Dai Bo, Wang Ziyang, Lu Qian, Ma Hucheng, Guissi Nida El Islem, Wang Yiqing, Wu Xingyu, Cai Huiming
Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.
Department of Biomedical Engineering, College of Engineering and Applied Sciences, Nanjing University, Nanjing, China.
Ann Transl Med. 2022 May;10(10):617. doi: 10.21037/atm-22-2338.
Prognosis of hepatocellular carcinoma (HCC) is closely related to residual tumor cells and tissues after tumor resection. Thus, close monitoring to ensure complete removal of residual tumor is fundamental. In this regard, intraoperative near-infrared fluorescence (NIRF) imaging has been of great assistance to surgeons for precision cancer surgeries. However, up to now, the identification of tiny lesions has not been reported. Herein, we report our findings on the case of an ultra-small HCC focus of about 430 µm that was successfully detected using NIRF during real-time monitored liver cancer surgery. The patient had a background of hepatitis B cirrhosis, which is the most phenomenon in China. Surgeons usually unable to distinguish sclerotic nodules from small tumor tissue with the naked eyes.
A 55-year-old man with chronic hepatitis B infection was preoperatively diagnosed with a space-occupying liver lesion. A fluorescence signal was detected on the surface of the liver through the NIRF imaging system which had not been found by preoperative computed tomography (CT) and ultrasound examination. We subsequently tested the residual liver surface and observed a high signal point, less than 1 mm in the right anterior lobe of the liver. Histopathological examination revealed that the tiny fluorescent spot belong to an early HCC focus.
Based on these results, we think indocyanine green (ICG)-NIRF imaging may be used as a routine intraoperative detection method for liver cancer surgery in order to remove any residual tumor cells and tissue, hence minimizing further risk of remnant tumor regrowth.
肝细胞癌（HCC）的预后与肿瘤切除后残留的肿瘤细胞和组织密切相关。因此，密切监测以确保残留肿瘤被彻底清除至关重要。在这方面，术中近红外荧光（NIRF）成像对外科医生进行精准癌症手术有很大帮助。然而，到目前为止，尚未有关于微小病变识别的报道。在此，我们报告了在实时监测的肝癌手术中使用NIRF成功检测出一个约430μm的超小HCC病灶的病例结果。该患者有乙型肝炎肝硬化背景，这在中国是最常见的情况。外科医生通常无法用肉眼区分硬化结节和小肿瘤组织。
一名55岁慢性乙型肝炎感染男性患者术前被诊断为肝脏占位性病变。通过NIRF成像系统在肝脏表面检测到一个荧光信号，而术前计算机断层扫描（CT）和超声检查均未发现。随后我们对残留的肝脏表面进行检测，在肝脏右前叶观察到一个小于1mm的高信号点。组织病理学检查显示，这个微小的荧光点属于早期HCC病灶。
基于这些结果，我们认为吲哚菁绿（ICG）-NIRF成像可作为肝癌手术的常规术中检测方法，以清除任何残留的肿瘤细胞和组织，从而将残留肿瘤复发的进一步风险降至最低。
