Brookes Marcus J, Chan Corey D, Nicoli Fabio, Crowley Timothy P, Ghosh Kanishka M, Beckingsale Thomas, Saleh Daniel, Dildey Petra, Gupta Sanjay, Ragbir Maniram, Rankin Kenneth S
North of England Bone and Soft Tissue Tumour Service, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK.
Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne NE1 7RU, UK.
Cancers (Basel). 2021 Dec 14;13(24):6284. doi: 10.3390/cancers13246284.
Sarcomas are rare, aggressive cancers which can occur in any region of the body. Surgery is usually the cornerstone of curative treatment, with negative surgical margins associated with decreased local recurrence and improved overall survival. Indocyanine green (ICG) is a fluorescent dye which accumulates in sarcoma tissue and can be imaged intraoperatively using handheld near-infrared (NIR) cameras, theoretically helping guide the surgeon's resection margins.
Patients operated on between 20 February 2019 and 20 October 2021 for intermediate to high grade sarcomas at our centres received either conventional surgery, or were administered ICG pre-operatively followed by intra-operative NIR fluorescence guidance during the procedure. Differences between the unexpected positive margin rates were compared.
115 suitable patients were identified, of which 39 received ICG + NIR fluorescence guided surgery, and 76 received conventional surgery. Of the patients given ICG, 37/39 tumours fluoresced, and surgeons felt the procedure was guided by the intra-operative images in 11 cases. Patients receiving ICG had a lower unexpected positive margin rate (5.1% vs. 25.0%, = 0.01).
The use of NIR fluorescence cameras in combination with ICG may reduce the unexpected positive margin rate for high grade sarcomas. A prospective, multi-centre randomised control trial is now needed to validate these results.
肉瘤是一种罕见的侵袭性癌症，可发生于身体的任何部位。手术通常是根治性治疗的基石，手术切缘阴性与局部复发率降低及总生存率提高相关。吲哚菁绿（ICG）是一种荧光染料，可在肉瘤组织中蓄积，并可在术中使用手持式近红外（NIR）相机进行成像，理论上有助于指导外科医生确定切除边界。
2019年2月20日至2021年10月20日期间，在我们中心接受中高级别肉瘤手术的患者，要么接受传统手术，要么在术前给予ICG，然后在手术过程中接受术中近红外荧光引导。比较意外阳性切缘率之间的差异。
确定了115例合适的患者，其中39例接受ICG+近红外荧光引导手术，76例接受传统手术。在给予ICG的患者中，37/39个肿瘤发生荧光，11例外科医生认为手术过程由术中图像引导。接受ICG的患者意外阳性切缘率较低（5.1%对25.0%，P=0.01）。
使用近红外荧光相机结合ICG可能会降低高级别肉瘤的意外阳性切缘率。现在需要进行一项前瞻性、多中心随机对照试验来验证这些结果。
