Liang Tingfeng, Hu Xueyong, Li Jing, He Yong, Zhu Zhenchao, Yang Jian, Zhang Hongzheng, Yu Chaosheng
Department of Otolaryngology Head and Neck Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China.
Department of Hepatobiliary Surgery I, General Surgery Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China.
Ann Surg Oncol. 2025 Jun 16. doi: 10.1245/s10434-025-17672-4.
Indocyanine green (ICG) fluorescence imaging enhances cancer surgery precision, showing great potential for resection of tumors such as liver cancer. Although early-stage recurrent nasopharyngeal carcinoma (rNPC) can be surgically removed, residual tumors hinder effectiveness. The application of ICG fluorescence imaging in precision surgery for rNPC has been rarely reported. To the authors' knowledge, this video is the first to document clinical practice using real-time ICG green fluorescence imaging for the surgical treatment of rNPC.
A 74-year-old man was admitted with left-sided nasal congestion for 3 months, 9 months after comprehensive treatment for NPC. Nasal endoscopy indicated a lesion in the left middle and lower nasal passage, and laboratory tests showed positive Epstein-Barr virus (EBV) DNA with a quantitative result of <5.00E+02 (copies/ml). Enhanced MRI of the nasopharynx showed a lesion in the left middle and lower nasal passage, with marked contrast enhancement, suggesting a recurrence of nasopharyngeal carcinoma. Indocyanine green fluorescent dye (0.4 mg/kg) was injected into the elbow vein 24 h before surgery, and an additional 5 mg was administered intraoperatively (Fig. 1). Intraoperatively, fluorescence imaging demonstrated significant fluorescence accumulation in the nasal and nasopharyngeal tumors. Under real-time imaging guidance, the tumor and its base were precisely resected.
The histopathologic diagnosis indicated non-keratinizing undifferentiated carcinoma. In situ hybridization showed EBV-encoded small RNAs (EBER+). Real-time fluorescence imaging detected no positive margins in the submitted specimens. A postoperative EBV recheck showed levels below the detection limit.
Surgery for rNPC guided by real-time ICG fluorescence imaging is feasible and effective. Fig. 1 Illustration showing the application of real-time indocyanine green fluorescence imaging during endoscopic nasal surgery. A ICG is injected intravenously 24 hours before operation at a dose of 0.4 mg/kg, and an additional 5 mg was administered intraoperatively. B Nasal endoscopy revealed green fluorescence imaging of the nasopharyngeal mass. PR：pharyngeal recess, NPW: nasopharynx posterior wall, TT: torus tubalis, SP: soft palate.
吲哚菁绿（ICG）荧光成像提高了癌症手术的精准度，在肝癌等肿瘤切除方面显示出巨大潜力。尽管早期复发性鼻咽癌（rNPC）可以通过手术切除，但残留肿瘤会影响治疗效果。ICG荧光成像在rNPC精准手术中的应用鲜有报道。据作者所知，本视频是首个记录使用实时ICG绿色荧光成像进行rNPC手术治疗临床实践的报道。
一名74岁男性患者，在鼻咽癌综合治疗9个月后，因左侧鼻塞3个月入院。鼻内镜检查显示左中鼻道和下鼻道有病变，实验室检查显示EB病毒（EBV）DNA阳性，定量结果<5.00E+02（拷贝/毫升）。鼻咽部增强MRI显示左中鼻道和下鼻道有病变，有明显的对比增强，提示鼻咽癌复发。术前24小时将吲哚菁绿荧光染料（0.4毫克/千克）注入肘静脉，术中再追加5毫克（图1）。术中，荧光成像显示鼻腔和鼻咽部肿瘤有明显的荧光聚集。在实时成像引导下，精确切除肿瘤及其基底。
组织病理学诊断为非角化未分化癌。原位杂交显示EBV编码的小RNA（EBER+）。实时荧光成像显示送检标本切缘无阳性。术后EBV复查显示水平低于检测限。
实时ICG荧光成像引导下的rNPC手术可行且有效。图1内镜鼻腔手术中实时吲哚菁绿荧光成像的应用示意图。A术前24小时静脉注射ICG，剂量为0.4毫克/千克，术中再追加5毫克。B鼻内镜显示鼻咽部肿物的绿色荧光成像。PR：咽隐窝，NPW：鼻咽后壁，TT：咽鼓管圆枕，SP：软腭。
