Department of Spine Surgery and Musculoskeletal Tumor, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, People's Republic of China.
J Surg Oncol. 2023 Sep;128(4):612-627. doi: 10.1002/jso.27306. Epub 2023 May 13.
Negative surgical margins are significant in improving patient outcomes. However, surgeons can only rely on visual and tactile information to identify tumor margins intraoperatively. We hypothesized that intraoperative fluorescence imaging with indocyanine green (ICG) could serve as an assistive technology to evaluate surgical margins and guide surgery in bone and soft tissue tumor surgery.
Seventy patients with bone and soft tissue tumors were enrolled in this prospective, non-randomized, single-arm feasibility study. All patients received intravenous indocyanine green (0.5 mg/kg) before surgery. Near-infrared (NIR) imaging was performed on in situ tumors, wounds, and ex vivo specimens.
60/70 tumors were fluorescent at NIR imaging. The final surgical margins were positive in 2/55 cases, including 1/40 of the sarcomas. Surgical decisions were changed in 19 cases by NIR imaging, and in 7/19 cases final pathology demonstrated margins were improved. Fluorescence analysis showed that the tumor-to-background ratio (TBR) of primary malignant tumors was higher than that of benign, borderline, metastatic, and tumors ≥5 cm in size had higher TBR than those <5 cm.
ICG fluorescence imaging may be a beneficial technique to assist in surgical decision making and improving surgical margins in bone and soft tissue tumor surgery.
切缘阴性对改善患者预后具有重要意义。然而，外科医生只能依靠视觉和触觉信息在术中识别肿瘤切缘。我们假设吲哚菁绿（ICG）的术中荧光成像可以作为一种辅助技术，用于评估骨和软组织肿瘤手术中的手术切缘并指导手术。
本前瞻性、非随机、单臂可行性研究纳入了 70 例骨和软组织肿瘤患者。所有患者在术前均接受静脉注射吲哚菁绿（0.5mg/kg）。对原位肿瘤、伤口和离体标本进行近红外（NIR）成像。
60/70 个肿瘤在 NIR 成像时具有荧光性。55 例中有 2 例最终的手术切缘阳性，其中包括 40 例肉瘤中的 1 例。NIR 成像改变了 19 例手术决策，在 7/19 例中最终病理显示切缘得到改善。荧光分析显示，原发性恶性肿瘤的肿瘤与背景比（TBR）高于良性、交界性、转移性肿瘤，且大小≥5cm 的肿瘤 TBR 高于大小<5cm 的肿瘤。
ICG 荧光成像可能是一种有益的技术，可以辅助骨和软组织肿瘤手术中的手术决策，并改善手术切缘。
