Ochi Takahiro, Sakairi Yuichi, Sata Yuki, Toyoda Takahide, Inage Terunaga, Tanaka Kazuhisa, Tamura Hajime, Chiyo Masako, Matsui Yukiko, Shiko Yuki, Ota Masayuki, Ikeda Jun-Ichiro, Yoshino Ichiro, Suzuki Hidemi
Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan.
Division of Thoracic Surgery, Chiba Cancer Center, Chiba, Japan.
PLoS One. 2025 Aug 4;20(8):e0328362. doi: 10.1371/journal.pone.0328362. eCollection 2025.
Indocyanine green (ICG) intravenous administration (ICG-iv) has been described for detecting the intersegmental plane in lung segmentectomy. However, errors with preoperative planning and accuracy comparisons with alternative methodologies have not been fully validated.
This single-center retrospective study identified 138 patients with 140 lesions who underwent segmentectomy using the inflation-deflation (I-D) method or ICG-iv method. The planned margin was calculated using three-dimensional imaging, and the surgical margin was measured for the resected specimen. We evaluated the surgical and planned margin ratio (S/P ratio) and log S/P ratio. Accuracy was also tested using the Root Mean Squared Logarithmic Error (RMSLE): the smaller the RMSLE, the more accurate.
The study enrolled 86 patients with 88 lesions in the I-D group and 52 patients with lesions in the ICG-iv group. All lesions were completely resected. The ICG-iv group underwent significantly more complex segmentectomies compared to the I-D group (P < 0.001). The median S/P ratio was 0.886 (I-D) and 0.912 (ICG-iv). The mean log S/P ratio was -0.061 (I-D) and -0.013 (ICG-iv). The RMSLE values were 0.258 (I-D) and 0.229 (ICG-iv). In the ICG-iv group, eight patients with lesions (15.3%) had poor staining for intersegmental identification. Notably, the poor staining subgroup included a higher proportion of patients with obstructive pulmonary disease (4/8: 50.0%) compared to the good staining group (6/44: 13.6%) (P = 0.035).
The ICG-iv method demonstrated superior accuracy in identifying the intersegmental plane compared to I-D method; however, concerns persist regarding suboptimal staining in patients with obstructive pulmonary disease.
已描述了通过静脉注射吲哚菁绿（ICG）来检测肺段切除术中的节段间平面。然而，术前规划中的误差以及与其他方法的准确性比较尚未得到充分验证。
这项单中心回顾性研究纳入了138例患有140个病灶的患者，这些患者接受了使用膨胀-萎陷（I-D）法或ICG静脉注射法的肺段切除术。使用三维成像计算计划切缘，并测量切除标本的手术切缘。我们评估了手术切缘与计划切缘的比例（S/P比例）和S/P比例的对数。还使用均方根对数误差（RMSLE）测试准确性：RMSLE越小，准确性越高。
该研究纳入了I-D组的86例患有88个病灶的患者和ICG静脉注射组的52例患有病灶的患者。所有病灶均被完全切除。与I-D组相比，ICG静脉注射组进行的肺段切除术明显更复杂（P <0.001）。S/P比例的中位数在I-D组为0.886，在ICG静脉注射组为0.912。S/P比例对数的平均值在I-D组为-0.061，在ICG静脉注射组为-0.013。RMSLE值在I-D组为0.258，在ICG静脉注射组为0.229。在ICG静脉注射组中，8例患有病灶的患者（15.3%）节段间识别染色不佳。值得注意的是，与染色良好组（6/44：13.6%）相比，染色不佳亚组中患有阻塞性肺病的患者比例更高（4/8：50.0%）（P = 0.035）。
与I-D法相比，ICG静脉注射法在识别节段间平面方面显示出更高的准确性；然而，对于阻塞性肺病患者染色欠佳的问题仍然存在担忧。
