOI":"10.1002\/hed.23946","type":"journal-article","created":{"date-parts":[[2014,12,19]],"date-time":"2014-12-19T06:54:11Z","timestamp":1418972051000},"page":"715-723","source":"Crossref","is-referenced-by-count":14,"title":["Surgical molecular navigation with ratiometric activatable cell penetrating peptide for intraoperative identification and resection of small salivary gland cancers"],"prefix":"10.1002","volume":"38","author":[{"given":"Timon","family":"Hussain","sequence":"first","affiliation":[{"name":"Division of Head and Neck Surgery University of California San Diego San Diego California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elamprakash N.","family":"Savariar","sequence":"additional","affiliation":[{"name":"Department of Pharmacology University of California San Diego San Diego California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julio 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