Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands.
Cancer. 2013 Sep 15;119(18):3411-8. doi: 10.1002/cncr.28203. Epub 2013 Jun 21.
The fundamental principle of oncologic surgery is the complete resection of malignant cells. However, small tumors are often difficult to find during surgery using conventional techniques. The objectives of this study were to determine if optical imaging, using a contrast agent already approved for other indications, could improve hepatic metastasectomy with curative intent, to optimize dose and timing, and to determine the mechanism of contrast agent accumulation.
The high tissue penetration of near-infrared (NIR) light was exploited by use of the FLARE (Fluorescence-Assisted Resection and Exploration) image-guided surgery system and the NIR fluorophore indocyanine green in a clinical trial of 40 patients undergoing hepatic resection for colorectal cancer metastases.
A total of 71 superficially located (< 6.2 mm beneath the liver capsule) colorectal liver metastases were identified and resected using NIR fluorescence imaging. Median tumor-to-liver ratio was 7.0 (range, 1.9-18.7) and no significant differences between time points or doses were found. Indocyanine green fluorescence was seen as a rim around the tumor, which is shown to be entrapment around cytokeratin 7-positive hepatocytes compressed by the tumor. Importantly, in 5 of 40 patients (12.5%, 95% confidence interval = 5.0-26.6), additional small and superficially located lesions were detected using NIR fluorescence, and were otherwise undetectable by preoperative computed tomography, intraoperative ultrasound, visual inspection, and palpation.
NIR fluorescence imaging, even when used with a nontargeted, clinically available NIR fluorophore, is complementary to conventional imaging and able to identify missed lesions by other modalities.
肿瘤外科的基本原则是完全切除恶性细胞。然而，在传统技术下，小肿瘤在手术中往往难以发现。本研究的目的是确定使用已批准用于其他适应症的造影剂进行光学成像是否可以提高具有治愈意图的肝转移切除术的效果，以优化剂量和时间，并确定造影剂积累的机制。
利用近红外（NIR）光的高组织穿透性，使用 FLARE（荧光辅助切除和探查）图像引导手术系统和 NIR 荧光染料吲哚菁绿，对 40 例接受结直肠癌肝转移切除术的患者进行临床试验。
共识别并切除了 71 个位于肝包膜下<6.2mm 处的结直肠肝转移灶。肿瘤与肝脏的中位数比值为 7.0（范围，1.9-18.7），并且在时间点或剂量之间没有发现显著差异。吲哚菁绿荧光呈肿瘤周围的环状，这被证明是被肿瘤压迫的 CK7 阳性肝细胞的捕获。重要的是，在 40 例患者中的 5 例（12.5%，95%置信区间=5.0-26.6）中，使用 NIR 荧光检测到了另外 5 个小而位于表面的病变，而这些病变在术前计算机断层扫描、术中超声、肉眼检查和触诊中无法检测到。
即使使用非靶向、临床可用的 NIR 荧光染料，近红外荧光成像也与传统成像互补，能够识别其他方式无法检测到的遗漏病变。
