Institute of Global Health Innovation, Imperial College London, Hamlyn Centre, London, United Kingdom.
Imperial College London, Department of Surgery and Cancer, London, United Kingdom.
J Biomed Opt. 2024 Mar;29(3):030901. doi: 10.1117/1.JBO.29.3.030901. Epub 2024 Mar 4.
Breast-conserving surgery (BCS) is limited by high rates of positive margins and re-operative interventions. Fluorescence-guided surgery seeks to detect the entire lesion in real time, thus guiding the surgeons to remove all the tumor at the index procedure.
Our aim was to identify the optimal combination of a camera system and fluorophore for fluorescence-guided BCS.
A systematic review of medical databases using the terms "fluorescence," "breast cancer," "surgery," and "fluorescence imaging" was performed. Cameras were compared using the ratio between the fluorescent signal from the tumor compared to background fluorescence, as well as diagnostic accuracy measures, such as sensitivity, specificity, and positive predictive value.
Twenty-one studies identified 14 camera systems using nine different fluorophores. Twelve cameras worked in the infrared spectrum. Ten studies reported on the difference in strength of the fluorescence signal between cancer and normal tissue, with results ranging from 1.72 to 4.7. In addition, nine studies reported on whether any tumor remained in the resection cavity (5.4% to 32.5%). To date, only three studies used the fluorescent signal for guidance during real BCS. Diagnostic accuracy ranged from 63% to 98% sensitivity, 32% to 97% specificity, and 75% to 100% positive predictive value.
In this systematic review, all the studies reported a clinically significant difference in signal between the tumor and normal tissue using various camera/fluorophore combinations. However, given the heterogeneity in protocols, including camera setup, fluorophore studied, data acquisition, and reporting structure, it was impossible to determine the optimal camera and fluorophore combination for use in BCS. It would be beneficial to develop a standardized reporting structure using similar metrics to provide necessary data for a comparison between camera systems.
保乳手术（BCS）受到阳性切缘和再次手术干预率高的限制。荧光引导手术旨在实时检测整个病变，从而指导外科医生在首次手术中切除所有肿瘤。
我们的目的是确定荧光引导 BCS 中最佳的相机系统和荧光团组合。
使用“荧光”、“乳腺癌”、“手术”和“荧光成像”等术语对医学数据库进行系统评价。通过比较肿瘤与背景荧光之间的荧光信号比值以及诊断准确性指标（如敏感性、特异性和阳性预测值）来比较相机。
21 项研究确定了 14 种使用 9 种不同荧光团的相机系统。12 个相机工作在红外光谱中。10 项研究报告了癌症组织和正常组织之间荧光信号强度的差异，结果范围从 1.72 到 4.7。此外，9 项研究报告了任何肿瘤是否留在切除腔中（5.4%至 32.5%）。迄今为止，只有 3 项研究在真正的 BCS 中使用荧光信号进行指导。诊断准确性范围从 63%到 98%的敏感性、32%到 97%的特异性和 75%到 100%的阳性预测值。
在这项系统评价中，所有研究都报告了使用各种相机/荧光团组合时肿瘤与正常组织之间存在临床显著差异的信号。然而，鉴于方案的异质性，包括相机设置、研究的荧光团、数据采集和报告结构，无法确定用于 BCS 的最佳相机和荧光团组合。开发一种使用类似指标的标准化报告结构将有助于提供相机系统之间比较所需的数据。
