Department of Hepatobiliary Surgery, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China (mainland).
Department of Pathology, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China (mainland).
Med Sci Monit. 2019 May 8;25:3406-3416. doi: 10.12659/MSM.916423.
BACKGROUND This study aimed to compare the application value of intraoperative fluorescence navigation technology (FNT) and intraoperative ultrasound (IOUS) in primary liver cancer surgery. MATERIAL AND METHODS Fifty consecutive patients with primary liver cancer scheduled to receive surgical treatment were divided into FNT group and IOUS group. FNT and IOUS were separately used to guide tumor resection and detect new cancerous lesions in the 2 groups. The complete tumor resection rate (R0) resection rate, length of the tumor distance from cutting edge, the diagnostic efficacy of cancerous nodules and the fluorescence imaging characteristics of different types tumors were recorded. RESULTS The R0 resection rate was 100% (25 out of 25 patients) in the FNT group and 96% (24 out of 25 patients) in the IOUS group. In the FNT group, 1 case (4%, 1 out of 25 patients) had cancer tissue that was less than 1 cm from the cutting edge, compared to 7 cases (28%, 7 out of 25 patients) in the IOUS group (P=0.049), which was a significant difference. In the remaining livers of 50 consecutive patients, FNT found 5 new cancerous nodules with a sensitivity of 71.4%, a specificity of 11.1%, and a false-positive rate of 88.9%; for IOUS the results were 42.9%, 88.9%, 11.1%. The fluorescence imaging characteristics of all well-differentiated hepatocellular carcinomas were tumor tissue imaging, but all other types of tumors were ring imaging around the tumor. CONCLUSIONS FNT can improve the R0 resection rate, ensure a safe distance between tumor and cutting edge and can identify more new cancerous nodules compared to IOUS. Thus, FNT could improve the surgical treatment effect for primary liver cancer and hopefully further improve the prognosis of patients.
本研究旨在比较术中荧光导航技术（FNT）和术中超声（IOUS）在原发性肝癌手术中的应用价值。
连续 50 例原发性肝癌患者接受手术治疗，分为 FNT 组和 IOUS 组。两组分别采用 FNT 和 IOUS 引导肿瘤切除和检测新的癌性病变。记录完全肿瘤切除率（R0）、肿瘤距切缘长度、癌结节诊断效能及不同类型肿瘤荧光成像特征。
FNT 组 R0 切除率为 100%（25/25 例），IOUS 组为 96%（24/25 例）。FNT 组有 1 例（4%，1/25 例）肿瘤组织距切缘小于 1cm，与 IOUS 组 7 例（28%，7/25 例）相比差异有统计学意义（P=0.049）。在 50 例连续肝脏中，FNT 发现 5 个新的癌性结节，其灵敏度为 71.4%，特异性为 11.1%，假阳性率为 88.9%；IOUS 的结果分别为 42.9%、88.9%、11.1%。所有高分化肝细胞癌的荧光成像特征均为肿瘤组织成像，而其他类型肿瘤均为肿瘤周围环状成像。
FNT 可提高 R0 切除率，确保肿瘤与切缘安全距离，可检出更多新的癌性结节，优于 IOUS。因此，FNT 可提高原发性肝癌的手术治疗效果，有望进一步改善患者预后。
