Department of Surgery, Groningen, The Netherlands; Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Br J Surg. 2015 Jan;102(2):e56-72. doi: 10.1002/bjs.9713.
In the past decade, there has been a major drive towards clinical translation of optical and, in particular, fluorescence imaging in surgery. In surgical oncology, radical surgery is characterized by the absence of positive resection margins, a critical factor in improving prognosis. Fluorescence imaging provides the surgeon with reliable and real-time intraoperative feedback to identify surgical targets, including positive tumour margins. It also may enable decisions on the possibility of intraoperative adjuvant treatment, such as brachytherapy, chemotherapy or emerging targeted photodynamic therapy (photoimmunotherapy).
This article reviews the use of optical imaging for intraoperative guidance and decision-making.
Image-guided cancer surgery has the potential to be a powerful tool in guiding future surgical care. Photoimmunotherapy is a theranostic concept (simultaneous diagnosis and treatment) on the verge of clinical translation, and is highlighted as an effective combination of image-guided surgery and intraoperative treatment of residual disease. Multispectral optoacoustic tomography, a technique complementary to optical image-guided surgery, is currently being tested in humans and is anticipated to have great potential for perioperative and postoperative application in surgery.
Significant advances have been achieved in real-time optical imaging strategies for intraoperative tumour detection and margin assessment. Optical imaging holds promise in achieving the highest percentage of negative surgical margins and in early detection of micrometastastic disease over the next decade.
在过去的十年中，人们一直在大力推动光学技术的临床转化，尤其是在手术中的荧光成像。在肿瘤外科中，根治性手术的特点是没有阳性切缘，这是改善预后的关键因素。荧光成像是为外科医生提供可靠的实时术中反馈，以识别手术目标，包括阳性肿瘤边缘。它还可以决定是否进行术中辅助治疗，如近距离放射治疗、化疗或新兴的靶向光动力治疗（光免疫治疗）。
本文综述了光学成像在术中指导和决策中的应用。
图像引导的癌症手术有可能成为指导未来手术护理的有力工具。光免疫治疗是一种治疗诊断的概念（同时诊断和治疗），即将进入临床转化阶段，并被强调为图像引导手术和术中治疗残留疾病的有效结合。多谱光声断层扫描是一种与光学图像引导手术互补的技术，目前正在进行人体测试，预计在未来十年的围手术期和术后应用中具有巨大的潜力。
在实时光学肿瘤检测和边缘评估的术中成像策略方面取得了显著进展。在未来十年中，光学成像有望实现更高的阴性手术切缘率，并更早地检测到微转移疾病。
