Li Ke, Yang Jiajin, Lian Haosen, Tian Zixi, Li Chunjie, Gao Ning, Guo Zhiyong
State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
Quant Imaging Med Surg. 2024 Dec 5;14(12):8167-8182. doi: 10.21037/qims-24-564. Epub 2024 Nov 8.
In head and neck cancer (HNC), real-time evaluation of tumor margin status following surgical excision of the tumor is of critical importance. This systematic review aimed to assess the effectiveness of near-infrared fluorescence (NIRF) imaging for the real-time delineation of tumor margins in HNC resections.
Two investigators independently conducted a comprehensive search following the Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies (PRISMA-DTA) guidelines across the PubMed, Scopus, Embase, and China National Knowledge Infrastructure (CNKI) databases until August 1, 2023. Observational studies were included, while other studies with inappropriate study design were excluded. The primary outcomes included the specificity, sensitivity, and area under the summary receiver operating characteristic (SROC) curve when using NIRF imaging to assess surgical margins. We compared fluorescence in the resection specimen margins and residual fluorescence in the surgical cavity margins as methods of utilizing NIRF to evaluate surgical margins. Diagnostic trial quality was assessed, and statistical heterogeneity was determined.
The initial search yielded 1,607 articles. After reviewing the full texts, seven articles with 103 patients were included, among which five were incorporated for quantitative analysis. The selected studies had an average score of 10.1 of quality. Heterogeneity analysis revealed I values of 26% [95% confidence interval (CI): 0-100%] and 78% (95% CI: 52-100%) for NIRF specimen imaging with close margin considered positive or negative. Comparing NIRF imaging to the gold standard of pathology for surgical margin diagnosis, with close margin considered positive, sensitivity and specificity in excised specimens were 0.84 (95% CI: 0.39-0.98) and 0.96 (95% CI: 0.80-0.99), respectively. When a close margin was considered negative, sensitivity and specificity were 0.98 (95% CI: 0.10-1.00) and 0.96 (95% CI: 0.45-1.00), respectively. The areas under the SROC curves were 0.97 (95% CI: 0.95-0.98) and 0.99 (95% CI: 0.98-1.00), respectively. A quantitative analysis of residual fluorescence at surgical cavity margins was not performed due to an insufficient number of studies.
NIRF imaging is a promising method for real-time surgical margin assessment of HNC. With its robust diagnostic capabilities in excised tumor specimens, it is also an effective technique for detecting residual tumor fluorescence in the surgical cavity for supplementary assessment. But the results should be interpreted with caution.
在头颈癌（HNC）中，肿瘤手术切除后实时评估肿瘤边缘状态至关重要。本系统评价旨在评估近红外荧光（NIRF）成像在HNC切除术中实时勾勒肿瘤边缘的有效性。
两名研究者按照诊断试验准确性研究的系统评价和Meta分析的首选报告项目（PRISMA-DTA）指南，独立对PubMed、Scopus、Embase和中国知网（CNKI）数据库进行全面检索，检索截至2023年8月1日。纳入观察性研究，排除其他研究设计不当的研究。主要结局包括使用NIRF成像评估手术切缘时的特异性、敏感性和汇总受试者工作特征（SROC）曲线下面积。我们比较了切除标本边缘的荧光和手术腔边缘的残余荧光作为利用NIRF评估手术边缘的方法。评估诊断试验质量，并确定统计异质性。
初步检索得到1607篇文章。在审阅全文后，纳入了7篇文章共103例患者，其中5篇纳入定量分析。所选研究的质量平均得分为10.1分。异质性分析显示，对于切缘接近视为阳性或阴性的NIRF标本成像，I值分别为26%[95%置信区间（CI）：0-100%]和78%（95%CI：52-100%）。将NIRF成像与手术切缘诊断的病理金标准进行比较，切缘接近视为阳性时，切除标本中的敏感性和特异性分别为0.84（95%CI：0.39-0.98）和0.96（95%CI：0.80-0.99）。当切缘接近视为阴性时，敏感性和特异性分别为0.98（95%CI：0.1-1.00）和0.96（95%CI：0.45-1.00）。SROC曲线下面积分别为0.97（95%CI：0.95-0.98）和0.99（95%CI：0.98-1.00）。由于研究数量不足，未对手术腔边缘的残余荧光进行定量分析。
NIRF成像是一种很有前景的HNC手术切缘实时评估方法。它在切除的肿瘤标本中具有强大的诊断能力，也是检测手术腔中残余肿瘤荧光以进行补充评估的有效技术。但对结果的解释应谨慎。
